两种常用衍射型多焦点人工晶状体的视觉评估
량충상용연사형다초점인공정상체적시각평고
Estimation of visual performance of two diffractive multifocal intraocular lenses
  • 万方数据
    中华眼科杂志 중화안과잡지
    Chinese Journal of Ophthalmology
    2010年 8期 679-685 ,共7页

    季樱红%卢奕%汪琳%蒋永祥

    계앵홍%로혁%왕림%장영상

    晶体,人工%像差%对比敏感度%屈光,眼 晶體,人工%像差%對比敏感度%屈光,眼
    정체,인공%상차%대비민감도%굴광,안
    Lenses,intraocular%Aberration%Contrast sensitivity%Refraction,ocular
    目的 比较Tecnis和Restor两种衍射型多焦点人工晶状体(IOL)(简称TMF和Restor)植入术后患者的视觉质量.方法 前瞻性病例系列研究.将2008年3月至8月行超声乳化白内障吸除联合衍射型IOL植入的73例(90只眼)白内障患者采用SPSS Syntax程序随机分为两组,各45只眼,分别植入TMF和Restor,术后3个月时随访患眼的屈光状态、裸眼视力和矫正的远、中、近视力;不同对比度视力;阅读能力;瞳孔大小、像差、球差及对比敏感度;离焦曲线及IOL位置的测定等;进行生活质量调查问卷,并针对整体视觉、脱镜率和光晕眩光等进行评价.对分类变量资料进行x2检验,对计量资料进行非参数Mann-Whitney U检验.结果 TMF和Restor两种IOL远、中、近和不同对比度视力比较,其中裸眼和矫正远视力(Z=-1.006,P=0.315和Z=-0.685,P=0.493);裸眼和远矫正中间距离(60 cm)视力(Z=-0.294,P=0.768和Z=-0.365,P=0.715);裸眼、远矫正和最佳矫正近视力(Z=-1.285,P=0.199;Z=-0.881,P=0.378和Z=-0.142,P=0.887);60%、50%、45%、40%、30%和20%不同对比度视力(Z=-0.335,P=0.737,Z=-0.189,P=0.850,Z=-0.575,P=0.565,Z=-0.394,P=0.693,Z=-1.126,P=0.260和Z=-0.418,P=0.676)差异均无统计学意义.在暗光下,TMF的阅读视力和阅读速度都优于Restor(Z=-2.579,P=0.009;Z=-5.244,P=0.000).焦深曲线提示TMF的50 cm中间距离视力优于Restor(Z=-5.300,P=0.000),而Restor的25cm和28 cm近视力优于TMF(Z=-3.745,P=0.000;Z=-5.691,P=0.000).瞳孔3 mm和5 mm时,TMF的全眼和眼内Z(4,0)明显低于Restor(Z=-8.175,P=0.000;Z=-5.210,P=0.000和Z=-4.453,P=0.000;Z=-3.790,P=0.000),而视觉质量评价的一些指标如点扩散函数Strehl比PSF Strehl Ratio值和调制转移函数面积比A/D值优于Restor(Z=-3.047,P=0.002;Z=-3.672,P=0.008和Z=-2.038,P=0.042;Z=-2.579,P=0.009).生活质量调查问卷分别将两种IOL的总体满意度评分、脱镜率、光晕和眩光的发生率进行了比较,其中远、中、近距离和夜间满意度(Z=-1.282,P=0.200,Z=-1.769,P=0.077和Z=-1.287,P=0.198和Z=-1.512,P=0.131);脱镜率(x2=0.104,P=0.748);光晕(x2=0.741,P=0.389)和眩光(x2=0.051,P=0.822)差异均无统计学意义.结论 两种衍射型多焦点IOL均可提高远、近视力.焦深曲线提示Restor的近视力优于TMF,而在阅读速度和中距离视力方面TMF优于Restor.负球差设计的TMF的部分视觉质量指标优于球面型Restor.
    목적 비교Tecnis화Restor량충연사형다초점인공정상체(IOL)(간칭TMF화Restor)식입술후환자적시각질량.방법 전첨성병례계렬연구.장2008년3월지8월행초성유화백내장흡제연합연사형IOL식입적73례(90지안)백내장환자채용SPSS Syntax정서수궤분위량조,각45지안,분별식입TMF화Restor,술후3개월시수방환안적굴광상태、라안시력화교정적원、중、근시력;불동대비도시력;열독능력;동공대소、상차、구차급대비민감도;리초곡선급IOL위치적측정등;진행생활질량조사문권,병침대정체시각、탈경솔화광훈현광등진행평개.대분류변량자료진행x2검험,대계량자료진행비삼수Mann-Whitney U검험.결과 TMF화Restor량충IOL원、중、근화불동대비도시력비교,기중라안화교정원시력(Z=-1.006,P=0.315화Z=-0.685,P=0.493);라안화원교정중간거리(60 cm)시력(Z=-0.294,P=0.768화Z=-0.365,P=0.715);라안、원교정화최가교정근시력(Z=-1.285,P=0.199;Z=-0.881,P=0.378화Z=-0.142,P=0.887);60%、50%、45%、40%、30%화20%불동대비도시력(Z=-0.335,P=0.737,Z=-0.189,P=0.850,Z=-0.575,P=0.565,Z=-0.394,P=0.693,Z=-1.126,P=0.260화Z=-0.418,P=0.676)차이균무통계학의의.재암광하,TMF적열독시력화열독속도도우우Restor(Z=-2.579,P=0.009;Z=-5.244,P=0.000).초심곡선제시TMF적50 cm중간거리시력우우Restor(Z=-5.300,P=0.000),이Restor적25cm화28 cm근시력우우TMF(Z=-3.745,P=0.000;Z=-5.691,P=0.000).동공3 mm화5 mm시,TMF적전안화안내Z(4,0)명현저우Restor(Z=-8.175,P=0.000;Z=-5.210,P=0.000화Z=-4.453,P=0.000;Z=-3.790,P=0.000),이시각질량평개적일사지표여점확산함수Strehl비PSF Strehl Ratio치화조제전이함수면적비A/D치우우Restor(Z=-3.047,P=0.002;Z=-3.672,P=0.008화Z=-2.038,P=0.042;Z=-2.579,P=0.009).생활질량조사문권분별장량충IOL적총체만의도평분、탈경솔、광훈화현광적발생솔진행료비교,기중원、중、근거리화야간만의도(Z=-1.282,P=0.200,Z=-1.769,P=0.077화Z=-1.287,P=0.198화Z=-1.512,P=0.131);탈경솔(x2=0.104,P=0.748);광훈(x2=0.741,P=0.389)화현광(x2=0.051,P=0.822)차이균무통계학의의.결론 량충연사형다초점IOL균가제고원、근시력.초심곡선제시Restor적근시력우우TMF,이재열독속도화중거리시력방면TMF우우Restor.부구차설계적TMF적부분시각질량지표우우구면형Restor.
    Objective To evaluate the visual performance after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) ( TMF) and the Restor SA60D3 multifocal IOL (Restor). Methods In a prospective study, TMF or Restor was implanted randomly in 73 patients (90 eyes) . The following parameters were assessed 3 months after surgery: refraction, uncorrected and best corrected visual acuities (VA) for distance, intermediate, near and different contrast levels, reading ability, pupil size, wave-front error, defocus curve and position of IOL Patient satisfaction (overall satisfaction, spectacle independence, photic phenomena) was assessed by a questionnaire. The chi-square test was applied to compare categorical variables and Mann-Whitney U test was used to compare the measured data. Results The uncorrected, best corrected and/or distance-corrected VA for distance, intermediate, near and different contrast levels did not show statistically significant differences between the two groups (P > 0. 05 ). Near reading acuity and reading speed were better in TMF under low-light conditions (Z= -2.579, P=0.009; Z = -5.244, P=0.000). The curve of defocus showed that TMF had significantly better intermediate distance (at 50 cm) (Z = -5.300, P = 0.000) and worse near distance (from 25 to 28 cm) than those of Restor (Z= -3.745, P = 0. 000; Z= -5. 691, P=0. 000). Measurements under pupil diameter at 3. 0 mm and 5. 0 mm, ocular and intraocularZ (4, 0) were significantly lower (Z = -8.175, P = 0.000; Z= -5.210, P=0.000andZ = -4.453, P=0.000; Z= -3.790, P = 0.000) , the values of PSF Strehl Ratio and MTF AreaRatio A/D were significantly higher (Z = - 3. 047, P = 0. 002; Z = - 3. 672, P = 0. 008 and Z = - 2. 038, P = 0.042; Z = -2.579, P =0.009) in TMF than those in Restor. On the questionnaire, there was no difference of overall satisfaction, spectacle independence and photic phenomena (P > 0.05 ). Conclusions Implantation of the TMF and Restor offers excellent distant and near VA. Restor had better near VA than that of TMF based on the curve of depth, TMF had better VA at 50 cm-distance. Reading speed is faster in TMF. Compared to spherical Restor, TMF provides a better quality of vision due to a negative spherical aberration.
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