摘要
目的探讨超声乳化白内障吸除术中不同类型人工晶状体(IOL)植入对患者术后视觉质量和视功能的影响。方法回顾性分析2021年12月至2023年5月山东第一医科大学附属人民医院眼科行超声乳化白内障吸除术的单眼白内障患者临床资料,按照植入IOL的类型分为单焦组、双焦组和景深延长组。术后3个月检测患者裸眼远、中、近视力和矫正远、中、近视力;采用视功能分析仪测量患者对比敏感度和全眼波前像差;采用医院自制满意度调查表评估视觉质量满意度。结果共纳入92例患者,男31例,女61例,年龄(61.8±5.2)岁。单焦组43例,双焦组28例,景深延长组21例,各组间临床基线资料比较差异均无统计学意义(均P>0.05)。景深延长组裸眼中、远视力(1.01±0.13、0.92±0.18)和矫正中、远视力(1.21±0.19、1.20±0.23)高于单焦组(裸眼中、远视力:0.62±0.12、0.74±0.13;矫正中、远视力:1.02±0.17、1.07±0.19)和双焦组(裸眼中、远视力:0.67±0.15、0.78±0.14;矫正中、远视力:1.01±0.16、1.01±0.18),等效球镜绝对值[(-0.42±0.07)D]小于单焦组[(-0.49±0.05)D]和双焦组[(-0.45±0.08)D](均P<0.05);双焦组裸眼近视力(0.91±0.18)和矫正近视力(1.25±0.18)高于景深延长组(0.63±0.24、1.19±0.17)(均P<0.05)。三组患者明视状态下以及单焦组和双焦组暗视状态下对比敏感度比较,差异均无统计学意义(均P>0.05),景深延长组暗视状态下3.0、6.0和12.0周期/度(c/d)下的对比敏感度更高(均P<0.05)。双焦组和景深延长组眼部不适得分均高于单焦组,双焦组高于景深延长组(均P<0.05);双焦组视觉干扰得分低于单焦组和景深延长组(均P<0.05);双焦组和景深延长组主观感受得分和阅读得分均高于单焦组,双焦组阅读得分高于景深延长组(均P<0.05)。三组患者总低阶像差比较差异无统计学意义(P=0.472)。与单焦组[(0.74±0.35)μm、(0.41±0.12)μm]比较,双焦组[(0.61±0.21)μm、(0.22±0.09)μm]和景深延长组[(0.46±0.13)μm、(0.06±0.09)μm]总像差和总高阶像差均较低(均P<0.05);与双焦组比较,景深延长组总像差和总高阶像差均较低(均P<0.05)。结论景深延长IOL植入能提高白内障患者术后视程范围、暗视力和对比敏感度,有效改善术后视觉质量和视功能。双焦IOL可更好地改善患者裸眼和矫正近视力,患者视觉质量满意度高。
Objective To explore the effects of different types of intraocular lens(IOL)implantation on patient′s visual quality and function after phacoemulsification.Methods The clinical data of patients with monocular cataract who underwent phacoemulsification in the Department of Ophthalmology,People′s Hospital Affiliated to Shandong First Medical University between December 2021 and May 2023 were retrospectively analyzed.According to the types of IOL,the patients were divided into monofocal group,bifocal group and depth of focus extension group.Three months later,uncorrected distance visual acuity(UCDVA),best corrected distance visual acuity(BCDVA),uncorrected intermediate visual acuity(UCIVA),best corrected intermediate visual acuity(BCIVA),uncorrected near visual acuity(UCNVA)and best corrected near visual acuity(BCNVA)were detected.Contrast sensitivity and total wavefront aberration were measured by visual function analyzer.Satisfaction with visual quality was evaluated by hospital-made satisfaction questionnaire.Results A total of 92 patients were included,with 31 males and 61 females,and their age was(61.8±5.2)years.There were 43,28 and 21 cases in monofocal group,bifocal group and depth of focus extension group,respectively.No statistically significant difference was found in clinical baseline data among the three groups.UCIVA,UCDVA,BCIVA and BCDVA in depth of focus extension group were 1.01±0.13,0.92±0.18,1.21±0.19 and 1.20±0.23,respectively,which were higher than those in monofocal group(0.62±0.12,0.74±0.13,1.02±0.17,1.07±0.19,respectively)and bifocal group(0.67±0.15,0.78±0.14,1.01±0.16,1.01±0.18,respectively),while absolute value of spherical equivalent[(-0.42±0.07)D]was lower than that in the other two groups[(-0.49±0.05)D and(-0.45±0.08)D](both P<0.05).UCNVA and BCNVA in bifocal group were 0.91±0.18 and 1.25±0.18,which were higher than those in depth of focus extension group(0.63±0.24 and 1.19±0.17)(both P<0.05).There were no significant differences in contrast sensitivity among the three groups under day vision or between monofocal group and bifocal group under night vision(all P>0.05),but the contrast sensitivity was higher in depth of focus extension group under night vision(3.0,6.0,12.0 c/d)than other two groups(all P<0.05).The score of ocular discomfort was the highest in bifocal group,followed by depth of focus extension group and monofocal group(both P<0.05).The score of visual interference in bifocal group was lower than that in monofocal group and depth of focus extension group(both P<0.05).The scores of subjective feeling in bifocal group and depth of focus extension group were higher than that in monofocal group(both P<0.05).The reading score was the highest in bifocal group,followed by depth of focus extension group and monofocal group(both P<0.05).There was no significant difference in total low-order aberration among the three groups(P=0.472).The total aberration and higher-order aberration[(0.74±0.35)μm and(0.41±0.12)μm]were the highest in monofocal group,followed by bifocal group[(0.61±0.21)μm and(0.22±0.09)μm]and depth of focus extension group[(0.46±0.13)μm and(0.06±0.09)μm](all P<0.05).Conclusions IOL implantation with depth of focus extension can enhance visual range,night vision and contrast sensitivity,and thus effectively improve postoperative visual quality and function in cataract patients.The bifocal IOL can better improve the patient′s UCNVA and BCNVA,resulting in high satisfaction with visual quality.
作者
王建民
车敬斌
袁祥文
张加宾
Wang Jianmin;Che Jingbin;Yuan Xiangwen;Zhang Jiabin(Department of Ophthalmology,People′s Hospital Affiliated to Shandong First Medical University,Jinan 271199,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第16期1391-1396,共6页
National Medical Journal of China
