儿童白内障摘出联合非球面多焦点人工晶状体植入术后远期临床观察

Long-term clinical effect of aspheric multifocal intraocular lens implantation for developmental cataracts in childhood

目的观察儿童白内障摘出联合衍射型非球面多焦点人工晶状体（IOL）植入术的远期临床效果和视觉质量变化。方法采用回顾性队列研究方法，收集2013年8月至2015年1月在郑州大学第一附属医院行超声乳化白内障摘出联合IOL植入术的8～14岁儿童白内障患者46例67眼临床资料。按照患者术中植入IOL的不同分为多焦点IOL组和单焦点IOL组，其中多焦点IOL组24例34眼，术中植入AMO（ZMB00）IOL；单焦点IOL组22例33眼，术中植入Bausch ＆ Lomb（MI60）IOL。对2个组术眼术后3、6和12个月远、中、近裸眼视力和矫正视力进行分析。于术后12个月采用i-Trace视觉功能分析仪分析术眼波前像差、调制传递函数（MTF）变化；分别采用Optec-6500视功能分析仪和Titmus Stereo Test图卡评估术眼远、近立体视觉变化；并测定术眼术后12个月的近附加度数，观察各组术眼脱镜率及近视漂移度。 结果术后3、6和12个月多焦点IOL组中程、近裸眼视力优于单焦点IOL组，差异均有统计学意义（中程视力：Z＝－3.74、－4.36、－3.66，均P＝0.00；近视力：Z＝－2.67、－2.50、－2.33，均P〈0.05）。术后12个月，2个组间术眼在5.0 mm瞳孔直径下的总像差、低阶总像差、高阶总像差、慧差、三叶草、球差、二阶散光的差异均无统计学意义（均P〉0.05）。5.0 mm瞳孔直径下多焦点IOL组术眼在各空间频率MTF值均稍低于单焦点IOL组，但差异均无统计学意义（均P〉0.05）。多焦点IOL组术眼近立体视、近附加度和屈光变化量（ΔD）均明显低于单焦点IOL组，差异均有统计学意义（均P〈0.05）。多焦点IOL组术眼视近脱镜率为93.3%，明显高于单焦点IOL组的33.3%，差异有统计学意义（χ2＝23.25，P＝0.00）。术后12个月，2个组后发性白内障发生率比较，差异无统计学意义（P〉0.05）。多焦点IOL组术眼近视漂移发生率为16.7%，明显低于单焦点IOL组的83.3%，差异有统计学意义（χ2＝15.02，P＝0.00）。 结论儿童白内障患者植入非球面多焦点IOL可以获得良好的全程视力，提供较好的近立体视觉，减少术后患儿对眼镜的依赖，降低近视漂移的发生率。

ObjectiveTo observe the long-term visual quality and clinical effect of aspheric diffractive multifocal intraocular lens （IOL） implantation for congenital and developmental cataracts in childhood.MethodsA retrospective cohort study on multifocal IOL implantation for congenital and developmental cataracts in childhood （aged 8 to 14 years） was performed in the First Affiliated Hospital of Zhengzhou University from August 2013 to January 2015.The clinical data of 67 eyes from 46 congenital cataract patients who received phacoemulsification with IOL implantation were collected.The AMO （ZMB00） IOL was implanted in 34 eyes of 24 patients in the multifocal IOL group, and Bausch ＆ Lomb （MI60） IOL was implanted in 33 eyes of 22 patients in the monofocal IOL group.The distance, intermediate and near vision acuity were analyzed in 3, 6 and 12 months after surgery, including uncorrected visual acuity （UCVA） and best corrected visual acuity （BCVA）. The wavefront aberrations, modulation transfer functions （MTF） and stereopsis were obtained with iTrace Analysis System, Optec-6500 Visual Functional Analyzer and Titmus Stereo Test Chart, respectively in 12 months after surgery.The near additional degree, removing glasses rate and myopic shift were compared between the two groups in postoperative 12 months.ResultsThe intermediate and near UCVA in the multifocal IOL group were obviously better than those in the monofocal IOL group 3, 6 and 12 months after surgery （intermediate： Z=-3.74, -4.36, -3.66; all at P=0.00.near： Z=-2.67, -2.50, -2.33; all at P〈0.05）. There were no significant differences between the two groups in total aberration, high and low order total aberrations, comatic aberration, trefoil aberration, spherical aberration and secondary astigmatism under the 5.0 mm optical zone in 12 months after surgery （all at P〉0.05）. The MTFs under the 5.0 mm optical zone and 5, 10, 15, 20, 25, 30 c/d in the multifocal IOL group were insignificantly lower than those in the monofocal IOL group （all at P〉0.05）. In addition, the near stereopsis, near additional degree and myopic shift （ΔD） were reduced in the multifocal IOL group compared with monofocal IOL group （both at P〈0.05）. The glasses removing rate was 93.3% in the multifocal IOL group, which was significantly higher than 33.3% in the monofocal IOL group （χ2=23.25, P=0.00）. No significant difference in the incidence of posterior capsular opacification was found between the two groups （P〉0.05）. The myopic shifting rates were 16.7% and 83.3% in the multifocal IOL group and monofocal IOL group, with a significant difference between the two groups （χ2=15.02, P=0.00）. Conclusions The aspheric multifical IOL implantation can achieve good and stable distance, intermediate and near visual acuities, provide better near stereopsis, reduce postoperative dependence on spectacles and decrease the incidence of myopic shift in child cataract patients.