双眼植入不同类型多焦点人工晶状体术后视功能的临床观察

摘要

Objective To evaluate the visual quality after combined implantation of refractive and diffractive multifocal intraocular lenses (IOL) in both eyes.Methods Prospective,nonrandomized study.Age-related cataract patients were divided into multifocal IOL group (MIOL group) and monofocal IOL group (SIOL group) and received phacoemulsification.In MIOL group,a ReZoom NXG1 IOL and a Tecnis Z M900 IOL were implanted into the dominant eye and the fellow eye,respectively.In SIOL group,Sensar AR40e IOLs were implanted into both eyes.Monocular or binocular test was performed one month after surgery,including wavefront aberration,contrast sensitivity with or without glare and near stereoacuity.Results The root mean square of spherical aberration at pupil diameter of 5 mm was 0.058±0.159 μm in NXG1 eyes and 0.005±0.169 μm in ZM900 eyes,both of them were significantly lower than 0.408±0.160 μm achieved in AR40e eyes (F=11.734;P=0.001,0.000).There was no significant difference in the total ocular aberration,contrast sensitivity and high-order aberration among eyes with these different IOLs.The uncorrected near stereoacuity in MIOL group was (45.60±35.04) seconds of arc,which was significantly better than (110.00±41.23) seconds of arc achieved in SIOL group (F=2.923;P=0.010).Conclusion Combined implantation of muhifocal ReZoom NXG1 IOL and Tecnis ZM900 IOL provides a good visual quality with reduced spherical aberration and satisfactory near stereoacuity.%目的 探讨超声乳化白内障吸除联合双眼分别植入折射型与衍射型多焦点人工晶状体(MIOL)术后的波前像差、对比敏感度(CS)及立体视功能.方法 前瞻性研究.将年龄相关性白内障患者分为MIOL组与单焦点人工晶状体(SIOL)组,每组各15例(30只眼),行超声乳化白内障吸除联合人工晶状体(IOL)植入术.MIOL组为主导眼植入ReZoom NXG1 IOL(即NXG1组),对侧眼植入Tecnis ZM900 IOL(即ZM900组);SIOL组为同期双眼植入Sensar AR40e IOL(即AR40e组).观察患者术后波前像差、CS、眩光敏感度(GS)及近立体视锐度.两组中波前像差和近立体视锐度比较分别采用单因素方差分析,CS和GS比较采用析因设计方差分析,两两比较采用ISD检验.结果 术后1个月观察发现,ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼的球差明显低于Sensar AR40e IOL眼的球差(F=11.734;P=0.001,0.000),三者之间的总体像差和高阶像差间的差异无统计学意义(F=0.724,0.173;P=0.493.0.842).ReZoom NXG1 IOL眼、Tecnis ZM900 IOL眼和Sensar R40e IOL眼在各视角的CS及CS比较,差异均无统计学意义(CS:F=0.959,0.978,2.779,0.590,0.485,0175;rnP=0.398,0.388,0.079,0.564,0.625,0.847;GS:F=0.117,0.479,0.806,1.235,0.531,1.144;P=0.902,0.627,0.458,0.309,0.597,0.383).MIOL组患者术后近立体视锐度可达45.6弧秒,与SIOL组比较差异有统计学意义(F=2.923;P=0.010,0.014).结论 双眼联合植入折射型与衍射型IOL,在一定程度上可以使患者获得良好的视功能.