实时导航下＋3.5 D非球面衍射型多焦点人工晶状体植入手术效果

A pilot study of ＋3.5 D aspheric diffractive multifocal intraocular lens implantation using a real-time intraoperative navigation system

目的 评估在实时导航下新型＋3.5 D非球面衍射型多焦点人工晶状体（IOL）植入术后视觉质量.方法 前瞻性临床研究.8例（12眼）白内障患者在Version实时导航下行超声乳化白内障吸除联合Diffractiva-aA多焦IOL （Diff-aA）植入术,术后3d、1个月、1年随访,评估项目包括裸眼及最佳矫正远近视力（LogMAR）、离焦曲线、撕囊口圆度（通过眼前节照相及Photoshop软件分析）,IOL偏心值及倾斜度（Pentacam）,以及患者满意度问卷调查.利用配对f检验、秩和检验、重复测量方差分析对手术前后数据改变进行统计分析.结果 术后3d裸眼远视力（UCDVA）为0.07（0.05～0.28）,裸眼近视力（UCNVA）为0.38±0.13,均较术前UCDVA （0.51±0.25）及UCNVA （0.72±0.23）显著提高（P＜0.01）.术后1个月、1年UCDVA、UCNVA较术后3d有小幅提升,但差异无统计学意义.术后离焦曲线呈现双峰状态,第一峰在0（0～＋0.5）D,代表患者接近正视,第二峰在-2.0（-2.4～-2.0）D,代表近工作距离在40～55 cm处.术后1个月撕囊口圆度平均为0.81±0.02,Diff-aA偏心值为（0.21±0.12）mm,倾斜度为1.11°±0.36°.术后1年视觉质量问卷显示7例（11眼）完全脱镜,无一例患者报告严重的视力困扰,3例（4眼）受到轻微或一般夜间光晕的影响.结论 在最新眼科手术导航系统的辅助下,植入新型＋3.5 D多焦IOL能提供良好的全程视力.

Objective To evaluate visual performance after implantation of a ＋3.5 diopter （D） aspheric diffractive multifocal intraocular lens （IOL） under a real-time intraoperative navigation system.Methods In this prospective clinical study,8 patients （12 eyes） underwent implantation of a ＋3.5 D aspheric,diffractive,multifocal IOL Diffractiva-aA using a real-time intraoperative navigation system.Distance and near visual acuity,defocus curve,capsulorhexis circularity,IOL centration,and patient satisfaction questionnaire were monitored at 3 days,1 month,and 1 year postoperatively.Data were analyzed by paired t-test or rank sum test and repeated measured ANOVA.Results Patients achieved significantly better uncorrected distance and near visual acuity after surgery （P〈0.01） with a gradual,slight improvement at 3 days,1 month,and 1 year post-surgery,but there were no significant differences between the time points （P〉0.05）.The defocus curves were bimodally distributed with peaks at spherical equivalents of 0 D （0 to ＋0.5 D） and-2.0 D （-2.4 to-2.0 D）,which represented emmtropia at a distance and at the near and median operating distances of 40-55 cm.One month postoperatively,capsulorhexis circularity was 0.81±0.02,and the values of the eccentricity and inclination of the IOLs were 0.21±0.12 mm and 1.11°±0.36°,respectively.The visual quality score of the questionnaire showed that 7 patients did not use spectacles after surgery,and there was no report of severe visual problems.Only 3 patients were affected by a slight halo at night.All patients were satisfied with the results of the surgery.Conclusion A ＋3.5 D aspheric,diffractive,multifocal IOL can provide good visual acuity at near-intermediate and far distances for those who are used to close work.With the guidance of the latest ophthalmic surgical navigation system,the benefits of a multifocal IOL will be maximized and help patients to achieve better visual quality.