Predictive factors for photic phenomena after refractive,rotationally asymmetric,multifocal intraocular lens implantation

AIM： To investigate the independent factors associated with photic phenomena in patients implanted with refractive,rotationally asymmetric,multifocal intraocular lenses（MIOLs）.METHODS： Thirty-four eyes of 34 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs were included.Distance and near visual acuity outcomes,intraocular aberrations,preferred reading distances,preoperative and postoperative refractive errors,mesopic and photopic pupil diameters,and the mesopic and photopic kappa angles were assessed.Patients were also administered a satisfaction survey.Photic phenomena were graded by questionnaire.Independent-related factors were identified by correlation and bivariate logistic regression analyses.RESULTS： The distance from the photopic to the mesopic pupil center（pupil center shift） was significantly associated with glare/halo symptoms [odds ratio（OR）=2.065,95% confidence interval（CI）=0.916-4.679,P=0.006] and night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007）.The preoperative photopic angle kappa was significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041）.The photopic angle kappa was also significantly associated with glare/halo symptoms（OR=2.155,95% CI=1.065-4.362,P=0.041） and with night vision problems（OR=1.832,95% CI=0.721-2.158,P=0.007） in patients implanted with rotationally asymmetric MIOLs.CONCLUSION： A large pupil center shift and misalignment between the visual and pupillary axis（angle kappa）may play a role in the occurrence of photic phenomena after implantation of rotationally asymmetric MIOLs.

人工晶体眼异常眩光幻影的研究进展

白内障术后发生的眩光、光晕、阴影等眩光幻影问题成为影响视觉质量的重要因素。影响人工晶体眼眩光幻影的因素有晶体设计、手术因素、患者生理因素和心理适应。预防后发性白内障、晶体边缘纹理化、采用前圆后方边缘设计、使用更大的晶体光学面可以减少正像眩光幻影的发生。而手术切口位置和虹膜-晶体间距等可能是负像眩光幻影产生的影响因素。对于眩光幻影的治疗,6个月的临床观察是必要的,症状严重且持续者可考虑晶体置换或睫状沟植入另一枚驼背式人工晶体。

Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review

Multifocal intraocular lenses(IOLs) are currently usually implanted for the treatment of cataracts because they have been proved to be superior to monofocal IOLs with respect to spectacle independence. In turn, they are associated with a higher prevalence of dysphotopsia symptoms that is one of the most common causes of patient dissatisfaction. Neuroadaptation seems to play a major role in the optimal adaptation to multifocal IOLs. In this context, the development of strategies that facilitate the neuroadaptation process to multifocality might be an effective strategy to reduce patients' dissatisfaction. Video games have been proved to be effective for the improvement of visual acuity and for the promotion of neuroplasticity in elderly subjects and other populations with cortical-related visual impairment. This narrative review highlights the physiological potential of video games as a perceptual strategy to improve visual acuity and promote neuroplasticity in patients using multifocalIOLs, although research is still needed to confirm these benefits in this specific population, with only one comparative study to this date providing evidence of them.

可植入式接触镜术后眩光幻影与Zernike多项式像差的特征分析

目的观察可植入式接触镜(implantable contact lens,ICL)术后患者眩光幻影程度,探讨其形成原因。方法利用全眼球像差仪(OPD-ScanⅢ)检测22例患者44眼ICL术后3个月暗瞳及散瞳情况下Zernike多项式各像差值,对每只眼眩光幻影严重程度分4级计分,再对二者进行相关性分析。结果暗瞳时,患者瞳孔直径(5.75±0.75)mm,无眩光幻影33例(75%),轻度10例(23%),中度1例(2%),无重度眩光幻影。眩光幻影分别与二级散光(r=0.541、r=0.465,P<0.05)、球差(r=5.802,P<0.05)、散光(r=0.314、r=0.313,P<0.05)、失焦(r=0.569,P<0.05)、三叶草差(r=0.382,P<0.05)、彗差(r=0.422、r=0.310,P<0.05),以及四叶草差(r=0.303、r=0.455,P<0.05)等不同程度正相关,与其余各项指标不相关。散瞳时,患者瞳孔直径(8.21±0.15)mm,且全部有眩光幻影,其中轻度13例(28.6%),中度19例(43%),重度12例(27.4%),并且眩光幻影仅与失焦呈正相关(r=0.473,P<0.05),与其余各项指标不相关。结论眩光幻影程度与失焦像差呈正相关,主要与瞳孔散大时ICL晶体光学区外未矫正区域的屈光不正有关。

人眼眩光发生机制及测量方法的研究进展

人眼眩光一般是指由于从外界进入眼内的迷乱光线抑制了正常光线在视网膜上的成像而形成的不舒适感觉。其在不同的领域及专业中涵义均有所不同。尽管目前眩光测量方法众多，但尚无统一的评价标准。在临床及研究工作中需谨慎甄别不同眩光定义及测量方法对患者视觉质量评估造成的偏倚。由于眩光研究受到其复杂的发生机制和缺乏跨学科交流的影响，目前尚无一种方法能全面有效地防治眩光。本文通过回顾分析眩光在眼科、照明工程、神经学以及其他相关学科的出版物及研究报道，对临床上常见的眩光类型如失能眩光、幻影眩光、不舒适眩光和畏光的发生机制、测量手段和解决方法的研究现状进行综述。

人工晶状体植入术后闪光感异常的原因及处理

闪光感异常是超声乳化联合人工晶状体植人术后的常见并发症，包括正闪光感异常和负闪光感异常。正闪光感异常是指从外界进入眼内的光线在视网膜上形成的明亮干扰影像，以光亮、条纹为特征。本该参与正常视网膜成像的光线被人工晶状体方边折射后，在正常视网膜像的对应位置形成暗点、暗影等为负闪光感异常。后囊膜混浊，人工晶状体材料、边缘设计，人工晶状体光学部直径，手术切口位置，虹膜和人工晶状体光学部之间距离等都是闪光感异常产生的重要因素。随着人们生活质量的提高，闪光感异常已成为影响人工晶状体植入术后患者视觉质量的重要并发症。本文就闪光感异常的产生原因、影响因素及其处理等方面的研究现状进行综述。

0.2%酒石酸溴莫尼定对连续视程人工晶体植入术后伴有光学干扰患者夜间视觉质量的影响

目的 通过连续视程人工晶体(EDOF IOL)植入术后伴有光学干扰的患者应用0.2%酒石酸溴莫尼定滴眼液,观察患者瞳孔大小、视力和视觉质量的变化,探讨0.2%酒石酸溴莫尼定滴眼液对EDOF IOL植入术后视觉质量的影响。方法 选取行白内障超声乳化联合EDOF IOL植入术后伴有光学干扰的年龄相关性白内障患者21例(21只眼),EDOF IOL植入术后患者1个月复查时,术眼应用0.2%酒石酸溴莫尼定滴眼液,分别于给药前、给药后2 h、给药后4 h,中间视觉条件下应用OPD-ScanⅢ视觉质量分析仪测量EDOF IOL植入眼的客观视觉质量,包括斯特列尔比(SR)、高阶像差(HOA)、球差(SA)、彗差及三叶草像差等。分别于给药前、给药后2 h、给药后4 h,测量眼压(IOP),测量中间视觉条件下的瞳孔直径。在主观视觉质量方面测量术眼远视力(UDVA)及最佳矫正远视力(CDVA)。利用视功能指数量表(VF-14)对患者进行问卷调查。结果 应用0.2%酒石酸溴莫尼定滴眼液后,术眼客观视觉质量如:SR、HOA、SA及Trefoil得到明显改善,分别在用药后2 h达到最佳值,与给药前相比,差异均具有统计学意义(P<0.05)。效果可以持续到用药后4 h。而Coma无明显改善,差异不具有统计学意义(P=0.570)。应用0.2%酒石酸溴莫尼定滴眼液后,术眼IOP降低,给药后2 h、给药后4 h与给药前IOP比较,差异具有统计学意义(P<0.001)。中间视觉瞳孔直径在给药后开始缩小,并在2 h达到最低值,给药后2 h、给药后4 h与给药前比较,差异具有统计学意义(P<0.001)。应用0.2%酒石酸溴莫尼定滴眼液后,UDVA及CDVA,差异无统计学意义(P=0.051,P=0.063)。问卷调查显示,应用0.2%酒石酸溴莫尼定滴眼液后,67%的患者眩光或光晕的症状消失,24%的患者症状得到缓解,9%的患者症状没有得到改善。结论 EDOF IOL植入术后应用0.2%酒石酸溴莫尼定滴眼液可以抑制术眼夜间瞳孔散大,降低术眼HOA、SA和Trefoil,提高术眼SR,减轻患者眩光或光晕等症状,改善夜间视觉质量。