【摘要】 目的：比较白内障超声乳化联合植入Acrysof ResToR及Acrysof Natural的临床效果。方法：随机化临床试验，选择年龄性白内障患者，ReSTOR组 30例36眼，植入ReSTOR SA60D3衍射型多焦点人工晶状体( MIOL)，Natural组28例30眼，植入Natural SN60AT单焦点人工晶状体(SIOL)。观察术后未矫正远视力(UCDVA)、未矫正近视力(UCNVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、远矫正下的近视力(DCNVA)。中间距离视力(40,60,80cm)和视觉症状。结果：两组患者UCDVA，BCDVA和BCNVA无显著差异，术后ReSTOR组UCNVA，DCNVA及中间距离视力明显优于Natural组(P<0.05)。ReSTOR组术后4wk UCNVA，UCDVA明显优于1wk。术后12wk，ReSTOR组术后UCNVA优于中间距离视力(40cm)，差异有统计学意义。而中间距离视力之间(40与60cm;60与80cm)无统计学差异。ReSTOR组患者术后受眩光和光晕影响较Natural组明显(P<0.05)，但均可忍受。ReSTOR组戴镜率低于Natural组，差异有统计学意义(P<0.05)。结论：新型衍射型MIOL ReSTOR能提供良好的全程视力，有效减低患者对老视镜的依赖，提高白内障患者术后的视觉质量。
【关键词】 白内障超声乳化摘除术;多焦点;单焦点
Distant,near and intermediate vision of the apodized diffractive Acrysof ReSTOR multifocal intraocular lens
BaoYu Huang,ShaoJian Tan, Hao Liang,Xia Li
Foundation item:Guangxi Zhuang Autonomous Region Graduate Found Innovative Projects, China(No.2008105981002M182)
Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
AbstractAIM:To compare the clinical effects of Acrysof ReSTOR multifocal intraocular lens(IOL) and the monofocal Acrysof Natural IOL implantation after phacoemulsification.METHODS: Random clinical trial of 58 patients 66 eyes with agerelated cataract were divided into two groups: ReSTOR group included 30 patients 36 eyes implanted with ReSTOR SA60D3 multifocal IOL(MIOL),and Natural group included 28 patients 30 eyes implanted with Natural SN60AT monofocal IOL. Measurements were taken after operation, including uncorrected distant visual acuity (UCDVA), uncorrected near visual acuity(UCNVA), best corrected distant visual acuity(BCDVA), bestcorrected near visual acuity (BCNVA), distant corrected near visual acuity (DCNVA)， intermediate vision(40,60,80cm)and visual symptoms.
RESULTS: There was no significant difference in UCDVA,BCDVA,BCNVA between 2 groups. UCNVA,DCNVA and intermediate vision(40,60,80cm) were significantly higher in the ReSTOR group(P<0.05). In ReSTOR group the UCDVA、UCNVA at 4 weeks were significantly better than that of 1 week. At the 12 weeks postoperatively, UCNVA was significantly better than intermediate vision(40cm)in ReSTOR group and no statistical difference was noted between the intermediate vision(40 vs 60cm, 60 vs 80cm).Adverse symptoms such as glare and haloes were significantly more obvious in ReSTOR group than in Natural group(P<0.05) . The rate of dependence on glasses in the ReSTOR group was significantly lower than that of Natural group (P<0.05).CONCLUSION: Acrysof ReSTOR multifocal IOL provide excellent full range of vision, effectively decrease the dependence of glasses, improve the visual quality after surgery.
KEYWORDS: phacoemulsification; multifocal; monofocal
0引言
近年来，人们一直在为白内障术后如何获得更好的全程视力而努力。随着手术的日臻完美及IOL的推陈出新，人们发现植入(MIOL)能在不降低远视力的前提下获得较好的近视力。目前市面上最新型MIOL AcrySof ReSTOR SA60D3(Alcon Laboratories)是一种折射、衍射相结合的人工晶状体。我们自200804开始应用ReSTOR，并将其与Natural IOL的视力和视觉症状进行对比。
1对象和方法
1.1对象
选择200804/200903在我院行白内障超声乳化吸除联合人工晶状体植入的患者，按自愿选择植入(Acrysof Natural)或 (Acrysof ResToR)的原则分为两组，其中ReSTOR组30例36眼，植入ReSTOR SA60D3衍射型MIOL，男17例22眼，女13例14眼;Natural组28例30眼，植入Natural SN60AT SIOL，男18例19眼，女10例11眼。两组年龄、术前视力均无统计学差异。排除标准：角膜散光>1.50D;术前存在严重眼部病变患者;眼轴>26mm;既往曾接受屈光手术患者;需同时接受其他眼部手术患者;过分苛刻的患者;对术后效果抱有不切现实期望的患者;喜欢戴眼镜的患者。采用 SRKII公式进行计算人工晶状体的屈光度数,尽可能使术后屈光状态为正视。手术由同一人顺利完成。
1.2方法
表面麻醉下做 3.2mm透明角膜三面式切口，连续环形撕囊，水分离，晶状体囊袋内超声乳化晶状体核，自动灌注系统注吸残留晶状体皮质，推进器植入人工晶状体。全部手术过程顺利，无并发症发生术后1，4wk检查患者的未矫正远视力UCDVA和未矫正近视力UCNVA。术后12wk检查未矫正远视力(UCDVA)、未矫正近视力(UCNVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)、远矫正下的近视力(DCNVA)。其中UCNVA，BCNVA均在33cm处检测。中间距离视力(40,60,80cm)(使用the Radner Reading Charts[1]，视觉症状调查(采用五分制评估)[2]。
统计学分析:采用SPSS 13.0统计学软件分析，同一患者术后不同时期视力情况对比采用配对t检验，两组间比较采用独立样本t检验。P<0.05为有统计学意义。
2结果
术后1wk及4wk，ReSTOR组UCNVA优于Natural组，差异有统计学意义，两组UCDVA无统计学差异。术后12wk，ReSTOR组UCNVA,DCNVA优于Natural组，差异有统计学意义，两组UCDVA,BCDVA和BCNVA均无统计学差异(表1)。术后4wk ReSTOR组UCDVA，UCNVA优于术后1wk，差异有统计学意义。Natural组，术后1,4wk UCDVA,UCNVA无统计学差异。术后4wk与术后12wk比较，ReSTOR组和Natural组UCDVA，UCNVA差异均无统计学意义。术后12wk，ReSTOR组各距离中间距离视力均优于Natural组，差异有统计学意义(表2)。术后12wk，ReSTOR组术后UCNVA优于中间距离视力(40cm)，差异有统计学意义。而中间距离视力之间(40cm与60cm;60cm与80cm)无统计学差异。术后问卷调查视觉症 ReSTOR为1.6±0.52，Natural为1.1±0.32(t=2.611,P=0.018);眼镜依赖ReSTOR为1.5±0.53，Natural为2.5±0.53(t=4.243,P=0.000)。表1白内障超声乳化吸出联合人工晶状体植入术后视力情况(略)表2白内障超声乳化吸出联合人工晶状体植入术后12wk中间距离视力(略)
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