Comparative analysis of visual quality after implantation different multifocal intraocular lens in patients with cataract

doi:10.3877/cma.j.issn.2095-2007.2022.04.004

Abstract

Abstract:

Objective

To compare the visual quality of patients implanted the trifocal diffractive intraocular lens (IOL) and the segmented refractive bifocal IOL after cataract surgery.

Methods

Retrospective cohort study. From March 2019 to July 2020, 52 patients (104 eyes) with cataract phacoemulsification and IOL implantation in the Department of Ophthalmology of Peking University Third Hospital were collected. There were 17 males (34 eyes) and 35 females (70 eyes) with the average age of (69.3±11.2) years-old (ranged from 36 to 87 years-old). The patients were divided into segmented refractive group and trifocal diffractive group according to the type of IOL implanted. Lenstec SBL-3 IOL was implanted in segmented refractive group; AT LISA tri 839MP triple focus IOL was implanted in the trifocal diffractive group. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), best corrected distance visual acuity (BCVA), spherical equivalent (SE), defocus curve, objective visual quality, off-glasses rate, poor visual events, life quality and satisfaction were evaluated after surgery for 3 months. The questionnaire scores of two groups were expressed by (±s), independent sample t test was used for comparison between groups; UNVA, UIVA, UDVA, BCVA, modulation transfer function cut-off (MTF cut off), strehl ratio (SR), objective scatter index (OSI), contrast visual acuity (VA) and patient satisfaction were expressed by median and quartile intervals, compared by Mann-Whitney U test between groups. The distribution of SE, off-glasses rate and poor visual events were expressed in percentage, and chi-square test was used for comparison between groups. Spearman correlation analysis was used to analyze the correlation between objective visual quality and BCVA.

Results

The postoperative logMAR UNVA, UIVA, UDVA and BCVA of the trifocal diffractive group were 0.10(0.05, 0.10), 0.10(0.00, 0.20), 0.10(0.10, 0.20) and 0.00 (0.00, 0.05), and those of segmented refractive group were 0.05(0.00, 0.10), 0.10(0.00, 0.20), 0.10(0.00, 0.20) and 0.00(0.00, 0.05), respectively. There was a statistically significant difference in logMAR UNVA between two groups(Z=-2.596, P<0.05). The distribution of SE in ±0.25 D, ±0.50 D, ±0.75 D and ±1.00 D in the trifocal diffractive group were 34.6%, 65.4%, 90.4% and 100.0%, respectively; those of segmented refractive group were 57.7%, 71.2%, 78.9% and 92.4%. There was a statistically significant difference in the total distribution of SE (χ²=27.083, P<0.05). There was not a statistically significant difference in the average distribution of SE (t=0.667, P>0.05). The defocus curve analysis showed that there was a statistically significant difference in the logMAR BCVA when the spherical power was 2.00 D, -2.00 D and -2.50 D between two groups (Z=-2.378, -2.416, -2.821; P<0.05). After operation, the MTF cut off, SR, OSI, VA 100%, VA 20% and VA 9% in trifocal diffractive group were 27.7(21.2, 37.6) c/deg, 0.14(0.10, 0.21), 2.4(1.7, 2.9), 0.9(0.7, 1.3), 0.6(0.4, 0.8) and 0.3(0.2, 0.5); and those of segmented refractive group were 18.8(14.1, 24.4) c/deg, 0.11(0.09, 0.13), 2.4(1.8, 3.2), 0.6(0.5, 0.8), 0.4(0.3, 0.5) and 0.2(0.2, 0.3), respectively. There were significant correlations between MTF cut off, SR, OSI, VA 100%, VA 20%, VA 9% and logMAR BCVA in both patients (r=-0.352, -0.211, 0.542, 0.324, -0.314, -0.287; P<0.05). OSI was related with logMAR BCVA, which was bigger than others and there was not a statistically significant difference in OSI between groups (Z=-0.807, P>0.05). The total scores of visual function related quality of life questionnaire in two groups were (88.28±11.41) scores and (87.43±12.62) scores; the rates of mirror removal rate were 80.8% and 84.6%; the rates of poor visual quality was 23.1% and 19.2%; the satisfaction distribution were 3(3, 4) and 3(3, 4), respectively.

Conclusions

Both 839 MP and SBL-3 multifocal IOLs can improve the subjective and objective visual quality of cataract patients after surgery, and the effectiveness, accuracy, spectacle independence, and patient satisfaction of the two groups of patients are similar. Apart from that, the postoperative UNVA of SBL-3 was better than that of 839MP; the objective visual quality results (MTF cut off, SR, VA) of 839MP were better than those of SBL-3. OSI can be used for early detection of complications such as posterior capsular opacification and selection of surgical opportunity.

Key words: Cataract, Intraocular lens, Visual quality, Spectacle independence

Xiaoyu Wang, Yaxin Li, Yiyun Liu, Jiayi Geng, Rui Qin, Yancheng Li, Mingxin Ao, Dehai Liu, Hong Qi. Comparative analysis of visual quality after implantation different multifocal intraocular lens in patients with cataract[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(04): 210-215.

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References 30

[1]	Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies[J]. Prog Retin Eye Res, 2019, 68: 124－143.
[2]	班景飞，李景珂，郭黎霞. 三种IOL对年龄相关性白内障患者视力和视觉质量的影响[J]. 国际眼科杂志，2021，21(1)：106－110.
[3]	谢瞻，丁宇华，刘庆淮，等. 三焦点与单焦点人工晶状体植入术效果的比较[J]. 国际眼科杂志，2019，19(5)：103－106.
[4]	Venter JA, Barclay D, Pelouskova M, et al. Initial experience with a new refractive rotationally asymmetric multifocal intraocular lens[J]. J Refract Surg, 2014, 30 (11): 770－776.
[5]	Mangione CM, Lee PP, Gutierrez PR, et al. Development of the 25－item national eye institute visual function questionnaire[J]. Arch Ophthalmol, 2001, 119(7): 1050－1058.
[6]	钟慧，秦虹，王慧娟，等. 三焦点人工晶状体与双焦点人工晶状体植入术后视力及视觉质量的对比[J]. 中华眼视光学与视觉科学杂志，2020，22(4)：262－267.
[7]	Naderi K, Gormley J, O′Brart D. Cataract surgery and dry eye disease: A review[J]. Eur J Ophthalmol, 2020, 30(5): 840－855.
[8]	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.
[9]	Devries NE, Nuijts RM. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects[J]. J Cataract Refract Surg, 2013, 39(2): 268－278.
[10]	王文惠，巫雷，樊映川，等. 比较两种人工晶状体矫正老视效果的临床研究[J/CD]. 中华眼科医学杂志(电子版)，2020，10(5)：294－299.
[11]	林伟平，谷天瀑，厉娜，等. 视觉质量分析系统(OQAS－Ⅱ)在青少年人群中测量重复性研究[J]. 眼科新进展，2016，36(12)：1138－1140，1144.
[12]	Vilaseca M, Peris E, Pujol J, et al. Intra and intersession repeatability of a double－pass instrument[J]. Optom Vis Sci, 2010, 87(9): 675－681.
[13]	Güell JL, Pujo IJ, Arjona M, et al. Optical quality analysis system. Instrument for objective clinical evaluation of ocular optical quality[J]. J Cataract Refract Surg, 2004, 30 (7): 1598－1599.
[14]	Vargas V, Alio JL, Oliveira RF, et al. Long－term objective and subjective outcomes following bilateral implantation of diffractive bifocal or trifocal intraocular lenses[J]. Eur J Ophthalmol, 2021, 31(3): 1014－1020.
[15]	肖畅，张远平. 三种多焦点人工晶体植入术后视觉质量对比分析[J]. 黑龙江医药科学，2020，43(3)：78－81.
[16]	Wang X, Tu H, Wang Y. Comparative analysis of visual performance and optical quality with a rotationally asymmetric multifocal intraocular lens and an apodized diffractive multifocal intraocular lens[J]. J Ophthalmol, 2020: 7923045.
[17]	Lian H, Ma W, Wei Q, et al. A comparative study on early vision quality after implantation of refractive segmental and diffractive multifocal intraocular lens[J]. Pak J Med Sci, 2020, 36(7): 1607－1612.
[18]	Shen J, Zhang L, Ni S, et al. Comparison of visual outcomes and quality of life in patients with high myopic cataract after implantation of AT LISA Tri 839MP and LS－313 MF30 intraocular lenses[J]. J Ophthalmol, 2022: 5645752.
[19]	Steinwender G, Schwarz L, Böhm M, et al. Visual results after implantation of a trifocal intraocular lens in high myopes[J]. J Cataract Refract Surg, 2018, 44 (6): 680－685.
[20]	Liu Y, Lan Q, Sun T, et al. Binocular visual function after unilateral versus bilateral implantation of segmented refractive multifocal intraocular lenses: a pilot study[J]．Graefes Arch Clin Exp Ophthalmol, 2022, 260 (4): 1205－1213.
[21]	俞阿勇. 双通道客观视觉质量分析的临床实践[M]. 北京：人民卫生出版社，2017.
[22]	Marques EF, Ferreira TB. Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses[J]. J Cataract Refract Surg, 2015, 41(2): 354－363.
[23]	Mojzis P, Peña－garcía P, Liehneova I, et al. Outcomes of a new diffractive trifocal intraocular lens[J]. J Cataract Refract Surg, 2014, 40(1): 60－69.
[24]	肖燕，王骞，朱俊英，等. AcrySof ReSTOR及ATLIS Atri 839MP多焦点人工晶状体植入术后视觉质量的比较[J]. 实用防盲技术，2018，13(3)：25－28.
[25]	Cardona G, Vega F, Gil MA, et al. Visual acuity and image quality in 5 diffractive intraocular lenses[J]. Eur J Ophthalmol, 2018, 28(1): 36－41.
[26]	Khoramnia R, Yildirim TM, Tandogan T, et al. Optical quality of three trifocal intraocular lens models: An optical bench comparison[J]. Der Ophthalmologe, 2018, 115(1): 21－28.
[27]	杨静梅. 客观散射指数在指导年龄相关性白内障手术时机中的应用[D]. 温州：温州医科大学，2018.
[28]	Liu X, Xie L, Huang Y. Comparison of the visual performance after implantation of bifocal and trifocal intraocular lenses having an identical platform[J]. J Refract Surg, 2018, 34(4): 273－280.
[29]	Alba－bueno F, Vega F, Millán MS. Halos and multifocal intraocular lenses: origin and interpretation[J]. Archivos de la Sociedad Espanola de Oftalmologia, 2014, 89(10): 397－404.
[30]	Song JE, Han SY, Khoramnia R, et al. Clinical outcomes of combined implantation of an extended depth of focus IOL and a trifocal IOL in a Korean population [J]. J Ophthalmol, 2021: 9034258.

组别	眼数(只)	UDVA[M(Q1，Q3)]	BCVA[M(Q1，Q3)]	等效球镜(±s，D)	角膜散光度[M(Q1，Q3)，D]	眼轴长度(±s，mm)	前房深度(±s，mm)	角膜缘白到白距离(±s，mm)	IOL屈光度(±s，D)
衍射三焦组	52	0.40(0.20，0.70)	0.20(0.15，0.30)	－1.73±3.26	－0.04(－1.41，－1.26)	23.94±1.09	3.03±0.51	11.60±0.34	19.07±3.67
区域折射组	52	0.40(0.20，0.70)	0.20(0.10，0.40)	－1.39±2.49	－0.42(－1.39，－1.28)	23.96±0.90	3.15±0.40	11.62±0.58	18.23±2.81
Z/t值		－0.619^*	－0.653^*	－0.596^#	－1.791^*	－0.095^#	－1.313^#	－0.059^#	1.306^#
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	眼数(只)	UDVA[M(Q1，Q3)]	BCVA[M(Q1，Q3)]	等效球镜(±s，D)	角膜散光度[M(Q1，Q3)，D]	眼轴长度(±s，mm)	前房深度(±s，mm)	角膜缘白到白距离(±s，mm)	IOL屈光度(±s，D)
衍射三焦组	52	0.40(0.20，0.70)	0.20(0.15，0.30)	－1.73±3.26	－0.04(－1.41，－1.26)	23.94±1.09	3.03±0.51	11.60±0.34	19.07±3.67
区域折射组	52	0.40(0.20，0.70)	0.20(0.10，0.40)	－1.39±2.49	－0.42(－1.39，－1.28)	23.96±0.90	3.15±0.40	11.62±0.58	18.23±2.81
Z/t值		－0.619^*	－0.653^*	－0.596^#	－1.791^*	－0.095^#	－1.313^#	－0.059^#	1.306^#
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	眼数(只)	裸眼远视力	裸眼中视力	裸眼近视力	最佳矫正远视力	MTF cut－off(c/deg)
衍射三焦组	52	0.10(0.05，0.10)	0.10(0.00，0.20)	0.10(0.10，0.20)	0.00(0.00，0.05)	27.7(21.2，37.6)
区域折射组	52	0.05(0.00，0.10)	0.10(0.00，0.20)	0.10(0.00，0.20)	0.00(0.00，0.05)	18.8(14.1，24.4)
Z值		－0.451	－0.871	－2.596	－1.945	－4.271
P值		>0.05	>0.05	<0.05	>0.05	<0.05
组别	眼数(只)	斯特列尔比	客观散射指数	对比度视力
组别	眼数(只)	斯特列尔比	客观散射指数	100%	20%	9%
衍射三焦组	52	0.14(0.10，0.21)	2.4(1.7，2.9)	0.9(0.7，1.3)	0.6(0.4，0.8)	0.3(0.2，0.5)
区域折射组	52	0.11(0.09，0.13)	2.4(1.8，3.2)	0.6(0.5，0.8)	0.4(0.3，0.5)	0.2(0.2，0.3)
Z值		－3.693	－0.807	－4.530	－4.313	－3.850
P值		<0.05	>0.05	<0.05	<0.05	<0.05

组别	眼数(只)	裸眼远视力	裸眼中视力	裸眼近视力	最佳矫正远视力	MTF cut－off(c/deg)
衍射三焦组	52	0.10(0.05，0.10)	0.10(0.00，0.20)	0.10(0.10，0.20)	0.00(0.00，0.05)	27.7(21.2，37.6)
区域折射组	52	0.05(0.00，0.10)	0.10(0.00，0.20)	0.10(0.00，0.20)	0.00(0.00，0.05)	18.8(14.1，24.4)
Z值		－0.451	－0.871	－2.596	－1.945	－4.271
P值		>0.05	>0.05	<0.05	>0.05	<0.05
组别	眼数(只)	斯特列尔比	客观散射指数	对比度视力
组别	眼数(只)	斯特列尔比	客观散射指数	100%	20%	9%
衍射三焦组	52	0.14(0.10，0.21)	2.4(1.7，2.9)	0.9(0.7，1.3)	0.6(0.4，0.8)	0.3(0.2，0.5)
区域折射组	52	0.11(0.09，0.13)	2.4(1.8，3.2)	0.6(0.5，0.8)	0.4(0.3，0.5)	0.2(0.2，0.3)
Z值		－3.693	－0.807	－4.530	－4.313	－3.850
P值		<0.05	>0.05	<0.05	<0.05	<0.05

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