植入ReSTOR阶梯渐进衍射型人工晶状体的临床效果

Evaluation of the clinical effect of Acrysof ReSTOR multifocal intraocular lenses implantation

目的研究3种不同屈光状态白内障眼植入ReSTOR阶梯渐进衍射型多焦点人工晶状体（MIOL）的临床效果。方法前瞻性临床研究。白内障患者28例（42眼），按眼轴长度将这42眼分为近视（17眼）、正视（15眼）、远视（10眼）3组。所有患者均在白内障超声乳化术中植入ReSTORMIOL，术后6个月比较3组患者的裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、高对比度及低对比度下的裸眼及最佳矫正中间距离视力；结合患者术后的残留屈光度，分析常用的3种人工晶状体计算公式对术后屈光度的预测性；对患者术后满意度、脱镜率及术后视觉不良症状进行问卷调查。采用单因素方差分析及卡方检验对结果进行分析。结果3组患者术后裸眼及矫正远、中、近视力差异均无统计学意义，所有患者平均裸眼及矫正中间距离视力稍低于远、近视力，尤其是低对比度中间距离视力。术后3组的残留屈光度中，近视组与正视组、近视组与远视组之间差异有统计学意义（F=8．33．P〈0．05）。在近视组，Haigis公式及HolladayI公式计算的术后预期屈光度与实际残留屈光度比较差异有统计学意义（P〈0．05），SRK．T计算的术后预期屈光度与实际残留屈光度比较差异无统计学意义。3组患者对远、近距离的视力满意度差异无统计学意义，但远视组对中间距离视力的满意度要低于其他2组，差异有统计学意义（P〈0．05）。3组患者术后脱镜率、眩光及光晕等不良视觉症状的比较差异无统计学意义。结论正视、远视及近视白内障患者植入ReSTORMIOL后均能获得较好的术后视力、较高的脱镜率及较少的视觉不良症状。

Objective To evaluate the visual acuity and the rate of spectacle independence after implantation with ReSTOR multifocal intraocular lenses （MIOLs） in myopes, emmetropes and hyperopes. Methods It was a prospective clinical study. Twenty-eight patients （42 eyes） with age-related cataract were implanted with ReSTOR MIOLs after phaeoemulsification. The 42 eyes were classified as emmetropic, myopic or hyperopic based on axial length. Uncorrected and best corrected visual acuity for far, intermediate （with high and low contrast sensitivity） and near vision were compared at 6 months after surgery. The predictability of 3 different formula calculations were evaluated. Patients were asked to rate photic phenomena, quality of night vision, spectacle independence, and satisfaction with visual outcome by answering a questionnaire. The data were analyzed with an ANOVA and chi-square tests. Results Uncorrected and best corrected visual acuity for near, intermediate, and far vision were not significantly different among groups, but the intermediate visual acuity, especially low contrast sensitivity, was lower than far and near visual acuity. Postoperative residual refractive errors for the three groups were significantly difference （F=8.33, P〈0.05）. In the myopic group, there was a statisitically significant difference between the actual postoperative refractive error and the predicted refractive error calculated by the Haigis and Hotladay I formulas （P〈0.05）; the actual postoperative refractive error did not differ significantly from the predicted refractive error calculated by the SRK-T formula. Satisfaction with intermediate vision was lower in the hyperopic group than in the others, and the difference was statistically significant （P〈0.05）. The differences in the percentage of time without glasses and adverse visual symptoms such as glare and halo after surgery were not statistically significant among the 3 groups. Conclusion Preoperative refractive status is a relevant factor influencing the postoperative outcome after implantation of ReSTOR MIOLs.