CAJ | 학술논문

目的评价多焦点非球面阶梯渐进衍射型人工晶状体(IOL)植入术后患者的视觉质量.方法前瞻性非随机对照研究.2008年1月到2009年1月于首都医科大学附属北京同仁眼科中心诊断为双眼白内障的患者50例(100只眼)分别植入单焦点非球面AcrySof IQ(SN60WF)或多焦点非球面AcrySof IQ ReSTOR(SN6AD3)IOL.记录两组患者手术前后裸眼远、近及中间距离视力,矫正远、近距离视力.术后6个月,检测患者明视和暗视、有或无眩光状态的对比敏感度并在正常瞳孔下检测波阵面相差.视功能和生存质量调查问卷评价患者主观的视觉功能.术前、术后及组间计量资料采用配对样本t检验.计数资料采用x2检验.结果术后两组裸眼远视力(t=1.018,P=0.265),最佳矫正近视力(t=0.679,P=0.501),等效球镜度数(t=0.233,P=0.876)差异无统计学意义,最佳矫正远视力单焦点组较好(t=2.388,P=0.021).裸眼近视力多焦点组明显优于单焦点组(t=11.311,P=0.000),未矫正中间距离视力多焦点组则低于单焦点组(t=2.414,P=0.020).术后,多焦点组较单焦点组的总像差(F=5.169,P=0.041),总低阶像差(F=4.973,P=0.036),总高阶像差高(F=4.640,P=0.048),两组间离焦(F=0.862,P=0.358)散光(F=3.893,P=0.052),彗差(F=2.724,P=0.105),球差(F=1.743,P=0.055),三叶草差(F=3.014,P=0.109)差异无统计学意义.两组术后最佳镜片矫正的远距离对比敏感度在暗视无眩光6 c/d频段差异有统计学意义(t=2.16,P=0.041).在暗视有眩光3 c/d(t=2.329,P=0.029)和6 c/d(t=2.087,P=0.048)频段差异有统计学意义.两组术后视远时脱镜率均大于96%.看近时多焦点组16%(4/25),单焦点组60%(15/25)戴镜.日常总戴镜频率单焦与多焦点组分别为64%(16/25)和24%(6/25).主要视觉干扰中复视、夜间视物困难和眩光多焦点组比例较高,近距视物模糊单焦点组较多.结论与单焦点IOL比较,多焦点IOL可提供更宽的焦距范围,因此患者裸眼近视力较好,阅读脱镜率较高,具有较好的视觉功能,但对比敏感度有所下降. 目的評價多焦點非毬麵階梯漸進衍射型人工晶狀體(IOL)植入術後患者的視覺質量.方法前瞻性非隨機對照研究.2008年1月到2009年1月于首都醫科大學附屬北京同仁眼科中心診斷為雙眼白內障的患者50例(100隻眼)分彆植入單焦點非毬麵AcrySof IQ(SN60WF)或多焦點非毬麵AcrySof IQ ReSTOR(SN6AD3)IOL.記錄兩組患者手術前後裸眼遠、近及中間距離視力,矯正遠、近距離視力.術後6箇月,檢測患者明視和暗視、有或無眩光狀態的對比敏感度併在正常瞳孔下檢測波陣麵相差.視功能和生存質量調查問捲評價患者主觀的視覺功能.術前、術後及組間計量資料採用配對樣本t檢驗.計數資料採用x2檢驗.結果術後兩組裸眼遠視力(t=1.018,P=0.265),最佳矯正近視力(t=0.679,P=0.501),等效毬鏡度數(t=0.233,P=0.876)差異無統計學意義,最佳矯正遠視力單焦點組較好(t=2.388,P=0.021).裸眼近視力多焦點組明顯優于單焦點組(t=11.311,P=0.000),未矯正中間距離視力多焦點組則低于單焦點組(t=2.414,P=0.020).術後,多焦點組較單焦點組的總像差(F=5.169,P=0.041),總低階像差(F=4.973,P=0.036),總高階像差高(F=4.640,P=0.048),兩組間離焦(F=0.862,P=0.358)散光(F=3.893,P=0.052),彗差(F=2.724,P=0.105),毬差(F=1.743,P=0.055),三葉草差(F=3.014,P=0.109)差異無統計學意義.兩組術後最佳鏡片矯正的遠距離對比敏感度在暗視無眩光6 c/d頻段差異有統計學意義(t=2.16,P=0.041).在暗視有眩光3 c/d(t=2.329,P=0.029)和6 c/d(t=2.087,P=0.048)頻段差異有統計學意義.兩組術後視遠時脫鏡率均大于96%.看近時多焦點組16%(4/25),單焦點組60%(15/25)戴鏡.日常總戴鏡頻率單焦與多焦點組分彆為64%(16/25)和24%(6/25).主要視覺榦擾中複視、夜間視物睏難和眩光多焦點組比例較高,近距視物模糊單焦點組較多.結論與單焦點IOL比較,多焦點IOL可提供更寬的焦距範圍,因此患者裸眼近視力較好,閱讀脫鏡率較高,具有較好的視覺功能,但對比敏感度有所下降.
목적 평개다초점비구면계제점진연사형인공정상체(IOL)식입술후환자적시각질량.방법 전첨성비수궤대조연구.2008년1월도2009년1월우수도의과대학부속북경동인안과중심진단위쌍안백내장적환자50례(100지안)분별식입단초점비구면AcrySof IQ(SN60WF)혹다초점비구면AcrySof IQ ReSTOR(SN6AD3)IOL.기록량조환자수술전후라안원、근급중간거리시력,교정원、근거리시력.술후6개월,검측환자명시화암시、유혹무현광상태적대비민감도병재정상동공하검측파진면상차.시공능화생존질량조사문권평개환자주관적시각공능.술전、술후급조간계량자료채용배대양본t검험.계수자료채용x2검험.결과 술후량조라안원시력(t=1.018,P=0.265),최가교정근시력(t=0.679,P=0.501),등효구경도수(t=0.233,P=0.876)차이무통계학의의,최가교정원시력단초점조교호(t=2.388,P=0.021).라안근시력다초점조명현우우단초점조(t=11.311,P=0.000),미교정중간거리시력다초점조칙저우단초점조(t=2.414,P=0.020).술후,다초점조교단초점조적총상차(F=5.169,P=0.041),총저계상차(F=4.973,P=0.036),총고계상차고(F=4.640,P=0.048),량조간리초(F=0.862,P=0.358)산광(F=3.893,P=0.052),혜차(F=2.724,P=0.105),구차(F=1.743,P=0.055),삼협초차(F=3.014,P=0.109)차이무통계학의의.량조술후최가경편교정적원거리대비민감도재암시무현광6 c/d빈단차이유통계학의의(t=2.16,P=0.041).재암시유현광3 c/d(t=2.329,P=0.029)화6 c/d(t=2.087,P=0.048)빈단차이유통계학의의.량조술후시원시탈경솔균대우96%.간근시다초점조16%(4/25),단초점조60%(15/25)대경.일상총대경빈솔단초여다초점조분별위64%(16/25)화24%(6/25).주요시각간우중복시、야간시물곤난화현광다초점조비례교고,근거시물모호단초점조교다.결론 여단초점IOL비교,다초점IOL가제공경관적초거범위,인차환자라안근시력교호,열독탈경솔교고,구유교호적시각공능,단대비민감도유소하강.
Objective To evaluate the visual quality in patients implanted with aspheric diffractive multifocal intraocular lens. Methods Prospective nonrandomized controlled study. One hundred cataract eyes in 50 patients were included. Patients received AcrySof IQ ReSTOR IOL (SN6AD3) or AcrySof IQ IOL (SN60WF) implantation. The follow up period was 6 months. The mean of unconnected distance visual acuity ( UCDVA) , best corrected distance visual acuity ( BCDVA), unconnected near visual acuity (UCNVA), best distance-corrected near visual acuity (BCNVA) and intermediate unconrrected visual acuity in patients with SN6AD3 and SN60WF was compared preoperatively and postoperatively in all patients. Photopic and mesopic contrast sensitivity function with and without glare were tested at 6 months after operation. Aberrations were recorded postoperatively. Subjective outcomes were assessed by VF-14 questionnaire. The chi-square test was applied to compare categorical variables and the paired-samples t test was used to compare the measure data. Results Postoperatively, there were no significant differences between groups in spherical equivalent (SE) (t=0.233, P = 0.876), UCDVA (t = 1.018, P=0.265) or BCNVA (t = 0. 679, P = 0. 501). The BCDVA in the monofocal IOL group was better than that in the multifocal IOL group (t = 2. 388, P = 0. 021). UCNVA improved remarkably after the implantation of multifocal IOL (t = 11. 311 ,P =0.000). The intermediate UCVA in the monofocal IOL eyes was butter than that in the multifocal IOL at 60 cm(t =2.414,P=0.020). The total aberration (F = 5. 169,P =0. 041), total low grade (F =4.973,P =0.036) and total high grade total aberrations (F =4.640,P = 0.048) were higher in the multifocal IOL group. There was no difference between these two groups in the defocus ( F = 0.862, P=0.358), astigmatism(F=3.893, P=0.052), spherical aberration(F = 1.743, P=0.055), coma(F＝2. 724, P = 0. 105) and trefoil ( F = 3. 014, P = 0. 109). Contrast sensitivity in eyes with multifocal IOL was lower than that in eyes with monofocal IOL, especially under mesopic conditions without glare at 6 c/d (t =2.16,P=0.041) at 3 c/d (t =2.329,P=0.029) and 6 c/d under mesopic conditions with glare (t = 2.087, P =0.048). Most patients were satisfied with their IOL implantation. Percentage of patients wearing spectacle for distance vision were less than 4% in all groups. Percentage in patients wearing spectacle for near vision in SN60WF and SN6AD3 groups was 60% and 16% , respectively. Percentage of overall spectacle wear was 64% and 24% in patients wearing SN60WF and SN6AD3, respectively. On the questionnaire, patients in multifocal IOL group complained with double vision, trouble in night vision and halo; while patients in monofocal IOL group noted more about near blur. Conclusion Compared with monofocal lenses, multifocal IOL provide greater depth of focus so that better near vision, higher percentage of spectacle independence and satisfactory visual function, are obtained but the contrast sensitivity decreases slightly.