衍射型非球面多焦点人工晶状体植入术后视觉质量评价

Visual quality in patients with diffractive aspherical multifocal intraocular lens implantation

目的评价全光学面衍射型非球面多焦点人工晶状体（muhifocal intraocular lens，MI—OL）植入术后的视觉质量。方法将56例（82只眼）行白内障超声乳化联合人工晶状体植入的患者分为两组：多焦点组（MIOL组）：26例（36只眼）植入衍射型非球面多焦点人工晶状体TecnisZMA00；单焦点组（SIOL组）：30例（46只眼）植入非球面单焦点人工晶状体TecnisZA9003。术后随访3月，测量裸眼远、中、近视力、最佳矫正远视力及最佳矫正远视力下中、近视力、术后并发症、对比敏感度、焦点深度并进行问卷调查比较脱镜率、满意度及视觉不良症状。结果（1）术后3月，MIOL组裸眼近视力及最佳矫正远视力下近视力优于SIOL组，差异有统计学意义（P〈0．01）。两组裸眼远视力、最佳矫正远视力、裸眼中间视力及矫正远视力下中间视力差异无统计学意义（P〉0．05）。（2）术后3月，MIOL组对比敏感度在暗光条件空间频率3cpd低于SIOL组，差异有统计学意义外（P〈0．01），余差异均无统计学意义（P≥0．05）。（3）MIOL组和SIOL组焦点深度范围分别为（＋1．5—3．5）D和（＋1．0—1．5）D，差异有统计学意义（P〈0．05）。（4）MIOL组脱镜率为88．9％，而SI。OL组为27．8％，两组差异有统计学意义（P〈0．01）。全程视力满意度，MIOL组80．6％（29／36）与SI—OL组19．6％（9／46）相比，差异有统计学意义（P〈0．01）。少数患者诉轻度光晕、眩光现象，MIOL和SIOL组分别为27．8％（10／36）和23．9％（11／46），差异无统计学意义（P〉0．05）。患者诉这种现象对日常生活无明显影响。结论TecnisZMA00多焦点人工晶状体可提供良好的全程视力、尤其是近视力，具有较高的拟调节力及脱镜率，有效地提高了白内障患者术后的视觉质量。

Objective To evaluate the visual quality of patients after implantation of the diffrac- tive aspherical multifocal intraocular lens. Methods In the clinical research, 56 patients （82 eyes） who underwent phaocoemulsification were divided into two groups, 26 cases （36 eyes） who received the diffractive aspherical multifocal IOL （Tecnis ZMA00） were divided into multifocal group （MIOL group）, 30 patients （46 eyes） who received the single focus aspherical IOL （Tecnis ZA9003） were di- vided into single focus group （SIOL group）. Three months after surgery, uncorrected and best correct- ed distance visual acuity （UCDVA and BCDVA）, uncorrected intermediate and near visual acuity （UCIVA and UCNVA）, distance corrected intermediate and near visual acuity （DCIVA and DCNVA）, postoperative comptications, contrast sensitivity, pseudoaccommodation were recorded. The patient＇s degree of satisfaction, spectacle independence, severity of symptoms （night glare or halo） through a questionnaire was assessed. Results Three months after surgery, average uncorrected and distance corrected near visual acuity of MIOL group were better than those of SIOL group, the differences were statistically significant （P 〈0.05）. The uncorrected and best corrected distance visual acuity, uncorrected and distance corrected intermediate visual acuity were similar to SIOL group＇ s, no statistical differences were found in them （P 〉0.05）. Contrast sensitivity of MIOL group were lower than those of SIOL group,but no statistical differences were fotmd between them in all contrast sensitivi- ties except at the 3 cpd in dark condition. The depth of focal of MIOL group was better than SI- OL group＇s （＋1,5--3.5D versus ＋1.0 - -1.5D）, there was statistical difference between them, The spectacle independence in MIOL and SIOL groups were 88.9% and 27.8% （P 〈0.05）. The degrees of satisfaction about MIOL and SIOL group were 80.6% and 19.6% （P 〈0.01）. No statistical differences were found in night glare or halo phenomena between MIOL group 27.8% and SIOL group 23.9% （P 〉0.05）. Conclusions The diffractive aspherical multifocal lens （Tecnis ZMA00） can provide good full range visual acuity, especially near visual acuity and higher spectacle independence and depth of focus, so it can improve the quality of life for patients after surgery.