多焦点和单焦点人工晶状体植入术治疗白内障的临床疗效比较

Comparison of clinical efficacy between multifocal and monofocal intraocular lens implantation for thetreatment of cataract

背景 多焦点人工晶状体（IOL）根据衍射-折射的光学原理,可以产生远近两个焦点,全程视力优于单焦点IOL,可以使白内障患者同时获得良好的远、中、近视力. 目的 比较多焦点IOL植入术与单焦点IOL植入术术后白内障患者的临床疗效.方法 采用前瞻性队列研究设计,纳入2010年6月至2012年9月在潍坊高密市人民医院眼科收治的白内障患者100例100眼,将患者分为多焦点IOL组和单焦点IOL组,2个组间患者人口基线特征匹配.多焦点IOL组在超声乳化白内障摘出术后植入Acrysof ReSTOR SA60D3多焦点IOL,单焦点IOL组植入Acrysof SN60AT单焦点IOL.术后3个月对两组患者术眼的裸眼远视力（UCDVA）、最佳矫正远视力（BCDVA）、裸眼近视力（UCNVA）、最佳矫正近视力（BCNVA）、裸眼中近距离视力（UCMVA）和远视力矫正后的近视力（DCNVA）等指标进行观察和比较,对两组患者术后的近立体视锐度以及瞳孔直径分别为3 mm和5 mm时的IOL高阶像差、最适阅读距离和阅读速度等进行比较和分析,通过问卷调查对两组患者对各视觉功能区的满意度进行分析. 结果 术后3个月多焦点IOL组术眼的UCNVA和DCNVA明显优于单焦点IOL组,差异均有统计学意义（t=15.48、22.44,P＜0.05）；多焦点IOL组术眼在25、30、40、50、60 cm的近距离、中距离处视力均明显优于单焦点IOL组,差异均有统计学意义（t=12.60、16.75、23.18、14.04、7.60,均P＜0.05）；多焦点IOL组患者的裸眼近立体视锐度为（49.1±l5.2）”,明显小于单焦点IOL组的（85.3±18.6）”,差异有统计学意义（t=10.66,P＜0.05）；2个组间患者瞳孔直径为3 mm和5 mm时术眼的总高阶像差、球差及彗差的差异均无统计学意义（P＞0.05）；多焦点IOL组患者的最适阅读距离为（33.5±4.1）cm,较单焦点IOL组的（46.3±5.2）cm明显缩短,差异有统计学意义（t=13.67,P＜0.05）；多焦点IOL组患者的阅读速度为（172.5±52.3）字/min,明显快于单焦点IOL组的（108.3±31.4）字/min,差异有统计学意义（t=7.44,P＜0.05）；多焦点IOL组对近视力功能区和中视力功能区视觉质量满意的患者明显多于单焦点IOL组,差异均有统计学意义（x2 =56.59、40.85,P＜0.05）,多焦点IOL组对远视力功能区满意的患者数与单焦点IOL组比较差异无统计学意义（x2=3.09,P＞0.05）.结论 多焦点IOL植入术治疗白内障能够使患者在远距离成像清晰的基础上,保持近距离以及中等距离的成像清晰,改善了白内障患者术后的生活质量.

Background Multifocal intraocular lens （IOL） can produce two focus distance based on the principle of diffraction-refraction,and the full range of vision is better than monofocal IOL.So multifocal IOL can provide cataract patients better far,middle and near distant vision.Objective This study was to investigate and compare the clinical efficacy between multifocal IOL and monofocal IOL implantation in the patients after cataract surgery.Methods One hundred eyes of 100 patients with cataract enrolled in Gaomi People＇s Hospital from June 2010 to September 2012 and were divided into the monofocal IOL group and multifocal IOL group,with the matched demographic and medical baseline characteristics between the two groups.All the patients were aware of the trial and a written informed consent was obtained from each patient prior to the surgery.Multifocal IOL （Acrysof ReSTOR SA60D3） was implanted in the multifocal IOL group,and monofocal IOL was implanted in the monofocal IOL group after phacoemulsification.Uncorrected distant visual acuity （UCDVA）,best corrected distant visual acuity （BCDVA）,uncorrected near visual acuity （UCNVA）,best corrected near visual acuity （BCNVA）,uncorrected middle distance visual acuity （UCMVA） and distant-corrected near visual acuity （DCNVA） between the two groups were observed and compared,and near stereo acuity,IOL higher-order aberrations under the pupillary diameters of 3 mm and 5 mm,optimum reading distance and reading speed were compared 3 months after surgery.The satisfaction rates of patients for each visual function district were analyzed by a questionnaire survey.Results UCNVA and DCNVA in the multifocal IOL group were significantly better than those of the monofocal IOL group 3 months after surgery,and the differences were statistically significant （t=15.48,22.44,both at P〈0.05）.UCMVA at the distance of 25,30,40,50,60 cm in the multifocal IOL group were better than ones of the single IOL group （t=12.60,16.75,23.18,14.04,7.60,all at P〈0.05）.Uncorrected near stereo acuity in the multifocal IOL group was （49.1 ±15.2）＂,showing a significant reduction in comparison with （85.3 ± 18.6）＂ of the multifocal IOL group （t=10.66,P〈0.05）.The total higher-order aberrations,spherical aberration and coma under the pupil diameter of 3 mm and 5 mm were not significantly different between the two groups （all at P〉0.05）.The optimal reading distance in the multifocal IOL group was （33.5 ± 4.1） cm,and was significantly shorter than （46.3 ± 5.2） cm of the monofocal IOL （t=13.67,P〈0.05）.The reading speed in the multifocal IOL group was （172.5 ± 52.3） words/minute,and that in the monofocal IOL group was （108.3 ± 31.4） words/minute,with the significant difference between them （t =7.44,P〈0.05）.The patients who were satisfied with the functional areas of near vision and middle-distance vision were more in the multifocal IOL group than those of the monofocal IOL group （x2=56.59,40.85,both at P〈0.05）,but those in the distance vision zone between the two groups was no significant different （x2=3.09,P〉0.05）.Conclusions Comparison with the monofocal IOL,multifocal IOL implantation for the treatment of cataract can obtain clear imaging both at the far-distance and middle-and near-distance.Multifocal IOL implantation can improve the life quality of cataract patients after operation.