目的分析双眼白内障摘出术联合TECNIS Symfony人工晶状体(IOL)植入矫正老视前采取不同预留屈光度设计对疗效及视觉质量的影响。
方法采用前瞻性队列研究设计，连续纳入2016年10月至2018年12月在重庆爱尔麦格眼科医院行双眼白内障摘除术联合TECNIS Symfony IOL植入的患者120例240眼，根据手术设计不同分为正视组、微近视组和微单视组，每组40例80眼。正视组双眼预留屈光度为＋0.10～－0.20 D，微近视组双眼预留为－0.20～－0.50 D，微单眼视组主视眼预留屈光度为＋0.10～－0.20 D，非主视眼预留－0.50～－0.75 D。术后3个月绘制各组单眼视和双眼视离焦曲线，分析其全程视力情况；用iTrace视功能分析仪检测其MTF值并进行组间比较；采用老视矫正型人工晶状体术后视功能调查问卷完成视功能量表分析，比较各组老视眼术后脱镜率及不良视觉现象的发生率。
结果与正视组比较，微近视组术后双眼视的离焦曲线整体右移0.35 D，形态无变化；而微单视组双眼视时离焦曲线形态波峰明显变宽，曲线下降趋势更平缓。3组术后在远视力功能区脱镜率均为100.00%，在中视力功能区微单视组脱镜率为100.00%，高于正视组的80.00%及微近视组的90.00%，差异有统计学意义( χ 2＝9.49， P＝0.01)；在近视力功能区微单视组脱镜率为90.00%，明显高于正视组的27.50%及微近视组的75.00%，差异有统计学意义( χ 2＝37.04； P<0.01)。微单视组主视眼MTF值高于非主视眼，差异有统计学意义( t＝3.74， P＝0.001)。各组患者不良视觉现象发生率比较差异无统计学意义( P>0.05)。
结论双眼白内障摘出术联合TECNIS symfony IOL植入矫正老视，不同的预留度数设计适用于不同的人群，其中采用微单眼视设计术后脱镜率最高，可以提供满意的双眼远、中、近全程视力。
ObjectiveTo compare the efficacy and visual quality of biocular cataract surgery combined with TECNIS Symfony intraocular lens(IOL) implantation in the correction of presbyopia with three different methods of reserved diopters.
MethodsA prospective cohort design was adopted.From October in 2016 to December in 2018, 120 patients 240 eyes with binocular cataract surgery implanted TECNIS Symfony IOL were divided into regular group, micro-near-vision group and micro-monovision group according to different reserved diopters, 40 patients 80 eyes in each group.The binocular IOL reserved diopter is + 0.10--0.20 D in regular group.The binocular IOL reserved diopter is -0.20--0.50 D in micro-near-vision group, meanwhile, the dominant eye reserved diopter is + 0.10--0.20 D, and the non-dominant eye reserved the myopia of -0.50--0.75 D in micro-monovision group.Defocus curves of single eye and binocular were measured and full distance visual acuity were analyzed 3 months after surgery.MTF values were detected by iTrace and compared between different groups.Visual function questionnaire of multifocal intraocular lenes (MIOLs)were analyzed and spectacle independence rate of presbyopia correction and disturbing photic phenomena were compared 3 months after surgery.This study protocol was approved by the ethics committee of Chongqing Aier Mega Eye Hospital, and this study followed the Declaration of Helsinki.
ResultsCompared with regular group, the whole defocus curve of micro-near-vision group actually shifted to the right by 0.35 D, with almost no change in shape.The shape of the binocular defocus curve of micro-monovision group changed significantly compared with that of regular group, that is the wave peak became significantly wider, and the downward trend was more gentle.Spectacle independence rate of the three groups were all 100.00%, spectacle independence rate of intermediate distance in Micro-monovision group was 100.00%, which was higher than that of regular group(80.00%) and micro-near-vision group(90.00%), and the differences were statistically significant ( χ 2=37.04; P<0.01). The MTF value of the dominant eye was higher than that of the non-dominant eye in the Micro-monovision group, and the difference was statistically significant( t=3.74, P=0.001). There was no statistically significant difference in the occurrence rate of disturbing photic phenomena among the three groups( P>0.05).
ConclusionsDifferent reserved diopter design during cataract extraction combined with TECNIS Symfony IOL implantation suits different patients.Among the three different reserved diopters methods, the effect of micro-monovision method can obtain the highest spectacle independence rate, and provide satisfactory binocular far to near full-distance visual acuity.
谭吉林,秦艳,王昌鹏,等. 白内障摘出术联合TECNIS Symfony人工晶状体植入不同预留度数设计对老视眼视觉质量的影响[J]. 中华实验眼科杂志,2019,37(10)：785-791.
DOI:10.3760/cma.j.issn.2095-0160.2019.10.004版权归中华医学会所有。
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