旋转非对称折射型多焦点人工晶状体植入术后影响全程视力的相关因素分析  

Associated factors influencing the full-distance visual acuity after refractive rotationally asymmetric multifocal intraocular lens implantation

作　　者：涂海霞 雷荣 孙明[1] 王潇[1,2] 王勇 TU Haixia;LEI Rong;SUN Ming;WANG Xiao;WANG Yong(Aier Eye Hospital of Wuhan University,Wuhan 430000;Hubei Province,China 2.Aier School of Ophthalmology,Central South University,Changsha 410000,Hunan Province,China)

机构地区：[1]武汉大学附属爱尔眼科医院,湖北省武汉市430000 [2]中南大学爱尔眼科学院,湖南省长沙市410000

出　　处：《眼科新进展》2020年第8期755-760,共6页Recent Advances in Ophthalmology

基　　金：武汉市卫健委医学科研项目(编号W17B22);湖北省卫健委医学科研项目(编号WJ2017M205)。

摘　　要：目的分析白内障超声乳化术联合旋转非对称折射型多焦点人工晶状体(multifocal intraocular lens,MIOL)植入术后患者远、中、近视力的影响因素。方法采用前瞻性研究,纳入2018年8月至2019年8月在我院行白内障超声乳化术联合旋转非对称折射型MIOL(SBL-3)植入术患者35例44眼,术后随访3个月。观察术前及术后3个月患者的裸眼远视力(uncorrected distance visual acuity,UDVA)、最佳矫正远视力(corrected distance visual acuity,CDVA)及患者术后3个月时的离焦曲线,小数视力均转换为logMAR视力表示;记录术前及术后明室及暗室下瞳孔直径(pupil diameter,PD)及kappa角,日夜瞳孔中心位移以及术后眼内像差。并将上述因素与患者术后UDVA、CDVA及离焦曲线中各屈光度对应的视力进行Spearman相关性分析。结果患者术后3个月时UDVA和CDVA LogMAR视力平均值为0.10(0.00~0.20)、0.00(0.00~0.20),均较术前明显提高,差异均有统计学意义(均为P<0.05);垂直彗差及垂直三叶草均较术前增大,差异均有统计学意义(均为P<0.05)。Spearman相关性分析显示,眼内水平三叶草差与-0.5 D及-1.0 D离焦水平处对应的logMAR视力相关系数分别为-0.377、-0.369(均为P<0.05),眼内垂直三叶草差与-2.5 D离焦水平对应的logMAR视力相关系数为-0.347(P<0.05),眼内总高阶像差与-0.5^-3.5 D离焦范围内对应的logMAR视力均呈负相关(均为P<0.05)。眼内球差与UDVA、-0.5^-2.0 D离焦水平对应的logMAR视力均呈正相关(均为P<0.05)。此外,术后明室kappa角与-0.5 D离焦水平对应的视力呈正相关(r=0.315,P<0.05)。结论SBL-3 MIOL由于其设计特点,植入眼内后会引入特定的高阶像差,包括三叶草差及彗差。其中,三叶草差的增加对全程视力具有正相关,而垂直彗差一定程度上影响了SBL-3 MIOL植入的术后远视力。Kappa角过大可能影响SBL-3 MIOL术后近视力。Objective To investigate the independent factors associated with distance,intermediate and near visual acuity in patients implanted with refractive rotationally asymmetric multifocal intraocular lens(MIOL).Methods A prospective study was conducted.Forty-four eyes of 35 patients who underwent unilateral cataract surgery,followed by implantation of rotationally asymmetric MIOLs(SBL-3)were included from Aug.2018 to Aug.2019,and were followed by 3 months.The uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),intraocular aberrations,mesopic and photopic pupil diameters,mesopic and photopic kappa angles,distance from the photopic to the mesopic pupil center were assessed before and 3 months after surgery.The spearman correlation analysis was performed on the above factors and the logMAR visual acuity(VA)of+1.0 diopter(D)to-4.0 D defocus,UDVA and CDVA.Results The average logMAR UDVA was 0.10(0.00~0.20)and average logMAR CDVA was 0.00(0.00~0.20)at 3 months postoperatively,both of which were significantly higher than those before surgery,and the differences were statistically significant(both P<0.05).Improvement in vertical coma and vertical trefoil were observed,with significant differences(both P<0.05).The horizontaltrefoil aberration was negatively correlated with logMAR VA corresponding to the defocus level of-0.5 D(r=-0.377,P<0.05)and-1.0 D(r=-0.369,P<0.05).The vertical trefoil aberration was negatively correlated with logMAR VA of-2.5 D defocus(r=-0.347,P<0.05).Total high-order aberration was negatively correlated with logMARVAcorresponding to the defocus level of-0.5 D to-3.5 D(all P<0.05).The intraocular spherical aberration was positively correlated with the UDVAand the vision corresponding to the defocus level of-0.5 to-2.0 D(all P<0.05).Furthermore,the positive correlation was observed between photopic kappa angle and logMAR VA of-0.5 D defocus(r=0.315,P<0.05).Conclusion Due to its design features,SBL-3 MIOL introduces specific higher-order aberrations after implantation into the ey

关 键 词：旋转非对称折射型多焦点人工晶状体 高阶像差 视力 

分 类 号：R776.1[医药卫生—眼科]