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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2017, Vol. 07 ›› Issue (05) : 203 -210. doi: 10.3877/cma.j.issn.2095-2007.2017.05.003

所属专题： 文献；

论著

飞秒激光辅助白内障手术联合Restor＋2.5 D和Restor＋3.0 D多焦点人工晶状体双眼植入术后视觉质量的评价
秦艳1, 谭吉林1,†(), 周晓虹1, 朱思泉2, 陈茂盛3, 王世明3   
  1. 1. 400060　重庆爱尔麦格眼科医院白内障专科
    2. 100005　首都医科大学北京同仁医院眼科中心　北京市眼科学与视觉科学重点实验室
    3. 400020　重庆爱尔眼科医院白内障专科
  • 收稿日期:2017-09-22 出版日期:2017-10-28
  • 通信作者: 谭吉林
  • 基金资助:
    国家自然科学基金资助项目(51573101); 爱尔眼科医院集团科研基金资助项目(AF152D10, AM142D17, AF1602D1)

Vision quality evaluation after femtosecond laser assisted cataract surgery combined with implantation of Restor + 2.5 D and Restor + 3.0 D multifocal intraocular lens

Yan Qin1, Jilin Tan1,†(), Xiaohong Zhou1, Siquan Zu2, Maosheng Chen3, Shiming Wang3   

  1. 1. Department of Cataract, Chongqing Aier Mega Eye hospital, Chongqing 400060, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
    3. Department of Cataract, Chongqing Aier Eye hospital, Chongqing 400020, China
  • Received:2017-09-22 Published:2017-10-28
  • Corresponding author: Jilin Tan
  • About author:
    Corresponding author: Tan Jilin, Email:
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引用本文：

秦艳, 谭吉林, 周晓虹, 朱思泉, 陈茂盛, 王世明. 飞秒激光辅助白内障手术联合Restor＋2.5 D和Restor＋3.0 D多焦点人工晶状体双眼植入术后视觉质量的评价[J]. 中华眼科医学杂志(电子版), 2017, 07(05): 203-210.

Yan Qin, Jilin Tan, Xiaohong Zhou, Siquan Zu, Maosheng Chen, Shiming Wang. Vision quality evaluation after femtosecond laser assisted cataract surgery combined with implantation of Restor + 2.5 D and Restor + 3.0 D multifocal intraocular lens[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2017, 07(05): 203-210.

目的

通过观察行飞秒激光辅助白内障手术联合Restor＋2.5 D和Restor＋3.0 D多焦点人工晶状体(MIOL)双眼植入术后3个月患者的双眼全程视力、对比敏感度、视觉干扰现象及主观满意度等指标，综合评价其术后视觉质量及老视矫正的效果。

方法

连续选择自2015年3月至2017年3月就诊于重庆爱尔麦格眼科医院的双眼白内障合并老视患者105例(210只眼)，采用信封法随机分为观察组和对照组，观察组行飞秒激光辅助白内障超声乳化吸出联合双眼先后植入Restor＋2.5 D和Restor＋3.0 D MIOL，对照组行飞秒激光辅助白内障超声乳化吸出联合双眼植入Restor＋3.0 D MIOL。术后早期观察患者的并发症情况。术后3个月检查两组患者单眼与双眼的离焦曲线及对比敏感度，并填写MIOL植入术后的满意度调查问卷。裸眼远视力、对比敏感度及满意度评分采用均数±标准差(±s)进行描述。治疗前后的组内比较采用配对t检验，观察组与对照组的组间比较采用独立样本t检验，两组间术后并发症、视觉干扰及满意度调查的比较采用卡方检验。

结果

观察组与对照组术后角膜水肿、高眼压及黄斑囊样水肿等并发症发生率的比较，差异无统计学意义(χ2＝0, 0.10, 0.84；P>0.05)。所有患者术后裸眼远视力较术前均有明显改善，差异有统计学意义(t＝1.97，P<0.05)。观察组与对照组患者术后均获得了满意的双眼远视力，二者差异无统计学意义(t＝1.02，P>0.05)。对两组患者进行33 cm的近距离视力测试，对照组的裸眼视力较好，但组间差异无统计学意义(t＝1.89，P>0.05)。对两组患者进行67 cm的中距离视力测试，观察组视力明显好于对照组，差异有统计学意义(t＝2.35，P<0.05)。将观察组与对照组患者术后产生眩光、光晕及色差等视觉干扰现象的情况进行比较，差异均无统计学意义(χ2＝0.43，0.46，0.06；P>0.05)。在暗视状态下，观察组患者6c.d－1和12c.d－1空间频率的对比敏感度要高于对照组，差异有统计学意义(t＝2.35, 2.19；P<0.05)。观察组与对照组患者在看电视、阅读及使用手机时的眼镜依赖度及总体眼镜依赖度差异均无统计学意义(χ2＝0.04，0.04，0.43；P>0.05)。将使用电脑时的眼镜依赖度进行比较，观察组明显少于对照组，差异有统计学意义(χ2＝6.38，P<0.05)。观察组和对照组患者的满意度评分分别为9.31±0.12和8.78±0.20，观察组术后满意度更高，差异有统计学意义(t＝2.19，P<0.05)。

结论

飞秒激光辅助白内障手术联合Restor＋2.5 D和Restor＋3.0 D MIOL双眼植入术后可获得更令人满意的全程视力，减少光学干扰现象，术后中距离用眼脱镜率更高，长期稳定性好，整体满意度高。

关键词: 飞秒激光辅助白内障手术, Restor＋2.5 D, Restor＋3.0 D, 多焦点人工晶状体, 全程视力
Objective

Through the observation of femtosecond laser assisted cataract surgery combined with Restor+ 2.5 D and Restor+ 3.0 D multifocal intraocular lens (MIOL) implantation in eyes of patients 3 months after the whole binocular visual acuity and contrast sensitivity, visual interference and subjective satisfaction index, comprehensive evaluation of the postoperative visual quality and the effect of perception of presbyopia.

Methods

Continuous selection from March 2015 to March 2017 in eyes with cataract patients with presbyopia Chongqing Aier Mega Eye Hospital in 105 cases (210 eyes), were randomly divided into observation group and control group using the envelope method, the observation group underwent femtosecond laser assisted phacoemulsification combined with implantation of Restor+ 2.5 D and Restor+ 3.0 D eyes has MIOL, the control group underwent femtosecond laser assisted phacoemulsification combined with implantation of Restor+ 3.0 D MIOL eyes. The complications of the patients were observed early after operation. 3 months after surgery, the monocular and binocular defocus curves, contrast sensitivity, and satisfaction questionnaire of MIOL implantation were examined in the two groups. The uncorrected visual acuity, contrast sensitivity and satisfaction score were described by mean standard deviation (±s). Before and after treatment were compared by paired t-test, the observation group compared with the control group using independent samples t-test was used to compare the complications, visual disturbance and satisfaction between the two groups by Chi Square test.

Results

There was no significant difference in the incidence of complications such as corneal edema, intraocular pressure and cystoid macular edema between the observation group and the control group (χ2=0, 0.10, 0.84; P>0.05). The uncorrected visual acuity of all patients improved significantly compared with that before operation (t=1.97, P<0.05). There was no significant difference in binocular distant vision between the observation group and the control group (t=1.02, P>0.05). Visual acuity of 33 cm was measured in two groups, while uncorrected visual acuity in control group was slightly better, but there was no significant difference between the two groups (t=1.89, P>0.05). The middle distance visual acuity test of 67 cm was carried out in the two groups, and the visual acuity of the observation group was significantly better than that of the control group, the difference was statistically significant (t=2.35, P<0.05). There were no statistically significant differences in visual disturbances such as glare, halo and chromatic aberration between the observation group and the control group (χ2=0.43, 0.46, 0.06; P>0.05). In the scotopic 6 c. d-1 and 12 c. d-1 frequency, the observation group contrast sensitivity was higher than that of the control group, the difference was statistically significant (t=2.35, 2.19; P<0.05). The glasses dependence and overall glasses dependence of the observation group and the control group were not statistically significant when watching TV, reading and using mobile phone (χ2=0.04, 0.04, 0.43; P>0.05). Compared with the glasses dependence of the computer, the observation group was significantly less than that of the control group (χ2=6.38, P<0.05). The satisfaction scores of the observation group and the control group were 9.31±0.12 and 8.78±0.20, respectively, and the satisfaction degree of the observation group was higher, and the difference was statistically significant (t=2.19, P<0.05).

Conclusion

After femtosecond laser assisted cataract surgery combined with implantation of Restor + 2.5 D and Restor + 3.0 D MIOL, patients gain more satisfactory full-distance visual acuity , low incidence of optical interference phenomenon, high spectacle independence rate, good long-term stability, and higher overall postoperative satisfaction.

Key words: Femtosecond laser assisted cataract surgery, Restor + 2.5 D, Restor + 3.0 D, Multifocal intraocular lens, Full-distance visual acuity
图1 MIOL满意度调查问卷
表1 观察组与对照组术后并发角膜水肿、高眼压及黄斑囊样水肿情况的比较
组别 角膜水肿[%(眼数/总眼数)] 高眼压[%(眼数/总眼数)] 黄斑囊样水肿[%(眼数/总眼数)]
观察组 5.77(6/104) 4.81(5/104) 0.96(1/104)
对照组 5.81(5/86) 5.81(5/86) 0(0/86)
χ2值 0 0.10 0.84
P值 >0.05 >0.05 >0.05
图2 观察组患者术后3个月时单眼和双眼的离焦曲线图
图3 对照组患者术后3个月时单眼和双眼的离焦曲线图
图4 观察组与对照组患者术后3个月的双眼离焦曲线图
表2 术后3个月观察组与对照组患者双眼远、中及近距离UCDVA的比较(±s)
组别 眼数 裸眼远视力的测试距离
5 (m) 67(cm) 33(cm)
观察组 112 1.02±0.12 0.76±0.13 0.72±0.12
对照组 98 1.00±0.13 0.60±0.14 0.80±0.15
t值 ? 1.02 2.35 1.89
P值 ? >0.05 <0.05 >0.05
表3 术后3个月观察组与对照组患者产生视觉干扰现象的比较
组别 眩光[%(眼数/总眼数)] 光晕[%(眼数/总眼数)] 色差[%(眼数/总眼数)] 总计[%(眼数/总眼数)]
观察组 5.77(3/104) 3.84(2/104) 5.77(3/104) 15.38(8/104)
对照组 9.30(4/86) 6.98(3/86) 4.65(2/86) 20.93(9/86)
χ2值 0.43 0.46 0.06 0.49
P值 >0.05 >0.05 >0.05 >0.05
表4 术后3个月观察组与对照组患者双眼6c.d－1、12c.d－1空间频率下对比敏感度的比较(±s)
组别 眼数 6c.d－1明视 6c.d－1暗视 12c.d－1明视 12c.d－1暗视
观察组 112 4.28±0.14 2.68±0.12 4.30±0.13 1.94±0.10
对照组 98 4.21±0.12 2.17±0.10 4.28±0.11 1.43±0.08
t值 ? 1.20 2.35 1.00 2.19
P值 ? >0.05 <0.05 >0.05 <0.05
表5 术后3个月观察组与对照组患者各功能区眼镜依赖及满意度调查结果的比较
组别 看电视[%(例数/总例数)] 使用电脑[%(例数/总例数)] 阅读、使用手机[%(例数/总例数)] 脱镜率[%(例数/总例数)]
观察组 3.84(2/52) (0/52) 3.84(2/52) 92.31(48/52)
对照组 4.65(2/43) 11.63(5/43) 4.65(2/43) 79.07(34/43)
χ2值 0.04 6.38 0.04 0.43
P值 >0.05 <0.05 >0.05 >0.05
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