多焦点散光型与单焦点散光型人工晶状体植入术后视觉质量对比

Comparative analysis of visual quality after implantation of multifocal toric and monofocal toric intraocular lenses

目的比较多焦点散光型人工晶状体（IOL）和单焦点散光型IOL植入术后的视觉质量。方法回顾性非随机对照研究。角膜散光大于1．0D的白内障患者27例（32眼），其中8例（10眼）植入非球面多焦点散光型IOL（Acrys of IQ Res tortoric IOL，SND1T，SND1T组），19例（22眼）植入非球面单焦点散光型IOL（Acrys of IQtoric IOL，SN6AT，SN6AT组）纳人本研究。术后1、3、6个月观察2组远近裸眼视力（UCVA）、最佳矫正视力（BCVA），残余散光，IOL旋转度，对比敏感度，调制传递函数（MTF）以及全眼波前像差等。采用独立样本t检验及重复测量方差分析对数据进行分析。结果术后各时间点，SND1T组近UCVA均明显优于SN6AT组（t=11．683、8．252、7．384，P〈0．01）；术后6个月，SND1T组在有眩光低空间频率（3c／d）的对比敏感度低于SN6AT组（t=2．086，P〈0．05），其余空间频率差异无统计学意义；3mm瞳孔下，SND1T组在低空间频率（5、10c／d）的MTF值低于SN6AT组（t=2．050、2．078，P〈0．05）．其余空间频率差异无统计学意义。术后各时间点，2组间远UCVA、远近BCVA差异均无统计学意义：术后6个月，2组间术前术后角膜散光差值、IOL旋转度差异均无统计学意义；2组在无眩光所有空间频率的对比敏感度、5mm瞳孔下各空间频率的MTF值以及3mm和5mm瞳孔下的全眼总像差、总高阶像差、球差、彗差的差异均无统计学意义。结论与单焦点散光型IOL相比，多焦点散光型IOL可获得良好的全程视力。并能有效矫正散光，同时提供理想的视觉质量。

Objective To compare visual quality after implantation of either a muhifocal toric intraocular lens （IOL） or a monofocal torie IOL. Methods This retrospective case-control study was comprised of 32 eyes of 27 patients with more than 1.0 D of preexisting corneal astigmatism. Ten eyes of 8 patients were implanted with Acrysof IQ Restor torie IOLs （SND1T group） and the other 22 eyes of 19 patients were implanted with Aerysof IQ toric IOLs （SN6AT group）. Uncorrected （UDVA） and corrected （CDVA） distance visual acuities, uncorrected （UNVA） and corrected （CNVA） near visual acuities, residual astigmatism, IOL rotation, contrast sensitivity （CS）, modulation transfer functions （MTF） and total eye wavefront aberrations were evaluated for 6 months postoperatively. Data were analyzed using an independent-samples t test and repeated-measures ANOVA. Results The UNVA in the SND1T group was better than that in the SN6AT group at the postoperative time points （t=11.683, 8.252, 7.384, P〈0.01）. At 6 months postoperatively,the CS with glare at low spatial frequencies （3 c/d） in the SND1T group was significantly lower than that in the SN6AT group （t= 2.086, P〈0.05）. MTFs were significantly lower in the SND1T group than that in the SN6AT group with 3-mm pupils at middle spatial frequencies （5, 10 c/d） （t=2.050, 2.078, P〈0.05）. There were no statistically significant differences in UDVA, CDVA and CNVA throughout the postoperative time points between the 2 groups. At 6 months postoperatively, the difference in corneal astigmatism between preoperative and postoperative measurements, the mean IOL axis rotation, CS without glare and with glare at residual spatial frequencies, MTF with 3-mm pupils at medium and high spatial frequencies and with 5-mm pupils at all spatial frequencies, total eye wavefront aberrations, total higher-order aberrations, spherical aberrations and coma under 3- and 5-mm pupils were not statistically significant between the 2 groups. Conclusion Compared with the monofocal toric IOL, the multifocal toric IOL can provide excellent overall visual acuity,effective astigmatic correction and favorable visual quality.