区域折射型多焦点人工晶状体与非球面单焦点人工晶状体植入术后患者客观视觉质量的短期对比研究

Short-term objective visual quality comparison between after implantation of segmental refractive multifocal intraocular lens and aspheric-surface monofocal intraocular lens

目的对比区域折射型多焦点人工晶状体(MIOL)SBL-3与非球面单焦点人工晶状体Akreos Adapt AO植入术后短期内患者的客观视觉质量。方法选取2017年6月至2018年1月在北京大学第一医院眼科诊断为单纯老年性白内障,并行白内障超声乳化吸除联合人工晶状体植入术的患者26例(35只眼)为研究对象。其中,植入SBL-3晶状体有15只眼,植入AO晶状体有20只眼。术后1个月检查SBL-3组及AO组患者术眼的裸眼远视力(UDVA)、裸眼中视力(UIVA)、裸眼近视力(UNVA)、矫正远视力(CDVA)、矫正近视力(CNVA)、最佳矫正远视力下的中视力(DCIVA)及最佳矫正远视力下的近视力(DCNVA),并使用视觉质量分析仪评估两组患者瞳孔直径4 mm与6 mm的全眼、角膜及眼内的总高阶像差、球差及点扩散函数。术后1个月,绘制SBL-3组患者术眼的离焦曲线。两组患者术眼的UDVA、CDVA、CNVA、UIVA、UNVA、DCIVA、DCNVA及视觉质量以均数±标准差(x珋±s)表示,行非参数Mann-Whimey U检验比较。结果术后1个月时,SBL-3组及AO组患者术眼的UDVA、CDVA及CNVA差异均无统计学意义(Z=-0.99,0,-1.84;P>0.05);SBL-3组患者术眼的UIVA、UNVA、DCIVA及DCNVA分别为0.32±0.08、0.44±0.18、0.30±0.10及0.33±0.11,均优于AO组的0.25±0.10、0.27±0.09、0.20±0.07及0.21±0.10,差异均有统计学意义(Z=-2.26,-3.13,-1.84,-2.17;P<0.05)。视觉质量评估显示,瞳孔直径为4 mm的两组患者术眼球差的差异无统计学意义(Z=-1.50,-1.04,-0.82;P>0.05);瞳孔直径为6 mm的两组患者术眼球差的差异无统计学意义(Z=-0.12,-1.93,-1.16;P>0.05)。SBL-3组瞳孔直径4 mm与6 mm的全眼总高阶像差分别为0.45±0.12与1.41±0.21,高于AO组的0.26±0.12与0.82±0.13,差异均有统计学意义(Z=-3.45,-3.24;P<0.05)。SBL-3组患者术眼的点扩散函数为0.05±0.02,低于AO组的0.11±0.07,差异有统计学意义(Z=-2.60,P<0.05)。SBL-3组患者术眼的离焦曲线显示波峰出现在0 D处,在-1.0 D至-3.0 D范围内的曲线较平稳,下降不明显;在-3.0 D至-5.0 D范围内的曲线快速下降。结论 Adapt AO晶状体术后客观视觉质量优于SBL-3晶状体,但SBL-3晶状体在中、近视力的应用效果优于Adapt AO晶状体。SBL-3晶状体的离焦曲线波峰出现在0 D处,在-1.0D至-3.0 D范围内的曲线较平稳,下降不明显。本研究还需扩大样本量并长期观察其效果及安全性。

Objective To compare the short-term postoperative quality of vision of segmental refractive multifocal intraocular lens （MIOL） SBL-3 and aspheric-surface monofocal int raocular lens Akreos Adapt AO. Methods 26 cases of age-related cataract （35 eyes） after phacoemulsification cataract extraction combined with IOL implantation were collected from June of 2017 to January of 2018 in the Peking University First Hospital. There were 15 eyes in SBL- group,and 20 eyes in AO group according to the different types of IOL implanted. At 1 month after operation the following parameters of the two groups were assessed：uncorrected distant visual acuity（UDVA）, uncorrected intermediate visual acuity（UIVA）, uncorrected near visual acuity（UNVA）, corrected distant visual acuity（CDVA）, corrected near visual acuity （CNVA）, distance-corrected intermediate visual acuity（DCIVA）, distance-corrected near visual acuity（DCNVA）. And analyze total higher order aberrations （ocular, corneal, internal）, spherical aberration, point spread function for 4mm and 6mm optical zone. Defocusing curve of SBL-3 group was also drawn at 1 month postoperatively. The two groups of patients, UDVA, CDVA, CNVA, UIVA, UNVA, DCIVA, DCNVA and visual quality were expressed as mean standard deviation （x±s）, and were compared with non parametric Mann-Whimey U test. Results At 1 month after operation, the UIVA, UNVA, DCIVA and DCNVA in SBL-3 group [（0.32±0.08）, （0.44±0.18）, （0.30±0.10）, （0.33±0.11）] were all better than that of the eyes in AO group [（0.25±0.10）, （0.27±0.09）, （0.20±0.07）, （0.21±0.10）] （Z=-2.26, -3.13, -1.84, -2.17; P〉0.05）. But there were no statistical differences between two groups in UDVA, CDVA and CNVA（Z=-0.99, 0, -1.84; P〉0.05）. The visual quality assessment showed that the difference of eyeball difference between the two groups with the pupil diameter of 4 mm was not statistically significant （Z=-1.50, -1.04, -0.82; P〉0.05）, and the difference of eyeball difference between the two groups with 6 mm pupil diameter was not statistically significant （Z=-0.12, -1.93, -1.16; P〉0.05）. The total higher order aberrations of ocular for 4mm and 6mm optical zone in SBL-3 group [（0.45±0.12）, （1.41±0.21）] were better than that in AO group [（0.26±0.12）, （0.82±0.13）] （Z=-3.45, -3.24; P〈0.05）. But there were no statistical differences between two groups in spherical aberration. The point spread function in SBL-3 group （0.05±0.02） was lower than that in AO group （0.11±0.07） （Z=-2.60, P〈0.05）. There is a peak appeared at 0 D and the defocusing curve was smooth within -1.0 D and -3.0 D but was steep within -3.0 D and -5.0 D. Conclusions The objective visual quality of Adapt AO is better than that of SBL-3 lens, but the application of SBL-3 lens in medium and near vision is better than that of Adapt AO lens. The peak of the defocus curve of SBL-3 lens appeared at 0 D, and the curve in -1.0 D to -3.0 Dwas stable, and the decrease was not obvious. This study also needs to expand the sample size and observe its efficacy and safety in the long term.