目的 系统评价折射型多焦点人工晶状体(MIOL)与衍射型MIOL的临床应用效果.方法 采用Cochrane系统评价方法,计算机检索Central、Medline、EMbase、中国生物医学文献数据库、中国期刊全文数据库,手工检索相关会议文献,纳入所有折射型MIOL与衍射型MIOL对照的超声乳化白内障吸除联合IOL植入的随机对照试验文献.由两名评价员分别提取资料,评价方法学质量后,采用RevMan5.2软件进行Meta分析.结果 共纳入11个随机对照试验(1 460只眼).根据不同型号折射型与衍射型MIOL的比较进行亚组分析.结果显示:(1)裸眼远视力:折射型MIOL组与衍射型MIOL组间差异有统计学意义[标准化均数差(WMD)=-0.04,95％ CI为(-0.06,-0.03),P＜0.0l].(2)裸眼中距视力:折射型MIOL组与衍射型MIOL组间差异有统计学意义[WMD=-0.05,95％ CI为(-0.09,-0.02),P=0.001].(3)裸眼近视力:折射型MIOL组与衍射型MIOL组间差异有统计学意义[WMD =0.11,95％CI为(0.08,0.15),P＜0.01].(4)最佳矫正远视力:折射型MIOL组与衍射型MIOL组间差异无统计学意义[WMD=-0.01,95％ CI为(-0.03,0.01),P=0.45].(5)最佳矫正远视下的中距视力:折射型MIOL组与衍射型MIOL组间差异无统计学意义[WMD=-0.06,95％ CI为(-0.15,0.03),P=0.18].(6)最佳矫正远视下的近视力:折射型MIOL组与衍射型MIOL组间差异无统计学意义[WMD=0.08,95％ CI为(-0.01,0.17),P=0.09].(7)最佳矫正近视力:折射型MIOL组与衍射型MIOL组间差异无统计学意义[WMD=-0.02,95％ CI为(-0.26,0.23),P=0.88].(8)脱镜率:折射型MIOL组与衍射型MIOL组间差异有统计学意义[WMD=2.98,95％ CI为(2.17,4.09),P＜0.01].(9)光晕发生率:折射型MIOL组与衍射型MIOL组间差异有统计学意义[WMD=1.52,95％ CI为(1.14,2.04),P=0.004].(10)眩光发生率:折射型MIOL组与衍射型MIOL组间差异有统计学意义[WMD=1.27,95％ CI为(1.07,1.50),P=0.005].结论 折射型MIOL可以提供更优质的裸眼远距及中距视力;衍射型MIOL表现出更好的裸眼近视力,出现光晕、眩光等视觉不良反应的可能性更小;在戴镜矫正状况下,衍射型MIOL与折射型MIOL的远、中、近视力表现相同.%Objective To systematic review the effectiveness of refractive multifocal intraocular lens (MIOL) versus diffractive MIOL in the treatment of cataract.Method Randomized controlled trials comparing refractive MIOL with diffractive MIOL were identified by searching PubMed (1966 to May,2013),EMbase (1980 to May,2013),Medline (1966 to May,2013),and The Cochrane Library (Issue 1,2013).We also hand-searched related journals.All the searches were restricted in English or Chinese.Methodological quality of randomized controlled trials (RCT) was evaluated by simple evaluate method that recommended by the Cochrane Collaboration.Data extracted by two reviewers with designed extraction form.RevMan software (release 5.2) was used for data management and analysis.Results A total of 11 trials (1460 eyes) were included for systematic review.Subgroup analyses were used according to different model comparison of MIOL.The results showed a significant difference in the mean of the uncorrected distance visual acuity (UCDVA) and the uncorrected intermediate visual acuity (UCIVA) in the refractive MIOLgroup with WMD-0.04,95％ CI-0.06 to-0.03 (P ＜0.01) and WMD-0.05,95％ CI-0.09 to-0.02 (P =0.001).It showed a significantly difference in the mean of the uncorrected near visual acuity (UCNVA),complete spectacle independent rate,halo rate and glare rate in the diffractive MIOL group with WMD 0.11,95％ CI 0.08 to0.15 (P＜0.01),WMD2.98,95％CI2.17 to4.09 (P＜0.01),WMD 1.52,95％ CI 1.14 to 2.04 (P =0.004) and WMD 1.27,95％ CI 1.07 to 1.50 (P =0.005).There was no significant difference between the two groups in the mean of the best corrected distance visual acuity (BCDVA),the best distance corrected intermediate visual acuity (BDCIVA),the best distance corrected near visual acuity (BDCNVA) and the best corrected near visual acuity (BCNVA) with WMD-0.01,95％CI-0.03 to0.01 (P=0.45),WMD-0.06,95％CI-0.15 to 0.03 (P=0.18),WMD 0.08,95％CI-0.01 to 0.17 (P =0.09) and WMD-0.02,95％CI-0.26 to 0.23 (P=0.88).Conclusions Patients implanted with refractive MIOL show better uncorrected distance and intermediate visual acuity; patients implanted with diffractive MIOL show better uncorrected near visual acuity with less likely to appear light halo,glare and other visual adverse reactions.As for spectacles correction cases,patients implanted with diffractive or refractive MIOL have considerable performances in the far,middle,near visual acuity.
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