折射型与衍射型多焦点人工晶状体临床应用效果随机临床对照试验的Meta分析
절사형여연사형다초점인공정상체림상응용효과수궤림상대조시험적Meta분석
Meta-analysis of clinical randomized controlled trials comparing refractive with diffractive multifocal intraocular lenses in cataract surgery
  • 万方数据
    中华眼科杂志 중화안과잡지
    Chinese Journal of Ophthalmology
    2014年 2期 109-120 ,共12页

    邵德望%何守志

    소덕망%하수지

    晶体,人工%屈光,眼%光学%随机对照试验%Meta分析 晶體,人工%屈光,眼%光學%隨機對照試驗%Meta分析
    정체,인공%굴광,안%광학%수궤대조시험%Meta분석
    Lenses,intraocular%Refraction,ocular%Optics%Randomized controlled trial%Meta-analysis
    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.
    목적 계통평개절사형다초점인공정상체(MIOL)여연사형MIOL적림상응용효과.방법 채용Cochrane계통평개방법,계산궤검색Central、Medline、EMbase、중국생물의학문헌수거고、중국기간전문수거고,수공검색상관회의문헌,납입소유절사형MIOL여연사형MIOL대조적초성유화백내장흡제연합IOL식입적수궤대조시험문헌.유량명평개원분별제취자료,평개방법학질량후,채용RevMan5.2연건진행Meta분석.결과 공납입11개수궤대조시험(1 460지안).근거불동형호절사형여연사형MIOL적비교진행아조분석.결과현시:(1)라안원시력:절사형MIOL조여연사형MIOL조간차이유통계학의의[표준화균수차(WMD)=-0.04,95％ CI위(-0.06,-0.03),P＜0.0l].(2)라안중거시력:절사형MIOL조여연사형MIOL조간차이유통계학의의[WMD=-0.05,95％ CI위(-0.09,-0.02),P=0.001].(3)라안근시력:절사형MIOL조여연사형MIOL조간차이유통계학의의[WMD =0.11,95％CI위(0.08,0.15),P＜0.01].(4)최가교정원시력:절사형MIOL조여연사형MIOL조간차이무통계학의의[WMD=-0.01,95％ CI위(-0.03,0.01),P=0.45].(5)최가교정원시하적중거시력:절사형MIOL조여연사형MIOL조간차이무통계학의의[WMD=-0.06,95％ CI위(-0.15,0.03),P=0.18].(6)최가교정원시하적근시력:절사형MIOL조여연사형MIOL조간차이무통계학의의[WMD=0.08,95％ CI위(-0.01,0.17),P=0.09].(7)최가교정근시력:절사형MIOL조여연사형MIOL조간차이무통계학의의[WMD=-0.02,95％ CI위(-0.26,0.23),P=0.88].(8)탈경솔:절사형MIOL조여연사형MIOL조간차이유통계학의의[WMD=2.98,95％ CI위(2.17,4.09),P＜0.01].(9)광훈발생솔:절사형MIOL조여연사형MIOL조간차이유통계학의의[WMD=1.52,95％ CI위(1.14,2.04),P=0.004].(10)현광발생솔:절사형MIOL조여연사형MIOL조간차이유통계학의의[WMD=1.27,95％ CI위(1.07,1.50),P=0.005].결론 절사형MIOL가이제공경우질적라안원거급중거시력;연사형MIOL표현출경호적라안근시력,출현광훈、현광등시각불량반응적가능성경소;재대경교정상황하,연사형MIOL여절사형MIOL적원、중、근시력표현상동.
    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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