单眼多焦点人工晶状体植入术眼与对侧透明晶状体眼的视功能对照研究

Comparison of visual acuity in pseudophakic eyes with multifocal intraocular lens versus fellow eyes with clear lens

目的 评价不同年龄的单眼白内障患者植入ReSTOR多焦点人工晶状体（MIOL）后的视功能状况及患者的主观满意度.方法 前瞻性对照研究.研究对象为行超声乳化白内障吸除联合ReSTOR MIOL植入的单眼白内障患者24例,按年龄分为2组：老视组,年龄≥45岁,17例;非老视组,年龄＜45岁,7例.研究参数：裸眼及远矫正状态下的远（4 m）、中（80cm,60 cm）、近视力,对比敏感度和问卷调查.统计学方法采用秩和检验.结果 老视组患者ReSTOR MIOL植入眼近视力优于对侧透明晶状体眼（Z=2.864,Z=2.911;=0.004）,远视力、中距离视力及对比敏感度与对侧透明晶状体眼相比较,差异无统计学意义（Z=0.183～1.417,P=0.855～0.156）;主观满意度为7～10分,70.6%（12/17）的患者满意度9分以上,双眼脱镜率58.8%（10/17）.非老视组患者ReSTOR MIOL植入眼近视力及中距离视力均低于对侧透明晶状体眼（Z=2.197～2.371;=0.028～0.018）,MIOL植入眼的对比敏感度普遍低于对侧眼,其中夜晚眩光（3 cd/m2＋28 Lux）低频（1.5 c/d）对比敏感度,差异有统计学意义（Z=1.997,P=0.046）;主观满意度为6～9分,14.3%（1/7）的患者满意度9分以上,双眼脱镜率85.7%（6/7）.结论 伴有老视的单眼白内障患者,MIOL植入眼近视力优于对侧透明晶状体眼,远、中距离视力及对比敏感度差异不明显,主观满意度较高,因此较适合植入ReSTORMIOL;不伴有老视的年轻的单眼白内障患者,MIOL植入眼近、中距离视力均低于对侧透明晶状体眼,远视力差异不明显,主观满意度偏低（与老视患者相比较）,因此可以植入ReSTOR MIOL,但是术前需要与患者进行更加详细的沟通.

Objective To evaluate the visual acuity and subjective satisfaction of different aged monocular cataract patients who were implanted with ReSTOR multifocal intraocular lens （ MIOL）. Methods Prospective comparative study; the objects are 24 cases of monocular cataract patients who consecutively received phacoemulsification and implantation of ReSTOR MIOL. The patients were divided into two groups by age; the presbyopic group has 17 cases with age≥45 years, the non-presbyopic group has 7 cases with ages〈45 years. Research parameters; unconnected and corrected distance （4m）, intermediate （80 cm, 60 cm）, and near visual acuity; contrast sensitivity （CS）; and questionnaire survey. All data were statistically analyzed with rank sum test. Results Among presbyopia patients, the near vision of the eyes implanted with ReSTOR MIOL is better than that of the contralateral eyes with clear lens （Z =2. 864, Z = 2. 911 ;P = 0. 004） , whereas the distance and intermediate vision and the CS results show no significant differences compared to that of contralateral eyes with clear lens （Z =0.183—1. 417 ,P =0. 855-0.156） ; the subjective satisfactions are 7 to 10 points with 70. 6% （12/17） patients scoring higher than 9 points; and the spectacle-independent rate among presbyopia patients is 58.8% （10/17）. In non-presbyopic group, the near and intermediate visions of ReSTOR MIOL implanted eyes are lower than that of the contralateral eyes with clear lens （Z=2.197-2. 371 ;P =0.028—0.018） ; CS results of MIOL implanted eyes are also generally lower than that of the contralateral eyes, and the difference between CSs of bilateral eyes under night glare mode （3 cd/m2 4-28 Lux） with low spatial frequency （1.5 c/d） is statistically significant （Z = 1.997,P =0.046） ; the subjective satisfactions are 6 to 9 points with 14. 3% （1/7） patients scoring higher than 9 points; the spectacle-independent rate of both eyes is 85.7% （6/7）. Conclusions The monocular cataract patients with presbyopia are suitable for implantation of ReSTOR MIOL, because their near visual acuity of ReSTOR MIOL implanted eyes is better than that of the contralateral clear lens eyes with higher subjective satisfaction and without decrease in distance and intermediate visions and CS. For non-presbyopic young patients with monocular cataracts, the near and intermediate visions of MIOL implanted eyes are lower than that of the contralateral clear lens eyes and with lower subjective satisfaction （ compared to that of presbyopic patients）, though the distance visions are similar. Therefore, although ReSTOR MIOL can be implanted in non-presbyopic group, a more detailed preoperative communication with these patients is needed.