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中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (01) : 21 -27. doi: 10.3877/cma.j.issn.2095-2007.2019.01.004

论著

非对称区域折射型多焦点人工晶状体植入术后中期临床效果的研究
巫雷1,†(), 王文惠1, 常平骏2, 曲超3   
  1. 1. 610041　成都爱尔眼科医院白内障科
    2. 325000　温州医科大学附属眼视光医院白内障科
    3. 610072　成都，四川省人民医院眼科
  • 收稿日期:2018-12-25 出版日期:2019-02-28
  • 通信作者: 巫雷
  • 基金资助:
    浙江省自然科学基金项目(LY18H120008)

Mid-term clinical observation of SBL-3 asymmetric segmented multifocal intraocular lens

Lei Wu1,†(), Wenhui Wang1, Pingjun Chang2, Chao Qu3   

  1. 1. AIER Eye Hospital(Chengdu), Chengdu 610041, China
    2. Department of Cataract, Ophthalmology Hospital Affiliated to Wenzhou Medical University, Wenzhou 325000, China
    3. Department of ophthalmoloty, Sichuan Provincial Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, China
  • Received:2018-12-25 Published:2019-02-28
  • Corresponding author: Lei Wu
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引用本文：

巫雷, 王文惠, 常平骏, 曲超. 非对称区域折射型多焦点人工晶状体植入术后中期临床效果的研究[J]. 中华眼科医学杂志(电子版), 2019, 09(01): 21-27.

Lei Wu, Wenhui Wang, Pingjun Chang, Chao Qu. Mid-term clinical observation of SBL-3 asymmetric segmented multifocal intraocular lens[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(01): 21-27.

目的

探讨SBL-3新型区域折射型多焦点人工晶状体(MIOL)植入术后的中期临床效果。

方法

前瞻性研究。选取2016年6月至2018年1月在成都爱尔眼科医院诊断为年龄相关性白内障，并行超声乳化白内障吸除联合人工晶状体植入的患者59例(87只眼)为研究对象。根据植入人工晶状体类型的不同分为两组。其中，30例(40只眼)植入SBL-3新型区域折射多焦点人工晶状体为多焦组；29例(47只眼)植入Softec HD单焦点人工晶状体为单焦组。术后随访3~12个月，记录术后裸眼远距离(5 m)、中距离(80 cm)、近距离(40 cm)的裸眼视力，矫正远视力及术后等效球镜屈光度；利用VF-14量表行主观问卷调查；对术后眩光的发生率、日常生活老视眼镜依赖与否进行问卷记录；采用双通道视觉质量分析系统测量客观散射指数(OSI)、调制传递函数截止空间频率(MTF cutoff)、斯特尔比值(SR)、对比度视力(包含100%、20%及9%三种)及调节幅度等指标。单焦组和多焦组两组患者各个指标的比较采用独立样本t检验，术前术后的比较采用配对t检验。

结果

单焦组与多焦组患者术后裸眼远距离视力均较术前有显著提高，差异有统计学意义(t＝-10.859，-13.382；P<0.05)。多焦组与单焦组术后等效球镜屈光度差异无统计学意义(t＝1.370，P>0.05)。多焦组与单焦组患者术后裸眼远距离视力分别为(0.87±0.17)与(0.82±0.21)，差异无统计学意义(t＝-1.129，P>0.05)。多焦组与单焦组患者术后矫正远距离视力分别为(0.91±0.13)与(0.91±0.14)，差异无统计学意义(t＝0.081，P>0.05)。多焦组与单焦组患者术后裸眼中距离视力分别为(0.70±0.17)与(0.54±0.22)，差异具有统计学意义(t＝-3.888，P<0.05)。多焦组与单焦组患者术后裸眼近距离视力分别为(0.71±0.20)与(0.28±0.10)，差异具有统计学意义(t＝-12.340，P<0.05)。单焦组与多焦点组患者采用VF-14表评分分别为(75.39±10.30)与(97.50±4.50)，前者低于后者，差异有统计学意义(t＝-9.837，P<0.05)。多焦组与单焦组患者对老视眼镜的依赖程度分别为5%(2/40)与93.6%(44/47)，差异有统计学意义(χ2＝68.104，P<0.05)。多焦组与单焦组患者术后眩光的发生率分别为7.5%(3/40)与4.26%(2/47)，差异无统计学意义(χ2＝0.035，P>0.05)。多焦组与单焦组患者的MTF cutoff分别为(24.17±7.68)c/deg与(27.00±10.98)c/deg，差异无统计学意义(t＝1.398，P>0.05)。多焦组与单焦组患者的OSI分别为(2.0±0.7)与(1.7±0.8)，差异无有统计学意义(t＝-2.139，P>0.05)。多焦组与单焦组患者的SR分别为(0.13±0.03)与(0.15±0.06)，差异有统计学意义(t＝2.130，P<0.05)。多焦组与单焦组患者在100%、20%及9%对比度视力比较，差异均无统计学意义(t＝1.545，1.886，1.968；P>0.05)。多焦组与单焦组患者术眼调节幅度分别为(2.30±0.80)D与(1.60±0.70)D，差异有统计学意义(t＝-3.600，P<0.05)。

结论

SBL-3新型区域折射多焦点人工晶状体可以提供较好的全程视力和视觉质量，术后患者满意度较高。

关键词: 区域折射型多焦点人工晶状体, 双通道视觉质量分析系统, 视觉质量
Objective

The aim of this study was to study the mid-term clinical outcomes of SBL-3 asymmetric segmented multifocal intraocular lens.

Methods

Prospective study. 59 subjects (87 eyes) in AIER Eye Hospital(Chengdu) diagnosed with aged related cataract from Jun 2016 to Jan 2018 were enrolled in this study. All subjects were follow-up from 3 to 12 months postoperatively. They were divided into two groups according to the type of intraocular lens implanted. Multi-focal group: 30 subjects (40 eyes) were implanted with SBL-3 Mf-IOL. Monofocal group: 29 subjects (47 eyes) were implanted with mono-focal IOL (Softec HD). The uncorrected distance VA (5 meters), intermediate VA (80 cm), near VA and spherical equivalent were measured at each visit. Visual function was evaluated by using the VF-14-CN questionnaire. Double-pass visual quality analysis system was used to evaluated the visual quality, including the Objective Scatter Index (OSI), Modulation transfer function cut off (MTF cutoff), strehl ratio (SR), contrast sensitive at 100%, 20%, 9% respectively and the pseudo-accommodation. Independent sample t test was used to compare the indices of patients in monofocal group and multifocal group, and paired t test was used to compare the indices before and after operation.

Results

Distance VA of all subjects were improved dramatically after surgery (t=-13.382, -10.859; P<0.05). No significant statistical difference was found between multi-focal group and mono-focal group in spherical equivalent (t=1.370, P>0.05). Uncorrected distance VA in multi-focal group was (0.87±0.17) and in mono-focal group was (0.82±0.21), Corrected distance VA in multi-focal group was (0.91±0.13) and in mono-focal group was (0.91±0.14), but there were no statistical differences between two groups (t=-1.129, 0.081; P>0.05). Intermediate VA: Multi-focal group was (0.70±0.17), mono-focal group was (0.54±0.22), multi-focal group was better than mono-focal group (t=-3.888, P<0.05). Near VA: multi-focal group was (0.71±0.20), mono-focal group was (0.28±0.10), multi-focal group was better than mono-focal group (t=-12.340, P<0.05). In terms of VF-14 scale score, the former group (75.39±10.30) was significantly lower than the later group(97.50±4.50), and the difference was statistically significant (t=-9.837, P<0.05). As for reading glasses, 44 of 47 subjects (93.6%) need reading glasses for near vision in the mono-focal group, but only 2 of 40 (5%) need reading glasses in the multi-focal group. The difference was also statistically significant ( χ2=68.104, P<0.05). As for glare, 2 of 47 subjects (4.26%) of mono-focal group was reported glare compared to the multi-focal group (3 of 40 subjects). No statistical significance was found (χ2=0.035, P>0.05). MTF cutoff in mono-focal group (27.00±10.98)c/deg was better than in multi-focal group (24.17±7.68), but no significant statistical differences were found between two groups (t=1.398, P>0.05). OSI in mono-focal group (1.7±0.8) was better than in multi-focal group (2.0±0.7), but no significant statistical differences were found between two groups (t=-2.139, P>0.05). Significant statistical differences were found between two groups in SR (0.13±0.03), mono-focal group was (0.15±0.06), (t=2.130, P<0.05). The contrast sensitivity vision of mono-focal group was better than multi-focal at 100%, 20% and 9% contrast, but still no statistical difference was found. (t=1.545, 1.886, 1.968; P>0.05). In terms of pseudo-accommodation, multi-focal group (2.30±0.80) D was much higher than mono-focal group (1.60±0.70)D. (t=-3.600, P<0.05).

Conclusions

Compared to the traditional mono-focal IOL, the novel SBL-3 asymmetric segmented multifocal intraocular lens can provide better full range of clear vision and visual quality, which may help to achieve good patient postoperative satisfaction.

Key words: Asymmetric segmented multifocal intraocular lens, Mid-term, Double-pass optical quality analysis system, Visual quality
[1]
刘奕志 . 人工晶状体多焦点与单焦点优劣之争[J]．中华眼科杂志，2013，49(5)：389-391.
[2]
王蒙蒙，张凤妍，崔琨明，等. 衍射型非球面多焦点人工晶状体植入术后视觉质量评价[J]. 中国实用眼科杂志，2013，31(5)：561-564.
[3]
Robert A, Gladness M, Emerson C, et al. Prospective evaluation of visual outcomes with three presbyopia correcting intraocular lenses following cataract surgery[J]. Clinical Ophthalmology, 2013, 7: 1811-1823.
[4]
田亚宾，马忠旭，黄婉荣，等. 非对称区域折射型多焦点人工晶状体与可调节型人工晶状体的临床效果研究[J]. 眼科新进展，2016，36(12)：1157-1160.
[5]
陈琛，屈思萌，林珊，等. 区域折射多焦点人工晶状体SBL-3的临床应用[J]．国际眼科杂志，2018，18(3)：446-450.
[6]
中华医学会眼科学分会白内障和人工晶状体学组. 关于白内障围手术期预防感染措施规范化的专家建议(2013年)[J]. 中华眼科杂志，2013，49(1)：76-78.
[7]
彭程，赵江月，马立威，等. 不同形态年龄相关性白内障视觉质量的临床评价[J]. 中华眼科杂志，2011，47(11)：1001-1006.
[8]
Steinberg EP, Tielseh JM, Schein OD, et al. The VF-14 an index of functional impairment in patients with cataract[J]. Archives of ophthalmology, 1994, 112(5): 630-638.
[9]
穆晶，陈晖，李一壮. 双眼植入多焦点人工晶状体与单眼视设计术后视功能及满意度的比较[J]. 中华眼科杂志，2014，50(2)：95-99.
[10]
Osher RH, Golnik KC, Barrett G, el a1. Intentional extreme anisometropic pseudophakic monovision: new approach to the cataract patient with longstanding diplopia[J]. J Cataract Refract Surg, 2012, 38(8): 1346-1351.
[11]
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.
[12]
彭璟，邓应平，李爽乐，等. 高度近视患者LASIK矫正术后行白内障手术并植入区域折射型多焦点人工晶体1例[J]. 四川医学，2017，38(4)：487-488.
[13]
张利科，王晓冰，陈正伟. 两衍射多焦点人工晶状体的光学性能与视觉质量对比研究[J]. 眼科新进展，2017，37(5)：445-449.
[14]
吴杰，朱磊. 多焦点人工晶状体植入术后早期全程视力和拟调节力的临床观察[J]. 眼科新进展，2017，37(6)：572-575.
[15]
王宏伟，孙鹏. AcrySof ReSTOR多焦点人工晶状体应用的临床研究[J]．齐齐哈尔医学院学报，2016，37(30)：3772-3773.
[16]
Plaza-Puche AB, Alio JL. Analysis of defocus curves of different modern multifocal intraocular lenses[J]. European journal of ophthalmology, 2016, 26(5): 412-417.
[17]
Gunnar GK, Rick P. Comparison of visual outcomes and subjective visual quality after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of apodized diffractive bifocal intraocular lenses[J]. Clinical Ophthalmology, 2016, 10: 805-811.
[18]
Alwin KFT, Young CC, Matthias Müller, et al. Visual Outcomes，Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens[J]. Korean Journal of Ophthalmology, 2016, 30(3): 180-191.
[19]
Jardim D, Soloway B, Starr C. Asymmetric vault of an accommodating intraocular lens[J]. J Cataract Refract Surg, 2006, 32(2): 347-350.
[20]
Dick HB, Dell S. Single optic accommodative intraocular lenses[J]. Ophthalmol Clin North Am, 2006, 19(1): 107-124.
[21]
Alio J, Plaza-Puche AB, Férnandez-Buenaga R, et al. Multifocal intraocular lenses：An overview[J]. Surv Ophthalmol, 2017, 62(5): 611-634.
[22]
毛一，张凤妍，邵敬芝. 多焦点人工晶状体的临床应用进展[J]. 中华眼外伤职业眼病志，2018，40(5)：397-400.
[23]
Venter JA, Barclay D, Pelouskova M, et al. Initial experience with a new refractive rotationally asymmetric multifocal intraocular lens[J]. Journal of refractive surgery, 2014, 30(11): 770-776.
[24]
王慧娟，秦虹，冯骅，等. 区域折射型与衍射折射型多焦点人工晶状体植入术后患者视力与视觉质量对比研究[J]. 眼科新进展，2018，38(6)：566-568.
[25]
Akondi V, Perez-Merino P, Martinez-Enriquez E, et al. Evalua-tion of the true wavefront aberrations in eyes implanted with a rota-tionally asymmetric multifocal intraocular lens[J]. J Refract Surg, 2017, 33(4): 257-265.
[26]
Pazo EE, Mcneely RN, Richoz O, et al. Pupil influence on the quality of vision in rotationally asymmetric multifocal IOLs with surface-embedded near segment[J]. Journal of Cataract & Refractive Surgery, 2017, 43(11): 1420-1429.
[27]
Park Y, Kim HS. Torsional and flattening effect on corneal astigmatism after cataract surgery: a retrospective analysis[J]. BMC Ophthalmol, 2017, 17(1): 10.
[28]
汤欣. 正确认识像差和散射合理选择人工晶状体[J]. 中华眼科杂志，2014，50(2)：81-83.
[29]
Steven H, Schwartz S. Visual perception[M]．New York: McGraw-Hill Medical, 2004: 319-315.
[30]
崔嵬，杨松霖，晏晓明. 区域折射型多焦点人工晶状体与非球面单焦点人工晶状体植入术后患者客观视觉质量的短期对比研究[J/CD]. 中华眼科医学杂志(电子版)，2018，8(3)：103-109.
[31]
Watt RJ. An outline of the primal sketch in human vision[J]. Pattern Recognition Letters, 1987, 5(2): 139-150.
[32]
Pazo EE, Richoz O, McNeely R, et al. Optimized Outcome After Asymmetrical Multifocal intraocular lens[J]. Journal of refractive surgery, 2016, 32(7): 494-496.
[33]
邢晓杰，宋慧，汤欣. 应用双通道视觉质量分析系统双通道系统对人工晶状体眼视觉质量评估可重复性研究[J]. 中国实用眼科杂志，2014，32(10)：1163-1168.
[34]
俞阿勇，施恩，王勤美，等. 不同年龄段成年人眼的综合光学质量客观评估[J]. 中华眼科杂志，2016，52(1)：47-50.
[35]
连慧芳，汤欣，王娟. 年龄及瞳孔直径对成人正视眼调制传递函数的影响[J]. 中华眼科杂志，2010，46(3)：227-232.
[36]
Di'az-Douto'n F, Benito A, Pujol J, et al. Comparison of the retinal image quality with a Hartmann-Shack wavefront sensor and a double-pass instrument[J]. Investigative ophthalmology & visual science, 2006, 47(4): 1710-1716.
[37]
Tognetto D, Toto L, Sanguinetti G, et al. Glistenings in foldable intraocular lenses 1[J]. J Cataract Refract Surg, 2002, 28(7): 1211-1216.
[38]
Alio JL, Pinero DP, Ortiz D, et a1. Clinical outcomes and postoperative intraocular optical qual ity with a microincision aberration free aspheric intraocular lens[J]. J Cataract Refract Surg, 2009, 35(9): 1548-1554.
[39]
周灵，刘奕志，郭建兵. 多焦点和单焦点人工晶体植入术后拟调节力的比较[J]. 江西医学院学报，2002，42(4)：102-104.
[40]
高佳佳. 双眼植入衍射型多焦点人工晶体术后全程视力及主观视觉质量分析[D]. 福州：福建医科大学，2015：1-34.
[41]
叶盼盼，姚克，李霞，等. 双眼植入Tecnis多焦点和单焦点球面人工晶状体的临床比较研究[J]. 中华眼科杂志，2010，46(7)：625-630.
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