区域折射型与衍射型多焦点人工晶状体植入术后视觉质量对比研究

Clinical investigation on visual quality after implantation of segmental refractive multifocal intraocular lens and diffractive multifocal intraocular lens

目的比较区域折射型多焦点人工晶状体(multifocal intraocular lens,MIOL)和衍射型MIOL植入术后的全程视力和视觉质量。方法采用前瞻性非随机病例对照研究。收集2016年6月至2017年7月在郑州大学第一附属医院眼科行超声乳化白内障摘出联合人工晶状体(intraocular lens,IOL)植入术患者50例60眼,其中行区域折射型MIOL植入术者28例33眼,为折射组,行衍射型MIOL植入术者22例27眼,为衍射组。术后1个月、3个月、6个月定期随访,检查患者视力、离焦曲线、对比敏感度、高阶像差及问卷调查,并对结果进行统计学分析。结果术后6个月,折射组的裸眼中视力为(0.169±0.184)logMAR,优于衍射组的(0.331±0.145)logMAR (P<0.05)。两组裸眼远视力、最佳矫正远视力、裸眼近视力比较,差异均无统计学意义(均为P>0.05)。瞳孔直径为3 mm时折射组的彗差和三叶草分别为(0.13±0.06)μm、(0.21±0.14)μm,分别大于衍射组的(0.06±0.03)μm、(0.06±0.05)μm;而瞳孔直径为5 mm时折射组的彗差和三叶草分别为(0.38±0.17)μm、(0.59±0.21)μm,分别大于衍射组的(0.16±0.09)μm、(0.41±0.33)μm,差异均有统计学意义(均为P<0.05)。在暗视条件下3 c·d^(-1)、6 c·d^(-1)和暗视+眩光条件下各空间频率的对比敏感度折射组优于衍射组,差异均有统计学意义(均为P<0.05),暗视条件下12 c·d^(-1)、18 c·d^(-1)时两组的对比敏感度差异均无统计学意义(均为P>0.05)。除中视力满意度折射组为100.0%,优于衍射组的74.1%(P<0.05),在眩光、光晕干扰程度,远、近、夜间、暗处视力和总体满意度方面,两组差异均无统计学意义(均为P>0.05)。结论区域折射型MIOL与衍射型MIOL相比,裸眼中视力好,对比敏感度高,而彗差和三叶草差较大。

Objective To investigate the visual quality after implantation of segmental refractive multifocal intraocular lens(MIOL) and diffractive MIOL. Methods This prospective case-control study enrolled 50 cataract patients (60 eyes) who underwent intraocular lens (IOL) implantation in the First Affiliated Hospital of Zhengzhou University from June 2016 to July 2017.The patients were divided into two groups based on the MIOL type:segmental refractive MIOL (MF30 Oculentis,Holland) as refractive group (28 patients,33 eyes),and diffractive MIOL (Tecnis ZMB00,Johnson & Johnson Vision,USA) as diffractive group (22 patients,27 eyes).All patients were followed 1 month,3 months and 6 months after surgery,and visual acuity,defocus cure,contrast sensitivity,high-order aberrations,and patient satisfaction questionnaire were measured.Data were analyzed by independent t test,χ^2 test,and Mann-Whitney U test. Results Six months postoperatively,uncorrected intermediate visual acuity (UIVA) was(0.169±0.184)logMAR in the refractive group,and (0.331±0.145)logMAR in diffractive group ( P <0.05).No statistically significant differences were observed in postoperative uncorrected distance visual acuity (UDVA),corrected distance visual acuity (CDVA),and uncorrected near visual acuity (UNVA) between two groups (all P >0.05).Coma aberration (CA) and trefoil aberration (TA) were (0.13±0.06)μm,(0.21±0.14)μm in the refractive group and ( 0.06± 0.03)μm,(0.06±0.05)μm in the diffractive group when the aperture was 3 mm.CA and TA were significantly larger in the refractive group than in the diffractive group when the aperture was 5mm (all P <0.05).Contrast sensitivity was significantly better in the refractive group than in the diffractive group at 3 c·d^-1 and 6 c·d^-1 ,respectively,under mesopic conditions (all P <0.05).No difference was found under mesopic conditions at 12 c· d^-1 and 18 c·d ^-1 between two groups (both P >0.05).The satisfaction rate of UIVA was 100.0% and 74.1% for refractive group and diffractive group,respectively,but there were no significant differences in the interference degree of glare and halo,the satisfaction rates of UDVA,CDVA,UNVA,nigh vision,dark vision and overall vision between two groups (all P >0.05). Conclusion Segmental refractive MIOL provides better UIVA,better contrast sensitivity,larger CA and TA than diffractive MIOL.