散光多焦点人工晶状体联合植入的临床观察

Efficacy of combined implantation of toric multifocal intraocular lens for cataract patients with corneal astigmatism

目的观察散光多焦点人工晶状体联合植入的术后效果。方法收集2018年10月至2019年6月宁波市医疗中心李惠利医院收治的散光白内障患者18例36眼,通过术前规划测量,在主视眼植入Acrysof IQ Restor Toric+2.5D(SV25TX)人工晶状体,非主视眼植入Acrysof IQ Restor Toric+3D(SND1TX)人工晶状体,术后至少随访3个月以上,在最后一次随访中记录患者远中近视力,电脑验光记录残余散光和等效球镜度数,对比敏感度检查,散瞳裂隙灯下观察人工晶状体在囊袋内位置以及轴位旋转情况。结果联合植入术后患者远距离(4m)视力(Log MAR)0.05±0.04、中距离(60cm)视力(Log MAR)0.10±0.00、近距离(40cm)视力(Log MAR)0.06±0.04。术后残余散光为(0.29±0.17)D,明显低于术前的(1.37±0.49)D,差异有统计学意义(P<0.01)。等效球镜接近正视(-0.33±0.16)D。术前角膜散光与术后实际矫正散光呈正相关(r=0.937,P<0.01)。术后在无眩光及有眩光条件下对比敏感度检查结果均明显高于术前,差异均有统计学意义(均P<0.01)。散瞳裂隙灯下观察人工晶状体位置:所有人工晶状体位置居中,4眼无旋转,28眼旋转<3°,4眼旋转3°~5°,无一眼旋转>5°。结论散光多焦点人工晶状体联合植入具有可预测性,安全性、稳定性、可靠性高,适合临床医师选择应用,值得临床推广。

Objective To observe the clinical outcomes of combined implantation of toric multifocal intraocular lens for cataract patients with corneal astigmatism.Methods Eighteen cataract patients(36 eyes)with corneal astigmatism admitted in Ningbo Medical Center Lihuili Hospital from October 2018 to June 2019 were recruited.By preoperative planning and measurements,the+2.5D toric multifocal intraocular lens were implanted in the dominant eye and+3D toric multifocal intraocular lens were implanted in the fellow eye.The full range of visual acuity fromnear to distance was observed in at least 3 months follow up,and the residual astigmatismand postoperative manifest refraction spherical equivalent(MRSE)were observed with computer optometry,the contrast sensitivity outcomes,IOL position and rotation were observed with slit lamp.Results After combined implantation,the distance uncorrected visual acuity(LogMAR)was 0.05±0.04,the intermediate uncorrected visual acuity(Log-MAR)was 0.10±0.00,the near uncorrected visual acuity(LogMAR)was 0.06±0.04;postoperative residual astigmatism was(0.29±0.17)D,which was significantly lower than that of pre-operation(1.37±0.49)D(P<0.01);the postoperative MRSE trended to zero(-0.33±0.16)D;a statistically significant correlation was showed between preoperative astigmatism and postoperative achieved astigmatism correction(r=0.937,P<0.01);the postoperative contrast sensitivities were significantly higher than those before surgery under glare and no glare conditions(all P<0.01).The position and rotation of IOL was also observed in slit lamp by pupillary dilation:all IOLs were in the central capsule,4 eyes with no IOL rotation,28 eyes with IOL rotation less than 3°,4 eyes with IOL rotation 3°-5°,and no eye with IOL rotation more than 5°.Conclusion The outcome of combined implantation of toric multifocal intraocular lens is predictable,safe,stable and reliable,which is suitable for clinical selection and application.