阶梯渐进衍射型非球面多焦点人工晶状体植入术后的视觉质量研究

摘要

目的 观察阶梯渐进衍射型非球面多焦点人工晶状体(AcrySof ReSTOR SN6AD1和SN6AD3)植入术后的视觉质量.方法 前瞻性病例系列研究.连续选取2009年6月至2010年4月于中山眼科中心收治的60例年龄相关性白内障患者,男29例,女31例,年龄为50～79岁.所有患者均行超声乳化白内障摘除联合人工晶状体植入术.按照植入人工晶状体的不同分为三组:SN6AD1多焦点人工晶状体组(20例,40眼),SN6AD3多焦点人工晶状体组(20例,40眼)及SN60WF单焦点人工晶状体组(20例,40眼).术后3个月,观察患者裸眼近视力、高低对比度裸眼中视力、裸眼远视力、裸眼汉字近视力、对比敏感度、最适阅读距离及阅读速度.对相关数据进行one-way ANOVA检验、Bonferroni比较、秩和检验或t检验.结果 裸眼近视力:SN6AD1组及SN6AD3组分别为(0.074±0.862)logMAR和(0.075±0.772)logMAR,明显优于SN60WF组[(0.351±0.691)logMAR],差异有统计学意义(Z=-6.756,P=0.000;Z=-6.508,P=0.000).裸眼中视力:40 cm距离处的高、低对比度裸眼中视力比较,三组之间差异有统计学意义(x2=29.085,P=0.000;F=9.672,P=0.000);63 cm处的高、低对比度裸眼中视力比较,三组之间差异有统计学意义(x2=14.869,P=0.001;x2=8.018,P=0.018);而100 cm处高、低对比度裸眼视力比较,三组间差异均无统计学意义(F=1.917,P=0.152;X2=5.408,P=0.067).裸眼远视力:三组之间差异无统计学意义(x2=1.555,P=0.460).裸眼汉字近视力:除少笔画低对比度情况外,SN6AD1组与SN6AD3组单、双眼的高、低对比度汉字近视力均优于SN60WF组,差异有统计学意义(P均＜0.05).对比敏感度:在明光、暗光、明光眩光、暗光眩光时,SN6AD1组与SN6AD3组中低空间频率对比敏感度稍低于SN60WF组,差异有统计学意义(P均＜0.05).最适阅读距离和阅读速度:SN6AD1组、SN6AD3组和SN60WF组的最适阅读距离分别为(38.5±3.1)、(32.8±3.9)、(47.6±4.7)cm;阅读速度分别为(173.7±58.1)、(179.3±23.6)和(106.9±31.0)字/分,SN6AD1组和SN6AD3组均较SN60WF组快,差异有统计学意义(Z=-3.423,P=0.001;Z=-4.522,P=0.000).结论 SN6AD1和SN6AD3多焦点人工晶状体可以提供较SN60WF单焦点人工晶状体更好的近视力、40 cm及63 cm高低对比度裸眼中视力,以及更舒适的阅读距离和更快的阅读速度.SN6AD1人工晶状体能提供较SN6AD3更优秀的40 cm及63 cm高低对比度中视力.%Objective To evaluate visual performance after bilateral implantation with either the AcrySof ReSTOR SN6AD1 multifocal intraocular lens (MIOL) or the AcrySof ReSTOR SN6AD3 MIOL. Methods This was a prospective case series study. Sixty age-related cataract patients (120eyes) at the Zhongshan Ophthalmic Center from June 2009 to April 2010 were enrolled in this study.Based on the principal of voluntary choice, phacoemulsification combined with IOL implantation was performed. There were 20 patients (40 eyes) in each group, the SN6AD1 MIOL group, SN6AD3MIOL group and SN60WF group. There were 8 male patients and 12 female patients (8/12) in the SN6AD1 group, and 10/10 and 11/9 in the SN6AD3 and SN60WF groups, respectively. The average ages in years were 64.6±12.7, 67.5±8.5, and 61.1±11.0, respectively. Uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA) under high and low contrast conditions,uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity for Chinese characters under high and low contrasts, contrast sensitivity, preferred reading distance and reading speeds were assessed 3 months postoperatively. A one-way ANOVA, Bonferroni, rank-sum test or independent samples t test was used to analyze the data. Results UCNVA was (0.074±0.862)logMAR for the SN6AD1 group and was (0.075±0.772)logMAR for the SN6AD3 group, which was significantly better than the (0.351±0.691)logMAR for the SN60WF group (Z=-6.756, P=0.000; Z=-6.508, P=0.000).Significant differences were found for UCIVA at 40 cm under either high or low contrast conditions when the 3 groups were compared (high contrast: x2=29.085, P=0.000; low contrast: F=9.672, P=0.000). UCIVA was also significantly different at 63 cm under either high or low contrast conditions when the 3 groups were compared (high contrast: x2=14.869, P=0.001; low contrast: x2=8.018, P=0.018). There were no significant differences in UCDVA among the 3 groups (x2=1.555, P=0.460).Monocular and binocular uncorrected near vision for Chinese characters was significantly better for the SN6AD1 and SN6AD3 groups than for the SN60WF group, but there were no significant differences for Chinese characters with fewer strokes viewed under low contrast conditions (P＞0.05). Compared to the SN60WF group, contrast sensitivity under intermediate or low spatial frequencies was lower for both the SN6AD1 and SN6AD3 groups (P＜0.05). The preferred reading distances were (38.5±3.1)cm,(32.8±3.9)cm, and (47.6±4.7)cm, respectively. Reading speeds of the SN6AD1 and SN6AD3 groups were faster than that of the SN60WF group(P＜0.05). Conclusion UCNVA and UCIVA at 40 cm and 63 cm, preferred reading distance and reading speed are better for the SN6AD1 and SN6AD3MIOL SN6AD1 MIOL provide better UCIVA at 40 cm and 63 cm under high and low contrast conditions than SN6AD3 MIOL.