双眼联合植入不同附加度数多焦点散光矫正型人工晶状体(ART)患者术后视觉质量及满意度

Visual quality and satisfaction of both eyes after combined implantation of AcrySof IQ ReSTOR Toric-intraocular lens with different addition powers

目的探讨双眼联合植入不同附加度数多焦点散光矫正型人工晶状体(AcrySof IQ ReSTOR Toric-Intraocular lens,ART)患者术后视觉质量及满意度。方法收集2016年11月至2017年12月在我院就诊的双眼白内障合并散光和老视的患者共34例(68眼),行白内障超声乳化吸出联合ART植入术。随机将患者分为两组,观察组16例(32眼),双眼分别植入ART+2.5 D和ART+3.0 D,第一次手术植入ART+2.5 D,第二次手术植入ART+3.0 D;对照组18例(36眼),双眼均植入ART+3.0 D。术后3个月检测两组患者裸眼视力及最佳矫正远(5 m)、中(80 cm)、近(40 cm)视力,绘制双眼离焦曲线,比较分析两组患者对比敏感度及问卷调查结果。结果术后3个月,观察组患者裸眼中视力、最佳矫正中视力均优于对照组,差异均有统计学意义(均为P<0.05);两组患者裸眼远视力、裸眼近视力、最佳矫正远视力、最佳矫正近视力比较,差异均无统计学意义(均为P>0.05)。术后3个月,观察组离焦曲线在-3.5^+0.5 D区间趋于平稳,视力均优于0.3 logMAR,形成平台期;对照组离焦曲线呈现双峰,峰值在0 D和-3.0 D;离焦曲线结果显示,观察组中视力明显优于对照组,近视力对照组优于观察组。术后3个月,在暗视状态下,观察组在6.0 c·d-1及12.0 c·d-1空间频率的对比敏感度要优于对照组,差异均有统计学意义(均为P<0.05)。术后3个月,两组患者共34例68眼均有不同程度光晕等视觉干扰表现,以夜间为重,但不影响生活质量。观察组患者在日常生活中完全脱镜,无患者诉双眼视物不适、重影、头晕等症状;对照组中5例(10眼)中距离视物欠佳(主要看电脑屏幕)。中距离用眼活动满意度观察组为100%,对照组为72.2%,差异有统计学意义(P=0.002);近距离用眼活动满意度观察组为87.5%,对照组为94.4%,差异无统计学意义(P=0.678)。结论双眼联合植入不同附加度数ART能够为患者提供良好的术后视觉质量及满意度。

Objective To evaluate visual quality and satisfaction of both eyes after combined implantation of AcrySof IQ ReSTOR Toric-intraocular lens(ART)with different addition powers.Methods Totally 34 cataract cases(68 eyes)with astigmatism and presbyopia admitted to our hospital from November 2016 to December 2017 were collected for cataract phacoemulsification and ART implantation,and were randomly divided into two groups observation group(16 cases,32 eyes)implanted with ART+2.5 D and ART+3.0 D for both eyes(ART+2.5 D for the first surgery and ART+3.0 D for the second surgery),and control group(18 cases,36 eyes)implanted with ART+3.0 D in both eyes.At 3 months after surgery,uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA;5 m),distance-corrected middle visual acuity(DCMVA;80 cm)and distance-corrected near visual acuity(DCNVA;40 cm)were measured to draw binocular defocus curve.Contrast sensitivity and results of questionnaire were compared between the two groups.Results At 3 months after operation,uncorrected middle visual acuity(UCMVA)and DCMVA in the observation group were better than those in the control group,and there were statistically significant differences(both P<0.05).There was no significant difference between the two groups in UCVA,uncorrected near visual acuity(UCNVA),BCVA and DCNVA(all P>0.05).At 3 months after surgery,the defocusing curve tended to be stable between-3.5^+0.5D in the two groups,and the vision was above 0.3 logMAR,forming a platform stage;the defocusing curve showed a double peak,with peak values of 0 D and-3.0 D in control group.The results of defocusing curve showed that the visual acuity of the observation group was better than that of the control group,and near visual acuity of the control group was better than that of the observation group.At 3 months after surgery,contrast sensitivity at spatial frequency of 6.0 c·d-1 and 12.0 c·d-1 in the scotopic condition was better in the observation group than that in the control group,and statistical differences were observed(both P<0.05).At 3 months after surgery,totally 68 eyes of 34 cases in both two groups showed different degrees of visual interference such as halo,which was more severe at night but did not affect the quality of life.Patients in the observation group did not need glasses at all in daily life,and no patients complained of ocular discomfort,double vision,dizziness and other symptoms.Five patients in the control group had poor middle distance vision(mainly looking at the computer screen).The satisfaction degree of middle distance vision was 100%in the observation group and 72.2%in the control group,and the difference was statistically significant(P=0.002).Satisfaction degree of near distance vision was 87.5%in the observation group and 94.4%in the control group,and the difference was not statistically significant(P=0.678).Conclusion Binocular implantation of ART with different addition powers can provide good visual quality and improve degree of satisfaction.