衍射双焦点与扩展景深人工晶状体混搭植入术后视觉质量的临床研究

doi:10.3877/cma.j.issn.2095-2007.2026.02.002

目的

观察双焦点与扩展景深人工晶状体(EDoF IOL)混搭植入与双眼双焦点人工晶状体(IOL)植入术后的视觉质量。

方法

纳入2023年6月至2024年9月于郑州大学第一附属医院行白内障手术的患者46例(92只眼)。其中，男性20例(40只眼)，女性26例(52只眼)；年龄16~80岁，平均年龄(51.6±15.2)岁。按照植入IOL类型，分为混搭组20例(40只眼)和双焦组26例(52只眼)。混搭组主导眼植入TECNIS Symfony ZXR00EDoF IOL，非主导眼植入Tecnis ZMB00双焦点IOL；双焦点组双眼均植入Tecnis ZMB00 IOL。于术后6个月比较两组患者的未矫正远中近距离视力、离焦曲线、对比敏感度、立体视锐度、动态视力(DVA)及主观视觉质量。计量资料经Shapiro-Wilk检验正态性后，年龄、离焦曲线下面积、立体视锐度及主观视觉质量(量表平均得分)等符合正态分布采用±s描述；未矫正远视力、未矫正中距离视力、未矫正近距离视力、主观视觉质量(差异事件平均得分)等不符合正态分布采用M(P25, P75)描述；性别、脱镜率及光学干扰现象等计数资料采用频数和百分比(%)描述。两组患者对比敏感度、在不同视标速度下的未矫正远距离DVA、未矫正中距离DVA及未矫正近距离DVA呈现不统一特点，符合正态分布的采用±s描述，反之采用M(P25, P75)描述。

结果

术后6个月，混搭组患者未矫正中视力、未矫正远视力、未矫正近视力分别为0.00(-0.08，0.00)最小分辨角对数(logMAR)、-0.10(-0.20，-0.10)logMAR及0.00(-0.07，0.00)logMAR；双焦点组患者分别为0.21(0.10，0.30)logMAR、-0.04(-0.10，0.00)logMAR及0.00(-0.02，0.10)logMAR。混搭组的双焦点组患者离焦曲线下面积分别为(1.54±0.19)D·logMAR和(1.03±0.17)D·logMAR。在明视、明视加眩光及暗视加眩光特定空间频率下，混搭组患者对比敏感度高于双焦点组。混搭组患者在中高速度下的远中近DVA均优于双焦点组。混搭组和双焦点组患者立体视锐度分别为(24.75±10.57)″和(26.92±9.60)″。混搭组和双焦点患者VF-14-CN评分分别为(98.15±2.64)分和(97.12±3.03)分。混搭组和双焦点患者无光学干扰者14例和12例，分别占70.00%和46.15%；混搭组和双焦点患者脱镜者19例和23例，分别占95.00%和88.46%。

结论

双焦点和EDoF IOL的混搭植入方案在保证良好近视力和立体视的同时，可提供更优的中远距离视力、明视环境下对比敏感度、中高速DVA及主观视觉满意度，是屈光性白内障手术的一种有效策略。

关键词: 混搭植入, 扩展景深人工晶状体, 双焦点人工晶状体, 白内障, 视觉质量

Objective

The aim of this study is to observe the visual quality after mix-and-match implantation of bifocal and extended depth-of-focus intraocular lenses (IOLs) versus bilateral bifocal IOL implantation.

Methods

A total of 46 patients (92 eyes) who underwent cataract surgery at the First Affiliated Hospital of Zhengzhou University from June 2023 to September 2024 were enrolled. Among them, there were 20 males (40 eyes) and 26 females (52 eyes); their ages ranged from 16 to 80 years, with an average age of (51.6±15.2) years. According to the type of implanted IOL, they were divided into a hybrid group of 20 cases (40 eyes) and a bifocal group of 26 cases (52 eyes). In the hybrid group, the dominant eye was implanted with a TECNIS Symfony ZXR00 EDoF IOL, while the non-dominant eye was implanted with a Tecnis ZMB00 bifocal IOL; in the bifocal group, both eyes were implanted with Tecnis ZMB00 IOL. At 6 months postoperatively, uncorrected distance, intermediate, and near visual acuities, defocus curves, contrast sensitivity, stereoacuity, dynamic visual acuity, and subjective visual quality were compared between the two groups. After shapiro-wilk test for normality of measurement data, age, area under defocus curve, stereoacuity and subjective visual quality (average score of the scale) conformed to normal distribution and were described by ±s . Uncorrected long-range vision, uncorrected medium-range vision, uncorrected short-range vision, subjective visual quality (mean score of difference events) and other non conformities to the normal distribution were described by M(P25, P75). The counting data of gender, mirror removal rate and optical interference phenomenon were described by frequency and percentage (%). The contrast sensitivity, uncorrected long-range DVA, uncorrected medium-range DVA and uncorrected short-range DVA at different visual target speeds of the two groups were not uniform. The normal distribution was described by ±s and M(P25, P75).

Results

At 6 months postoperatively, the uncorrected intermediate visual acuity, uncorrected distance visual acuity, and uncorrected near visual acuity in the mix-and-match group were 0.00 (-0.08, 0.00) logMAR, -0.10 (-0.20, -0.10) logMAR, and 0.00 (-0.07, 0.00) logMAR, respectively; while those in the bifocal group were 0.21 (0.10, 0.30) logMAR, -0.04 (-0.10, 0.00) logMAR, and 0.00 (-0.02, 0.10) logMAR, respectively. The area under the defocus curve was (1.54±0.19) D·logMAR in the mix-and-match group and (1.03±0.17) D·logMAR in the bifocal group. Under specific spatial frequencies under photopic, photopic with glare, and scotopic with glare conditions, contrast sensitivity was higher in the mix-and-match group than in the bifocal group. The mix-and-match group showed superior distance, intermediate, and near dynamic visual acuity (DVA) at medium and high speeds compared to the bifocal group. Stereopsis was (24.75±10.57)″ in the mix-and-match group and (26.92±9.60)″ in the bifocal group. The VF-14-CN scores were (98.15±2.64) scores and (97.12±3.03) scores , respectively. The proportion of patients without optical disturbances was 70.00% (14/20) in the mix-and-match group and 46.15% (12/26) in the bifocal group. The spectacle independence rate was 95.00% (19/20) in the mix-and-match group and 88.46% (23/26) in the bifocal group.

Conclusions

The mix-and-match implantation of bifocal and extended depth-of-focus IOLs can provide better intermediate and distance visual acuity, photopic contrast sensitivity, medium-to-high-speed dynamic visual acuity, and subjective visual satisfaction while maintaining good near visual acuity and stereoacuity. It represents an effective strategy for refractive cataract surgery.

Key words: Mix-and-match implantation, Extended depth-of-focus intraocular lens, Bifocal intraocular lens, Cataract, Visual quality

表1 混搭组和双焦组患者术前的基线资料

组别	例数	年龄(±s，岁)	性别(男/女，%)	未矫正远距离视力[M(P25，P75)，logMAR]	最佳矫正远视力[M(P25，P75)，logMAR]	球镜[M(P25，P75)，D]
混搭组	20	49.6±16.0	9/11(45.00，55.00)	0.65(0.33，1.00)	0.30(0.20，0.50)	-1.00(-6.00，0.00)
双焦组	26	53.3±14.7	11/15(42.31，57.69)	0.70(0.40，1.00)	0.30(0.20，0.57)	-1.00(-6.00，0.00)
组别	例数	柱镜[M(P25，P75)，D]	等效球镜[M(P25，P75)，D]	前房深度[M(P25，P75)，mm]	眼轴长度[M(P25，P75)，mm]	植入人工晶状体屈光度[M(P25，P75)，D]
混搭组	20	-0.75(-1.25，0.00)	-1.25(-6.59，0.00)	3.34(3.07，3.50)	24.23(23.68，25.88)	19.25(14.63，21.00)
双焦组	26	-0.75(-1.19，0.00)	-2.00(-6.70，0.00)	3.35(3.23，3.46)	24.16(23.36，25.74)	19.50(14.63，21.50)

表1 混搭组和双焦组患者术前的基线资料

组别	例数	年龄(±s，岁)	性别(男/女，%)	未矫正远距离视力[M(P25，P75)，logMAR]	最佳矫正远视力[M(P25，P75)，logMAR]	球镜[M(P25，P75)，D]
混搭组	20	49.6±16.0	9/11(45.00，55.00)	0.65(0.33，1.00)	0.30(0.20，0.50)	-1.00(-6.00，0.00)
双焦组	26	53.3±14.7	11/15(42.31，57.69)	0.70(0.40，1.00)	0.30(0.20，0.57)	-1.00(-6.00，0.00)
组别	例数	柱镜[M(P25，P75)，D]	等效球镜[M(P25，P75)，D]	前房深度[M(P25，P75)，mm]	眼轴长度[M(P25，P75)，mm]	植入人工晶状体屈光度[M(P25，P75)，D]
混搭组	20	-0.75(-1.25，0.00)	-1.25(-6.59，0.00)	3.34(3.07，3.50)	24.23(23.68，25.88)	19.25(14.63，21.00)
双焦组	26	-0.75(-1.19，0.00)	-2.00(-6.70，0.00)	3.35(3.23，3.46)	24.16(23.36，25.74)	19.50(14.63，21.50)

图1　两组患者植入方案术后6个月双眼离焦曲线　图2　两组患者植入方案术后6个月离焦曲线下面积的比较　图3　两组患者在不同空间频率及模拟环境下对比敏感度的比较折线图　图3A示明视环境；图3B示暗视环境；图3C示明视-眩光环境；图3D示暗视-眩光环境　图4　两组患者6个月时立体视锐度的比较　注：logMAR，最小分辨角对数

表2 两组VF-14-CN问卷有差异事件平均得分[M(P25，P75)]

组别	例数(例)	看小字体	读书看报	精细工作	填表或签名	白天开车	夜间开车
混搭组	20	4.00(3.00，4.00)	4.00(4.00，4.00)	4.00(3.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4，00)
双焦组	26	3.50(3.00，4.00)	3.70(3.00，4.00)	3.00(3.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)

表2 两组VF-14-CN问卷有差异事件平均得分[M(P25，P75)]

组别	例数(例)	看小字体	读书看报	精细工作	填表或签名	白天开车	夜间开车
混搭组	20	4.00(3.00，4.00)	4.00(4.00，4.00)	4.00(3.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4，00)
双焦组	26	3.50(3.00，4.00)	3.70(3.00，4.00)	3.00(3.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)	4.00(4.00，4.00)

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The visual quality following mix-and-match implantation of diffractive bifocal and extended depth-of-focus intraocular lenses

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The visual quality following mix-and-match implantation of diffractive bifocal and extended depth-of-focus intraocular lenses