非球面多焦点人工晶体(SN6AD1 MIOL)囊袋内植入术后的偏心研究

The decentration study after capsular bag implantation of aspheric multifocal intraocular lens(SN6AD1)

目的:观察阶梯渐进衍射型非球面多焦点人工晶体(Multifocal intraocular lens,MIOL)囊袋内植入术后人工晶体(intraoeularlens,IOL)的偏心情况和囊袋变化,探讨新一代多焦点人工晶体植入术后偏心的发生率、发生机理和预防措施。方法:将36例52眼符合条件的单纯性年龄相关性白内障患者随机分成2组:术中植入多焦点人工晶体者共18例24眼设为多焦组,术中植入单焦点人工晶体者(Monofocal intraocular lens,SIOL)共18例28眼设为单焦组。术后2-4月观察2组患者的人工晶体偏心情况、囊袋变化、人工晶体襻的情况并进行关于视觉不良症状、满意度等方面的问卷调查。结果:多焦组有6只眼偏心值≥0.5mm(25%),其中3只眼≥1mm(12.5%),单焦组有8只眼偏心值≥0.5mm(28.57%),两组相比差异无统计学意义(P>0.05)。通过问卷调查发现这些患者术后均存在着视觉不良症状,部分患者视远视近均不清楚。MIOL组和SIOL组植入术后的视觉不良症状,以眩光、视物晃动为主,两组相比差异无统计学意义(P>0.05)。不良视觉症状方面MIOL组患者表现更明显(P<0.05),其中3例患者在术后3个月时仍然觉视远视近均不清楚。结论:新一代多焦点人工晶体(SN6AD1MIOL)居中性可,偏心的发生率与同种材质的单焦点人工晶体相比无增加,但其偏心时表现出的视觉不良症状明显比单焦组更严重,偏心时部分患者视远、视近均不清楚,戴镜矫正后患者视力有所提高但其主观感觉仍然不满意,故在植入MIOL前应注意对适应症的选择,术中保证撕囊连续、完整,彻底吸净晶体皮质是保持晶体居中性的关键因素。

Objective：To observe the intraocular lens eccentric pouch changes after the ladder asymptotic diffractive aspherical muhifocal intraocular lens （ MIOL） is implanted into the sac, and to explore the incidence rate , mechanism and preventive measures of the decentration. Methods： Fifty - two eyes out of 36 patients with simple age - related cataract are divided into two groups at random. 24 eyes of 18 patients implanted MIOL in is set to muhifocal group and 28 eyes of 18 patients implanted monofocal intraocular lens （SIOL） in is set to monofocal group. Observe the two groups of patients with intraocular lens eccentric pouch changes, the situation of the intraocular lens haptics and visual adverse symptoms, satisfaction survey after two months of the implantation. Results： The rates ofthe deeentration 〉 0.5mm for two groups were respectively 25 %, 28.75 %, the rates of the d^enu＇ation〉 I mm in muhifocal group （ 12.5 % ）, thus the difference between them has no statistical meaning（ P 〉 0.05 ）. Th_rough the questionnaire , these patients have adverse visual symptoms , and some of them can＇ t see clearly both near and far. 3＇he adverse visual symptoms of the two groups are mainly glare and visual sway. And the difference between them has no statistical meaning（ P 〉 0.05 ）. The MIOL group＇ s adverse visual symptoms perform more obviously , and 3 patients of the group can＇ t see clearly both near and far 3 months after the surgery. Conclusion： The centration of the new generation of the MIOL is good , but its incidence rate of the decentration is not less than the SIOL of the same material and the adverse visual symptoms are worse when the decentration happens. Some patients can＇t see clearly both near and far. After spectacle correction ,the patients＇ corrected visual acuity improves, but it doesn＇t satisfy their subjective feeling. Therefore, before the implantation of MIOL, the choice of the eligible patients is noted. And during the surgery , to ensure the capsulorhexis＇ continuous ,complete and thorough absorption of the crystal cortex is the key factor of maintainin a crystal center.