双眼阶梯渐进衍射型多焦点人工晶状体植入术的视觉质量观察

Quality of vision in eyes that underwent implantation of ReSTOR apodized diffractive multifocal intraocular lens on bilateral eyes in cataract surgery

目的比较双眼行超声乳化白内障吸除联合植入ReSTOR阶梯渐进衍射型多焦点人工晶状体（MIOL）和单焦点人工晶状体（SIOL）的术后视觉质量。方法回顾性比较性系列病例研究。回顾性分析25例（50只眼）双眼行超声乳化白内障吸除联合ReSTOR MIOL植入（多焦点组）和28例（56只眼）双眼行超声乳化白内障吸除术联合Natural SIOL植入（单焦点组）的年龄相关性白内障患者的临床资料。观察术后3个月时裸眼远、近视力，最佳矫正远、近视力，远矫正状态下近视力、对比敏感度和眩光敏感度，视觉干扰以及脱镜率。两组间计量资料采用t检验；两组间计数资料采用X^2检验。结果术后3个月，多焦点组94％（47／50）和单焦点组96％（54／56）患眼术后裸眼远视力／〉0．6（X^2=0．347，P〉0．05）；多焦点组88％（44／50）和单焦点组13％（7／56）患眼裸眼近视力等于或好于L（X^2=60．315，P〈0．01）；多焦点组90％（45／50）和单焦点组11％（6／56）患眼远矫正状态下裸眼近视力等于或好于J3（X^2=66．515，P〈0．01）；两组各空间频段的对比敏感度和眩光敏感度差异均无统计学意义（P〉0．05）；多焦点组12％（3／25）和单焦点组7％（2／28）患者术后出现轻度以上的眩光感（X^2=0．365，P〉0．05）；多焦点组8％（2／25）和单焦点组4％（1／28）患者术后出现轻度以上的光晕（x。=0．485，P〉0．05）；两组均有96％（24／25、27／28）的患者术后视远完全脱镜（X^2=0．007，P〉0．05）；多焦点组80％（20／25）和单焦点组11％（3／28）患者术后视近完全脱镜（X^2=25．811，P〈0．01）。结论ReSTOR阶梯渐进衍射型MIOL能同时提供良好的远、近视力，减少了患者术后对眼镜的依赖，具有较好的视觉质量。

Objective To compare the visual outcomes and subjective parameters in patients who underwent implantation of ReSTOR apodized diffractive multifocal intraocular lens on bilateral eyes with those in patients who had monofocal intraocular lens in cataract surgery. Methods Retrospective observational case series. 50 eyes of 25 patients received ReSTOR muhifocal intraocular lens （muhifocal group） and 56 eyes of 28 patients taken implantation of Natural monofocal intraocular lens （ monofocal group） participated in the study. The distance and near visual acuity were compared, as well as contrast and glare sensitivity. Visual symptom and spectacle dependence were assessed using a standardized questionnaire. The minimal follow-up was 3 months. Results An uncorrected distance visual acuity of 0. 6 or better was achieved in 94% of eyes in muhifocal group and 96% in the monofocal group, respectively （ X^2 = 0. 347, P 〉 0. 05 ）. Uncorrected near visual acuity was J3 or better in 88% of eyes in the muhifocal group and 13% in the monofocal group （ X^2= 60. 315, P 〈 0. 01 ）. Best distant corrected near visual acuity was Jr3 or better in 90% of eyes in the multifocal group and 11% in the monofocal group （X^2 = 66. 515, P 〈 0. 01）. No significant difference in contrast and glare sensitivity was found between the groups （P 〉 0. 05 ）. Glare was reported as severe in 12% of the muhifocal group and 7% of the monofocal group, respectively（ X^2 = 0. 365, P 〉0. 05）. Halo was reported as severe in 8% of the muhifocal group and 4% of the monofocal group,respectively （ X^2 = 0. 485, P 〉 0.05 ）. 96% of patients in both groups never had to wear glasses for the distant purpose （X^2 =0. O07,P〉0. 05）, and 80% in multifocal group and 11% in monofocal group never bad to wear glasses for the near purpose （ X^2 = 25.811, P 〈 0. 01 ）. Conclusion The ReSTOR apodized diffractive intraoeular lens provided predictably excellent uncorrected distance and near visual acuities, and obtained satisfactory quality of vision. Spectacle independence was significantly higher with this muhifocal intraocular lens.