非球面多焦点人工晶状体植入术后视功能观察

Visual function after aspheric multifocal intraocular lenses implantation

目的 评价白内障超声乳化摘除联合非球面衍射型多焦点人工晶状体（MIOL）植入术后患者的视觉质量及拟调节力.方法 前瞻性病例系列研究.选取自愿进行超声乳化联合人工晶状体植入术的白内障患者35例（50眼）,随机分成2组：SN6AD3组17例（25眼）,植入非球面MIOL（AcrySof ReSTOR SN6AD3） SN60D3组18例（25眼）,植入MIOL（AcrySof ReSTOR SN60D3）.术后3个月时,检查裸眼及矫正远视力、裸眼及最佳矫正远视力下的近视力、波前像差、调制传递函数、拟调节力、对比敏感度,并问卷调查近阅读脱镜率.对两组术后视力及近阅读脱镜率的比较采用x2检验,波前像差、调制传递函数、拟调节力、对比敏感度的比较采用独立样本t检验.结果 术后3个月,两组患者术后裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正远视力下的近视力差异均无统计学意义（P＞0.05）.波前像差：3 mm瞳孔直径时,SN6AD3组的总高阶像差小于SN60D3组,差异有统计学意义（t=2.842,P=0.007） 5 mm瞳孔直径时,SN6AD3组的球面像差Zernike C12、4阶高阶像羞及总高阶像差均小于SN60D3组（P＜0.05）.调制传递函数：在3 mm和5 mm瞳孔直径下,SN6AD3组在各空间频率（5、10、15、20、25、30 c/d）的调制传递函数值均大于SN60D3组,除空间频率为5 c/d时两组差异无统计学意义（t=1.307,P=0.192）外,其余空间频率差异均有统计学意义（P＜0.05）.视近拟调节力：SN6AD3组为（0.925±0.549）D,SN60D3组为（0.964±0.582）D,差异无统计学意义（t=0.217,P＞0.05）.对比敏感度：无眩光时,在各空间频率（3、6、12、18 c/d）下,SN6AD3组的对比敏感度均大于SN60D3组（P＜0.05） 眩光时,SN6AD3组的对比敏感度亦大于SN60D3组,但仅在空间频率为3 c/d时差异有统计学意义（t=3.405,P＜0.01）.近阅读脱镜率：SN6AD3组为80%,SN60D3组为72%,两组差异无统计学意义（x2=0.439,P=0.508）.结论 ReSTOR衍射型非球面MIOL能提供良好的远、近视力和拟调节幅度,非球面设计的MIOL对比敏感度较球面设计的MIOL有明显提高.

Objective To evaluate visual quality and pseudoaccommodation in patients after the implantation of an apodized diffractive aspherical multifocal intraocular lens （MIOL）. Methods This was a prospective case series study. Thirty-five patients （50 eyes）who had agreed to undergo phacoemulsification and accept IOL implants were selected for the study. Any other eye disease or systemic disease was criteria for exclusion. The eyes were divided into 2 groups according to the type of IOL implanted. One group was implanted with apodized diffractive aspherical MIOL （AcrySof ReSTOR SN6AD3） and the other group was implanted with apodized diffractive MIOL （AcrySof ReSTOR SN60D3）. Twenty-five eyes of 17 patients were implanted with SN6AD3 and 25 eyes of 18 patients were implanted with SN60D3. All patients were assessed 3 months postoperatively for aberrations of the crystalline lens, the modulation transfer function, uncorrected distance visual acuity （UCDVA）, uncorrected near visual acuity （UCNVA）, best corrected distance visual acuity （BCDVA）, distance corrected near visual acuity （DCNVA）, pseudoaccommodation,contrast sensitivity and the rate of eyeglass removal for near. Data were compared using an independent samples t test and x2 test. Results UCDVA, BCDVA, UCNVA and DCNVA in the SN6AD3 group were not statistically different from the SN60D3 group （P〉0.05）. There were statistical differences between the two groups when spherical, 4th-order higher aberrations and total higher-order aberrations were compared. The SN6AD3 group had lower aberrations than the SN60D3group under 3 and 5 mm pupils. There were statistical differences in the MTF for spatial frequencies of 5, 10, 15, 20, 25 and 30 c/d. For these spatial frequencies, the SN6AD3 group had higher scores than the SN60D3 group. Accommodative range was （0.925±0.549）D in the SN6AD3 group and （0.964 ±0.582）D in the SN60D3 group. There were no statistically significant difference in accommodative range between the SN6AD3 and SN60D3 groups （t=0.217, P〉0.05）. There were statistical differences in contrast sensitivity for spatial frequencies of 3, 6, 12 and 18 c/d. At these spatial frequencies, the SN6AD3 group had better contrast sensitivity than the SN60D3 group. The rate of eyeglass removal for near for the two MIOL groups was 80% and 72% （x2=0.439, P=0.508）.Conclusion The AcrySof ReSTOR apodized diffractive aspherical MIOL provides excellent distance and near visual acuity, pseudoaccommodation and higher contrast sensitivity.