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临床研究散光矫正型与非散光矫正型多焦点人工晶状体植入术后视觉质量比较
蒋元丰
田芳
步绍翀
张红
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20200624-00449
Comparison of postoperative visual quality between toric and non-toric multifocal intraocular lens implantation
Jiang Yuanfeng
Tian Fang
Bu Shaochong
Zhang Hong
Authors Info & Affiliations
Jiang Yuanfeng
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Tian Fang
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Bu Shaochong
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
Zhang Hong
Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
·
DOI： 10.3760/cma.j.cn115989-20200624-00449
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摘要

目的评价超声乳化白内障摘出联合散光矫正型多焦点人工晶状体(ART IOL)植入术后的视觉质量，并与非散光矫正型多焦点IOL(ReSTOR IOL)进行比较。

方法采用队列研究方法，纳入2017年1月至2018年1月于天津医科大学眼科医院行超声乳化白内障摘出联合ART IOL植入术的患者39例50眼和联合ReSTOR IOL植入术的患者32例41眼，分别作为ART组和ReSTOR组。对比2个组患眼术后3个月时的裸眼远视力(UDVA)、裸眼中视力(UIVA)、裸眼近视力(UNVA)、最佳矫正远视力(CDVA)、显然验光、离焦曲线、对比敏感度(CS)、调制传递函数截止频率、二维斯特列尔比(SR)、客观散射指数、不同对比度下OQAS值(OV 100%、OV 20%、OV 9%)、总像差、总低阶像差、总高阶像差、球差、彗差和三叶草像差。

结果术后3个月，ART组和ReSTOR组的UDVA分别为(0.07±0.09)LogMAR和(0.09±0.12)LogMAR，CDVA分别为(-0.01±0.07)LogMAR和(-0.01±0.07)LogMAR，UIVA分别为(0.23±0.11)LogMAR和(0.22±0.13)LogMAR，UNVA分别为(0.11±0.15)LogMAR和(0.06±0.11)LogMAR。ReSTOR组的UNVA略优于ART组，差异有统计学意义( t＝2.085， P＝0.040)。ART组和ReSTOR组的平均焦点深度分别为(4.12±0.79)D和(4.24±0.95)D。ART组术后残余散光为(0.32±0.31)D，较术前角膜散光的(1.27±0.40)D显著降低，差异有统计学意义( t＝13.209， P<0.001)。ART组在明视6、12和18 c/d，明视眩光12和18 c/d，以及暗视3、6和12 c/d空间频率时的CS值略低于ReSTOR组，差异均有统计学意义(均 P<0.05)，但不具有临床意义。ART组的SR和OV 20%值分别为0.14±0.05和0.55±0.24，略低于ReSTOR组的0.17±0.06和0.66±0.29，差异均有统计学意义( t＝-2.012， P＝0.048； t＝-2.557， P＝0.043)。ART组在5 mm瞳孔直径下的总像差和彗差分别为0.88(0.59，1.13)μm和0.21(0.13，0.30)μm，高于ReSTOR组的0.58(0.47，0.74)μm和0.10(0.08，0.21)μm，差异均有统计学意义( Z＝-2.073， P＝0.038； Z＝-2.101， P＝0.036)。

结论超声乳化白内障摘出联合ART IOL植入可以在矫正术前角膜散光的同时为患者提供良好的全程视力和主客观视觉质量，但暗光下或中低空间频率的解析能力略弱于ReSTOR IOL植入眼。

白内障;超声乳化白内障摘出术;多焦点人工晶状体;Toric;视觉质量
ABSTRACT

ObjectiveTo evaluate and compare the postoperative visual quality after phacoemulsification combined with toric (ART) and non-toric (ReSTOR) multifocal intraocular lens (IOL) implantation.

MethodsA cohort study was conducted.Thirty-nine cataract patients (50 eyes) who underwent phacoemulsification combined with ART IOL implantation were enrolled as ART group, and 32 patients (41 eyes) who received ReSTOR IOL implantation were enrolled as ReSTOR group in Tianjin Medical University Eye Hospital from January 2017 to January 2018.Three months after surgery, the uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA), manifest refraction, defocus curve, contrast sensitivity (CS), modulation transfer function cutoff, Strehl2D ratio (SR), objective scattering index, OQAS values under 100%, 20%, 9% contrasts (OV 100%, OV 20%, OV 9%), total aberrations, total lower-order aberrations, total higher-order aberrations, spherical aberrations, coma and trefoil aberrations of the two groups were tested and compared.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-04). Written informed consent was obtained from each subject prior to entering the cohort.

ResultsUDVA at 3 months after surgery was (0.07±0.09)LogMAR and (0.09±0.12)LogMAR in ART group and ReSTOR group, and CDVA was (-0.01±0.07)LogMAR and (-0.01±0.07)LogMAR, and UIVA was (0.23±0.11)LogMAR and (0.22±0.13)LogMAR, and UNVA was (0.11±0.15)LogMAR and (0.06±0.11)LogMAR.UNVA was slightly better in ReSTOR group than ART group, and the difference was statistically significant ( t=2.085, P=0.040). The mean depth of focus was (4.12±0.79)D in ART group and (4.24±0.95)D in ReSTOR group.The postoperative residual astigmatism (0.32±0.31)D was significantly lower than preoperative corneal astigmatism (1.27±0.40)D in ART group ( t=13.209, P<0.001). CS values at 6, 12, and 18 c/d under photopic without glare, 12 and 18 c/d under photopic with glare, 3, 6, and 12 c/d under scotopic without glare in ART group were slightly lower than those in ReSTOR group, showing statistically significant differences (all at P<0.05) without clinical significance.SR and OV 20% values in ART group were 0.14±0.05 and 0.55±0.24, which were slightly lower than 0.17±0.06 and 0.66±0.29 in ReSTOR group, with statistically significant differences ( t=-2.012, P=0.048; t=-2.557, P=0.043). Total aberrations and coma aberration under 5 mm pupil diameter in ART group were 0.88(0.59, 1.13)μm and 0.21(0.13, 0.30)μm, which were higher than 0.58(0.47, 0.74)μm and 0.10(0.08, 0.21)μm in ReSTOR group, showing statistically significant differences ( Z=-2.073, P=0.038; Z=-2.101, P=0.036).

ConclusionsCataract phacoemulsification combined with ART IOL implantation can provide good vision and visual quality while correcting preoperative corneal astigmatism, and the resolution in dim light or low to medium spatial frequencies is slightly weaker than eyes implanted with ReSTOR IOL.

Cataract;Phacoemulsification;Multifocal intraocular lens;Toric;Visual quality
Zhang Hong, Email: mocdef.aabnisgnohceumt
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引用本文

蒋元丰,田芳,步绍翀,等. 临床研究散光矫正型与非散光矫正型多焦点人工晶状体植入术后视觉质量比较[J]. 中华实验眼科杂志,2022,40(05)：431-439.

DOI:10.3760/cma.j.cn115989-20200624-00449

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白内障是现阶段全球范围内首位致盲眼病 [ 1 ]。一方面，随着手术方式、技术设备和人工晶状体(intraocular lens，IOL)的不断进步和改良，现代白内障手术早已进入屈光性白内障手术时代。另一方面，随着我国中老年人群经济、健康和文化水平等综合素质的不断提高，其对白内障术后全程视力和视觉质量的要求也日益增高。虽然多焦点IOL(multifocal intraocular lens，MIOL)已被证实具有良好的术后效果和较高的满意度，但要求术者关注每个与术后视觉质量相关的手术规划细节，其中低阶像差中散光的管理尤为重要 [ 2 , 3 ]。角膜散光是白内障术后散光的主要来源，而合并1.00 D以上散光的患眼在白内障人群中约占1/3 [ 4 , 5 ]，散光矫正型MIOL(Toric MIOL)植入可使这部分患者实现完全脱镜 [ 6 , 7 ]。近年来，国外有关Toric MIOL的临床效果观察研究较多，而国内报道少见。本研究拟比较Toric MIOL与非散光矫正MIOL植入术后术眼视觉质量。
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参考文献
[1]
GBD 2019 Blindness and Vision Impairment Collaborators,Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years，and prevalence of avoidable blindness in relation to VISION 2020：the Right to Sight：an analysis for the Global Burden of Disease Study[J/OL]．Lancet Glob Health， 2021，9(2):e144-e160[2022-04-09]．http://www.ncbi.nlm.nih.gov/pubmed/33275949. DOI： 10.1016/S2214-109X(20)30489-7 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
中华医学会眼科学分会白内障及人工晶状体学组．中国多焦点人工晶状体临床应用专家共识(2019年)[J]．中华眼科杂志， 2019，55(7):491-494. DOI： 10.3760/cma.j.issn.0412-4081.2019.07.003 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
陈伟蓉．细节决定多焦点人工晶状体植入术后的视觉质量[J]．中华实验眼科杂志， 2013，31(4):313-315. DOI： 10.3760/cma.j.issn.2095-0160.2013.04.001 .
返回引文位置Google Scholar
百度学术
万方数据
Chen WR . Details matter in visual outcomes of multifocal intraocular lens implantation[J]．Chin J Exp Ophthalmol， 2013，31(4):313-315. DOI： 10.3760/cma.j.issn.2095-0160.2013.04.001 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[4]
Hoffmann PC , Hütz WW . Analysis of biometry and prevalence data for corneal astigmatism in 23，239 eyes[J]．J Cataract Refract Surg， 2010，36(9):1479-1485. DOI： 10.1016/j.jcrs.2010.02.025 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Hoffer KJ . Biometry of 7，500 cataractous eyes[J]．Am J Ophthalmol， 1980，90(3):360-368. DOI： 10.1016/s0002-9394(14)74917-7 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Visser N , Nuijts RM , de Vries NE ，et al. Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation[J]．J Cataract Refract Surg， 2011，37(11):2034-2042. DOI： 10.1016/j.jcrs.2011.05.041 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Khoramnia R , Auffarth G , abuz G ，et al. Refractive outcomes after cataract surgery[J/OL]．Diagnostics (Basel)， 2022，12(2):243[2022-04-06]．http://pubmed.ncbi.nlm.nih.gov/35204334. DOI： 10.3390/diagnostics12020243 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
ANSI Z80.12-American National Standards for Ophthalmics-Multifocal Intraocular Lenses[S]．New York：American National Standards Institute，Inc.， 2007∶1-34.
返回引文位置
[9]
International Organization for Standardization. Ophthalmic Implants-Intraocular Lenses-Part 9.Multifocal Intraocular Lenses[S]．Geneva：ISO， 2006∶1-20.
返回引文位置
[10]
Fletcher AE , Ellwein LB , Selvaraj S ，et al. Measurements of vision function and quality of life in patients with cataracts in southern India.Report of instrument development[J]．Arch Ophthalmol， 1997，115(6):767-774. DOI： 10.1001/archopht.1997.01100150769013 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Shah S , Peris-Martinez C , Reinhard T ，et al. Visual outcomes after cataract surgery：multifocal versus monofocal intraocular lenses[J]．J Refract Surg， 2015，31(10):658-666. DOI： 10.3928/1081597X-20150611-01 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Peng C , Zhao J , Ma L ，et al. Optical performance after bilateral implantation of apodized aspheric diffractive multifocal intraocular lenses with +3.00 D addition power[J/OL]．Acta Ophthalmol， 2012，90(8):e586-593[2021-09-05]．https://pubmed.ncbi.nlm.nih.gov/23194310/. DOI： 10.1111/j.1755-3768.2012.02497.x .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Jiang YF , Qin Y , Bu SC ，et al. Distribution and internal correlations of corneal astigmatism in cataract patients[J/OL]．Sci Rep， 2021，11(1):11514[2022-04-06]．http://pubmed.ncbi.nlm.nih.gov/34075156. DOI： 10.1038/s41598-021-91028-2 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Lehmann R , Modi S , Fisher B ，et al. Bilateral implantation of +3.0 D multifocal toric intraocular lenses：results of a US Food and Drug Administration clinical trial[J]．Clin Ophthalmol， 2017，11:1321-1331. DOI： 10.2147/OPTH.S137413 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Pepose JS , Qazi MA , Chu R ，et al. A prospective randomized clinical evaluation of 3 presbyopia-correcting intraocular lenses after cataract extraction[J]．Am J Ophthalmol， 2014，158(3):436-446. DOI： 10.1016/j.ajo.2014.06.003 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Sun Y , Zheng D , Song T ，et al. Visual function after bilateral implantation of apodized diffractive multifocal IOL with a +3.0 or +4.0 D addition[J]．Ophthalmic Surg Lasers Imaging， 2011，42(4):302-307. DOI： 10.3928/15428877-20110421-02 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Jonker SM , Bauer NJ , Makhotkina NY ，et al. Comparison of a trifocal intraocular lens with a +3.0 D bifocal IOL：results of a prospective randomized clinical trial[J]．J Cataract Refract Surg， 2015，41(8):1631-1640. DOI： 10.1016/j.jcrs.2015.08.011 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Alfonso JF , Knorz M , Fernandez-Vega L ，et al. Clinical outcomes after bilateral implantation of an apodized +3.0 D toric diffractive multifocal intraocular lens[J]．J Cataract Refract Surg， 2014，40(1):51-59. DOI： 10.1016/j.jcrs.2013.06.026 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Knorz MC , Rincón JL , Suarez E ，et al. Subjective outcomes after bilateral implantation of an apodized diffractive +3.0 D multifocal toric IOL in a prospective clinical study[J]．J Refract Surg， 2013，29(11):762-767. DOI： 10.3928/1081597X-20131021-06 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Pomerance GN , Evans DW . Test-retest reliability of the CSV-1000 contrast test and its relationship to glaucoma therapy[J]．Invest Ophthalmol Vis Sci， 1994，35(9):3357-3361.
返回引文位置Google Scholar
百度学术
万方数据
[21]
Montés-Micó R , España E , Bueno I ，et al. Visual performance with multifocal intraocular lenses：mesopic contrast sensitivity under distance and near conditions[J]．Ophthalmology， 2004，111(1):85-96. DOI： 10.1016/S0161-6420(03)00862-5 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
陈祥菲，侯培莉，陆燕，等．多焦点散光型与单焦点散光型人工晶状体植入术后视觉质量对比[J]．中华眼视光学与视觉科学杂志， 2015，17(8):474-479. DOI： 10.3760/cma.j.issn.1674-845X.2015.08.007 .
返回引文位置Google Scholar
百度学术
万方数据
Chen XF , Hou PL , Lu Y ，et al. Comparative analysis of visual quality after implantation of multifocal toric and monofocal toric intraocular lenses[J]．Chin J Optom Ophthalmol Vis Sci， 2015，17(8):474-479. DOI： 10.3760/cma.j.issn.1674-845X.2015.08.007 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[23]
Zhao G , Zhang J , Zhou Y ，et al. Visual function after monocular implantation of apodized diffractive multifocal or single-piece monofocal intraocular lens Randomized prospective comparison[J]．J Cataract Refract Surg， 2010，36(2):282-285. DOI： 10.1016/j.jcrs.2009.08.037 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
de Vries NE , Webers CA , Montés-Micó R ，et al. Visual outcomes after cataract surgery with implantation of a +3.00 D or +4.00 D aspheric diffractive multifocal intraocular lens：comparative study[J]．J Cataract Refract Surg， 2010，36(8):1316-1322. DOI： 10.1016/j.jcrs.2010.01.036 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Ouchi M , Kinoshita S ．AcrySof IQ toric IOL implantation combined with limbal relaxing incision during cataract surgery for eyes with astigmatism >2.50 D[J]．J Refract Surg， 2011，27(9):643-647. DOI： 10.3928/1081597X-20110317-03 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Zheng GY , Du J , Zhang JS ，et al. Contrast sensitivity and higher-order aberrations in patients with astigmatism[J]．Chin Med J (Engl)， 2007，120(10):882-885.
返回引文位置Google Scholar
百度学术
万方数据
[27]
Qin VL , Conti FF , Singh RP . Measuring outcomes in cataract surgery[J]．Curr Opin Ophthalmol， 2018，29(1):100-104. DOI： 10.1097/ICU.0000000000000434 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Liao X , Lin J , Tian J ，et al. Evaluation of optical quality：ocular scattering and aberrations in eyes implanted with diffractive multifocal or monofocal intraocular lenses[J]．Curr Eye Res， 2018，43(6):696-701. DOI： 10.1080/02713683.2018.1449220 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
乔利亚，蔡啸谷，李晓霞，等．我国北方农村地区成人视网膜成像质量评估[J]．中华眼科杂志， 2018，54(8):593-598. DOI： 10.3760/cma.j.issn.0412-4081.2018.08.006 .
返回引文位置Google Scholar
百度学术
万方数据
Qiao LY , Cai XG , Li XX ，et al. Retinal image quality in northern rural Chinese adult population[J]．Chin J Ophthalmol， 2018，54(8):593-598. DOI： 10.3760/cma.j.issn.0412-4081.2018.08.006 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[30]
Chen T , Yu F , Lin H ，et al. Objective and subjective visual quality after implantation of all optic zone diffractive multifocal intraocular lenses：a prospective，case-control observational study[J]．Br J Ophthalmol， 2016，100(11):1530-1535. DOI： 10.1136/bjophthalmol-2015-307135 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Leung TW , Lam AK , Kee CS . Ocular aberrations and corneal shape in adults with and without astigmatism[J]．Optom Vis Sci， 2015，92(5):604-614. DOI： 10.1097/OPX.0000000000000581 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Roh HC , Chuck RS , Lee JK ，et al. The effect of corneal irregularity on astigmatism measurement by automated versus ray tracing keratometry[J/OL]．Medicine (Baltimore)， 2015，94(13):e677[2021-09-08]．https://pubmed.ncbi.nlm.nih.gov/25837759/. DOI： 10.1097/MD.0000000000000677 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
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张红，Email： mocdef.aabnisgnohceumt
B

蒋元丰：直接参与设计试验、实施研究、采集数据、分析和解释数据、文章撰写；田芳：参与设计试验；步绍翀：采集数据、统计分析、文章修改；张红：酝酿和设计试验、对文章的知识性内容作批评性审阅、技术指导

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天津市教委科研计划项目 (2019KJ177)
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