单眼角膜散光白内障患者不同人工晶状体组合植入的对比研究

Comparison of different combinations of intraocular lenses implantation in cataract patientswith unilateral astigmatism

目的对比单眼角膜散光的白内障患者混合植入Toric和多焦点或单焦点人工晶状体（IOL）后的视功能状态。方法前瞻性病例对照研究。30例单眼角膜散光的年龄相关性白内障患者采用非随机对照方式分成两组，实验组15例，双眼分别植入AcrySof Toric和ReSTOR（SN6ADl）多焦点IOL；对照组15例．双眼分别植人AcrySof Toric和AcrySof IQ单焦点IOL。术后6个月以ETDRS视力表检测患者双眼的裸眼及最佳矫正远视力，以及在最佳远矫正下的中距离视力、近视力；采用综合验光仪检测其调节幅度曲线；同时检测患者在明光、暗光及有或无眩光状态下的对比敏感度；检查近立体视锐度；并行视功能和视觉不良症状问卷调查。数据采用配对t检验、独立样本t检验及卡方检验进行分析。结果随访期间实验组双眼远、中、近裸眼logMAR视力分别为0．05±0．05、0．24±0．10、0．14±0．06，对照组双眼远、中、近裸眼logMAR视力分别为0．06±0．07、0．26±0．08、0．37±0．10，两组相比，远、中视力差异无统计学意义，近视力差异有统计学意义（扛5．476，P=-0．000）。与对照组相比，实验组ReSTOR植入眼在明光、明光眩光18cpd下的对比敏感度下降（0．30±0．37V,S0．94±0．58，t=3．476，P=0．001；0．34±0．44 us0．88±0．52，t=2．975．P=-0．006）。在暗光及暗光眩光12cpd频段时对比敏感度下降（0．05±0．22 us0．50±0．61，t=3．057，P=0．005；0．05±0．22 us0．59±0．75，t=3．154，P=-0．004）。两组患者的调节幅度曲线形状差异明显，实验组为双峰曲线，峰位分别位于附加0和02．5D处，而对照组只存在0D处一个峰；且实验组调节幅度范围明显大于对照组。实验组近立体视锐度为60弧秒及以下者较对照组略低（53％us73％，X^2=1．262，P=0．263），但视近满意者比例明显较高（80％us26％，X^2=8．571，P=0．003），两组患者均无明显的不良视觉症状。结论双眼混合植入Tofic和多焦点IOL虽然对患者的近立体视略有影响．但可以提供更好的双眼全程视力，增加焦深，提高脱镜率，对于单眼角膜散光的白内障患者仍是一种合理的选择。

Objective To assess binocular visual function after combined implantation of toric and multifocal or monofocal intraocular lenses in unilateral astigmatism cataract patients. Methods This was a prospective case control study. A total of thirty unilateral astigmatism patients undergoing phacoemulsification were recruited. AcrySof Toric IOL were implanted in the astigmatic eye of patients, with ReSTOR （15 eyes） or AcrySof IQ （15 eyes） in the contralateral eye. Six months postoperatively, patients were assessed for visual acuity （5.0 m, 60.0 cm, 40.0 cm）, contrast sensitivity, amplitude of accommodation, and stereoacuity. Patients were surveyed for visual disturbances and lifestyle visual quality. Data were analyzed with a paired t test, an independent samples t test, or chi-square test. Results At 6 months postoperatively, for Toric-ReSTOR patients, uncorrected binocular logMAR visual acuity at 5.0 m, 60.0 cm, 40.0 cm was 0.05±0.05, 0.24±0.10, and 0.14±0.06, respectively. For Toric-AcrySof IQ patients, uncorrected binocular logMAR visual acuity was 0.06±0.07, 0.26：L-0.08, and 0.37±0.10, respectively. These values between the two group did not achieve significant differences except for near visual acuity （t=5.476, P=0.000）. The contrast sensitivity for ReSTOR eyes was lower at 18 cod under ohotooic and photooic ,,lare circumstance than for the AcrvSof IQ eves（0.30±0.37 versus 0.94±0.58, t=3.476, P=0.001; 0.34±0.44 versus 0.88±0.52, t=2.975, P= 0.006）. And was lower at 12 epd under scotopie and scotopie glare circumstance than for the AerySof IQ eyes （0.05±0.22 versus 0.50±0.61, t=3.057, P=0.005; 0.05±0.22 versus 0.59±0.75, t=3.154, P=0.004）. The amplitude curve of accommodation in Toric-ReSTOR patients had two wave peak （0 and -2.5 D）, but only one （0 D） in Toric-AerySof IQ patients. The stereopsis of Torie-ReSTOR eyes decreased slightly （53% versus 73%, X^2=1.262, P=0.263）. Patient satisfaction for mean near vision was significantly different： 80% for Toric-ReSTOR patients versus 26% for Torie-AerySof IQ patients （X^2=8.571, P=0.003）. There were no visual symptoms in either group. Conclusion Although a combination of toric and mutifoeal intraocular lens implantation compromises stereoacuity, it can still provide patients with high levels of spectacle freedom and good overall binocular visual acuity.