【摘要】 目的：评价ReSTOR +3D渐进衍射型多焦点人工晶状体植入术后临床效果。方法：收集我院200906/200911老年性白内障行白内障超声乳化联合Acrysof ReSTOR +3D人工晶状体植入手术患者32例48眼。术后连续随访3～6(平均4±1.5)mo。观察术后末次随访时裸眼远、中、近视力及最佳矫正远、中，近视力、脱镜率、人工晶状体的位置。结果：术后裸眼远视力为0.85±0.17，术后裸眼中距离视力为0.65±0.15，术后裸眼近视力为0.64±0.13，术后最佳矫正远视力为0.96±0.14，术后最佳矫正中距离视力为0.69±0.17，术后最佳矫正近视力为0.77±0.15。脱镜率为84%。裂隙灯检查见人工晶状体居中，无倾斜。随访期间未发现后发性白内障。结论：ReSTOR +3D衍射型多焦点人工晶状体能为患者提供满意的全程视力。
【关键词】 渐进衍射型多焦点;人工晶状体;ReSTOR +3D IOL
Preliminary result of ReSTOR +3D apodized diffractive multifocal IOL implantation
YingJie Lin, XianJun Liang, JinXian He, Jing Ye, MinZhuo Huo
Department of Ophthalmology, Foshan Hospital of TCM, Foshan 528000, Guangdong Province, China
Correspondence to: XianJun Liang. Department of Ophthalmology, Foshan Hospital of TCM, Foshan 528000, Guangdong Province, [email protected]
Received:20100622 Accepted:20100722
Abstract
AIM: To evaluate the visual performance of the Acrysof ReSTOR +3D intraocular lens (IOL) (SN6AD1, Alcon) implantation.
METHODS:Totally 32 patients 48 eyes were implanted with the Alcon ReSTOR +3D apodized diffractive multifocal IOL. The mean followup was 4±1.5 months(range form 3 to 6 months). Distant uncorrected , bestcorrected visual acuity; near uncorrected, bestcorrected visual acuity; intermediate visual acuity, bestcorrected visual acuity, spectacle independency and the position of the IOLs were observed.
RESULTS: Distance uncorrected visual acuity was 0.85±0.17 and distant bestcorrected visual acuity was 0.96±0.14. Near uncorrected visual acuity was 0.64±0.13 and near bestcorrected visual acuity was 0.77±0.15. Intermediate uncorrected visual acuity was 0.65±0.15 and intermediate bestcorrected visual acuity was 0.69±0.17. Spectacle independency was 84%. No tilt or decentration of the IOL were observed. Posterior capsular opacification was not found in the followup.
CONCLUSION: The Acrysof ReSTOR +3D IOL provides a satisfactory full range of vision.
KEYWORDS: apodized diffractive multifocal; intraocular lens; ReSTOR +3D IOL
Lin YJ,Liang XJ,He JX, et al. Preliminary result of ReSTOR +3D apodized diffractive multifocal IOL implantation. Int J Ophthalmol(Guoji
Yanke Zazhi) 2010;10(9):17501752
随着白内障手术和人工晶状体(intraocular lens,IOL)技术的提高，患者对术后视觉质量的要求也越来越高，患者期待通过植入人工晶状体即可获得满意的全程视力，而不需要依赖眼镜。文献表明， ReSTOR +4D非球面渐进衍射型多焦点人工晶状体(SN6AD3，美国爱尔康公司)为患者提供了良好的远距离及近距离视力，减少了患者对眼镜依赖[16]。为了使患者获得更好的中距离视力，ReSTOR +3D IOL (SN6AD1，美国爱尔康公司)非球面渐进衍射型多焦点人工晶状体基于ReSTOR +4D IOL的平台上进行了改良。ReSTOR +3D IOL与ReSTOR +4D IOL同样都有6mm的光学面、中央3.6mm渐进衍射环和一个外周折射带。衍射环渐进阶梯高度从中央向周边渐降，ReSTOR +3D IOL的9个阶梯比ReSTOR +4D IOL的12个阶梯更宽。ReSTOR+3D IOL在晶状体平面增加+3D IOL，相当于框架眼镜平面2.4D。其理念是希望通过使近点远移来提高中距离视力[1]。为观察植入非球面ReSTOR +3D IOL的疗效，现将我院200906/200911老年性白内障行白内障超声乳化联合Acrysof ReSTOR +3D IOL植入手术的结果报告如下。
1对象和方法
1.1对象
收集我院200906/200911老年性白内障行白内障超声乳化联合ReSTOR +3D衍射型多焦点人工晶状体植入手术患者32例48眼，男12例18眼，女20例30眼，年龄55～78(平均63±3.2)岁。所有入选患者均明确诊断为老年性白内障，排除糖尿病视网膜病变、青光眼、黄斑病变、高度近视眼、不规则瞳孔等;术眼角膜散光度数<1.00D。SRTT公式计算人工晶状体度数，目标屈光度为0～0.25D。图1 离焦曲线。
1.2方法
所有手术均由同一医师完成。常规进行白内障超声乳化,植入Acrysof ReSTOR +3D IOL于囊袋内，嘱患者注视显微镜光源，调整人工晶状体光学中心与角膜反光点重合。术后检查：术后3mo观察裸眼远、中、近视力(UCVA)及最佳矫正远、中、近视力(BCVA)，远视力检查距离为5m，采用标准对数视力表，以小数记录。中距离视力采用视力表，近视力采用标准对数近视力表。焦点深度：选择最佳矫正视力≥0.9的患眼进行焦点深度检查，检测术眼最佳矫正远视力后，在术眼前添加5.00～+3.00D球镜镜片，以0.5D递减。记录视力正好辨认到0.5视标时的离焦镜片屈光力的差值为焦点深度。将离焦镜片屈光力作为横坐标，视力作为纵坐标，绘制离焦曲线。裂隙灯检查观察人工晶状体的位置及眼前段情况[7]。
2结果
视力：术后裸眼远视力为0.85±0.17，术后裸眼中距离视力为0.65±0.15，术后裸眼近视力为0.64±0.13，术后最佳矫正远视力为0.96±0.14，术后最佳矫正中距离视力为0.69±0.17，术后最佳矫正近视力为0.77±0.15。脱镜率为84%。焦点深度：焦点深度为(4.61±0.87)D，平均患者最佳近视力距离为42±3.6cm。离焦曲线(图1)。脱镜率：84%患者在远、中、近距离完全脱镜。11%患者近距离和中距离视物偶然使用眼镜。97%患者视远不依赖眼镜，94%中距离不依赖眼镜，89%视近不依赖眼镜。异常光学症状：1眼(2% )有轻度夜间光晕及眩光现象，无1例发生严重的眩光及光晕。人工晶状体位置：术后随访3mo，裂隙灯检查见人工晶状体居中，无倾斜，未见囊袋皱缩，未发现后囊膜混浊。
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