非球面多焦點人工晶狀體（SN6AD1）囊袋內(nèi)植入術(shù)后的臨床研究
發(fā)布時間：2018-08-22 15:13
【摘要】：目的：比較階梯漸進衍射型非球面多焦點人工晶體SN6AD1(Multifocal intraocular lens, MIOL)和非球面單焦點人工晶體SN60WF (Monofocal intraocular lens, SIOL)囊袋內(nèi)植入術(shù)后人工晶狀體眼(intraoeularlens IOL)的視力、對比度視力、焦點深度(Depth of focus)、患者滿意度以及人工晶體的偏心(Eccentric)狀況和囊袋變化,探討非球面多焦點人工晶體SN6AD1(SN6AD1MIOL)囊袋內(nèi)植入術(shù)后的臨床效果、MIOL偏心的發(fā)生率、發(fā)生機理和預(yù)防措施。 方法：在符合條件的單純性年齡相關(guān)性白內(nèi)障(Age-related Cataract)患者中選擇36例52眼來進行觀察：術(shù)中植入多焦點人工晶體者為MIOL組,共18例24眼；術(shù)中植入單焦點人工晶體者為SIOL組,共18例28眼。觀察2組患者術(shù)后2-4月的視力并進行統(tǒng)計學分析：包括未矯正遠視力(Uncorrected distance vision acuity,UCDVA)、最佳矯正遠視力(Best corrected distance visual acuity,BCDVA)、未矯正近視力(uncorrected near visual acuity,UCNVA)、最佳矯正近視力(best corrected near visual acuity,BCNVA)、最佳矯正遠視力下的近視力(distant corrected near visual acuity, DCNVA)、中間距離視力(intermediate vision acuity,IVA),對比度視力、角膜曲率、焦點深度(Depth of focus)、囊袋內(nèi)IOL的偏心(Eccentric)狀況,觀察IOL偏心者的囊袋變化、IOL襻的情況,并對患者的視覺不良癥狀、戴鏡率和術(shù)后滿意度進行問卷調(diào)查。 結(jié)果：1、術(shù)后3月,MIOL組在未矯正遠視力(UCDVA)、最佳矯正遠視力(BCDVA)、最佳矯正近視力(BCNVA)方面與SIOL組相比差異無統(tǒng)計學意義(P0.05);但在未矯正近視力(UCNVA)、最佳矯正遠視力下的近視力(DCNVA)方面,MIOL組與SIOL組相比差異有統(tǒng)計學意義,MIOL明顯優(yōu)于SIOL組(P0.05)。 2、焦點深度結(jié)果顯示：MIOL組的焦點深度范圍為4.50D,SIOL組范圍僅為1.88D,兩組比較差異有統(tǒng)計學意義(P0.05)。 3、對比度視力：最佳矯正遠視力100%、25%對比度下MIOL組的視力與SIOL組基本接近,10%對比度下MIOL組的視力低于SIOL組,兩組相比差異有統(tǒng)計學意義(P0.05),5%對比度視力兩組患者無明顯差別。中距離視力高低對比度比較,MIOL組相差三行及以下者14眼(58.3%)(正常視力人群近視力高低對比度相差三行左右)。近視力MIOL組漢字視力100%對比度能閱讀字號8pt以下的21眼(87.5%),10%對比度能閱讀字號8pt以下的12眼(50%)(報紙正文和雜志相當于9pt,文字越大其字號也越大)。最佳矯正遠視力下的近視力：100%對比度MIOL組(0.093±0.171)明顯好于SIOL組(0.541±0.169),10%對比度MIOL組(0.467±0.169)稍好于SIOL組(0.739±0.159)(以上視力均為logMAR視力)。 4、人工晶體偏心方面,MIOL有6例在術(shù)后2-4月偏心值≥0.5mm,其中3例≥1mm。SIOL組有8例患者偏心值≥0.5mm,通過問卷調(diào)查發(fā)現(xiàn)這些患者術(shù)后均存在著視覺不良癥狀,部分患者視遠視近均不清楚。兩組患者術(shù)后的視覺不良癥狀,均主要表現(xiàn)為眩光、光暈、視物模糊、視物晃動等,且兩組患者發(fā)生率相當。不良視覺癥狀方面MIOL組患者表現(xiàn)更明顯(PO.05),其中3例患者在術(shù)后3個月時仍然覺視物時有輕微不適感,視遠視近均較模糊。在看近處時MIOL組的“戴鏡率”明顯低于SIOL組,兩組相比差異有統(tǒng)計學意義(P0.05)。 結(jié)論：階梯漸進衍射型非球面多焦點人工晶體(SN6AD1MIOL)完全囊袋內(nèi)植入術(shù)后能為大多數(shù)患者提供良好的遠、中、近全程視力,使患者術(shù)后的視功能和生活質(zhì)量得到了明顯的改善,降低了患者對老視鏡的依賴。隨著MIOL臨床應(yīng)用的日益廣泛,部分患者表現(xiàn)出視物模糊、偏心等問題,也引起了人們的廣泛關(guān)注。新一代多焦點人工晶體(SN6AD1MIOL)居中性良好,偏心的發(fā)生率與同種材質(zhì)的單焦點人工晶體相比無提高,但其偏心時表現(xiàn)出的視覺不良癥狀明顯比單焦組更嚴重,偏心時患者視遠、視近均不清楚,戴眼鏡后患者視力有所提高但其主觀感覺仍然不滿意,故在植入MIOL前應(yīng)注意對適應(yīng)癥的選擇,術(shù)中保證撕囊連續(xù)、完整,徹底吸凈晶體皮質(zhì)是保持晶體居中性的關(guān)鍵因素。
[Abstract]:Objective: To compare the visual acuity, contrast visual acuity, depth of focus (Depth of focus) of intraocular lens IOL (IOL) after stepped progressive diffraction aspheric multifocal intraocular lens (MIOL) and non-spherical monofocal intraocular lens (SIOL) capsular implantation. To investigate the clinical effect, incidence, mechanism and preventive measures of misalignment of aspheric multifocal intraocular lens SN6AD1 (SN6AD1MIOL) after intracapsular lens implantation.
Methods: Fifty-two eyes of 36 patients with Age-related cataract were selected and observed. Multifocal intraocular lens implantation was performed in MIOL group (18 cases, 24 eyes) and single-focal intraocular lens implantation was performed in SIOL group (18 cases, 28 eyes). Statistical analysis: Uncorrected distance vision acuity (UCDVA), Best corrected distance vision acuity (BCDVA), uncorrected near visual acuity (UCNVA), best corrected near visual acuity (BCNVA), and best corrected near visual acuity (BCNVA) were included. Distant corrected near visual acuity (DCNVA), intermediate visual acuity (IVA), contrast vision, corneal curvature, Depth of focus, Eccentric IOL in the capsule, changes in the capsule, IOL loops, and visual symptoms, wearing rate and surgery in patients with IOL eccentricity were observed. Questionnaire survey was conducted after satisfaction.
Results: 1. There was no significant difference in uncorrected far vision (UCDVA), best corrected far vision (BCDVA) and best corrected near vision (BCNVA) between MIOL group and SIOL group at 3 months after operation (P 0.05), but there was significant difference in uncorrected near vision (UCNVA) and best corrected near vision (DCNVA) between MIOL group and SIOL group. MIOL was significantly better than group SIOL (P0.05).
2. The results of focal depth showed that the range of focal depth in MIOL group was 4.50D and that in SIOL group was only 1.88D. There was significant difference between the two groups (P 0.05).
3. Contrast vision: the best corrected distant vision was 100%. The visual acuity of MIOL group was close to that of SIOL group at 25% contrast. The visual acuity of MIOL group at 10% contrast was lower than that of SIOL group. There was significant difference between the two groups (P 0.05). There was no significant difference in 5% contrast vision between the two groups. 14 eyes (58.3%) in the MIOL group were able to read 21 eyes (87.5%) with a 100% contrast of Chinese characters and 12 eyes (50%) with a 10% contrast of less than 8 Pt (newspaper and magazine equivalent to 9 pt, the larger the text, the larger the font size). Near vision: 100% contrast MIOL group (0.093.171) was significantly better than SIOL group (0.541.169), 10% contrast MIOL group (0.467.169) was slightly better than SIOL group (0.739.159).
4. For IOL eccentricity, there were 6 MIOL patients whose IOL eccentricity was greater than or equal to 0.5mm in 2-4 months after surgery, and 8 patients whose IOL eccentricity was greater than or equal to 1 mm in 3 SIOL patients. The results of questionnaire survey showed that all of these patients had poor vision symptoms after surgery, and some of them were not clear about hyperopia and myopia. The incidence of adverse visual symptoms in MIOL group was more obvious (PO.05). Three of them had slight discomfort when they still felt the object at 3 months after surgery, and the myopia and hyperopia were all blurred. The "wearing rate" of MIOL group was significantly lower than that of SIOL group at the near point. The difference was statistically significant (P0.05).
Conclusion: Stepped progressive diffraction aspheric multifocal intraocular lens (SN6AD1MIOL) implantation can provide good long-term, middle-term and near-term visual acuity for the majority of patients, which can significantly improve the visual function and quality of life of patients after surgery and reduce the dependence of patients on old glasses. The new generation of multifocal intraocular lens (SN6AD1MIOL) has good neutrality. The incidence of eccentricity has not been improved compared with monofocal intraocular lens of the same material, but the symptoms of poor vision are more serious and eccentric than monofocal intraocular lens. The patient's visual acuity was improved after wearing glasses, but his subjective feeling was still unsatisfactory. Therefore, we should pay attention to the choice of indications before implanting MIOL. Continuous and complete capsulorhexis and thorough absorption of lens cortex were the key factors to maintain lens neutrality.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.6
本文編號：2197486
[Abstract]:Objective: To compare the visual acuity, contrast visual acuity, depth of focus (Depth of focus) of intraocular lens IOL (IOL) after stepped progressive diffraction aspheric multifocal intraocular lens (MIOL) and non-spherical monofocal intraocular lens (SIOL) capsular implantation. To investigate the clinical effect, incidence, mechanism and preventive measures of misalignment of aspheric multifocal intraocular lens SN6AD1 (SN6AD1MIOL) after intracapsular lens implantation.
Methods: Fifty-two eyes of 36 patients with Age-related cataract were selected and observed. Multifocal intraocular lens implantation was performed in MIOL group (18 cases, 24 eyes) and single-focal intraocular lens implantation was performed in SIOL group (18 cases, 28 eyes). Statistical analysis: Uncorrected distance vision acuity (UCDVA), Best corrected distance vision acuity (BCDVA), uncorrected near visual acuity (UCNVA), best corrected near visual acuity (BCNVA), and best corrected near visual acuity (BCNVA) were included. Distant corrected near visual acuity (DCNVA), intermediate visual acuity (IVA), contrast vision, corneal curvature, Depth of focus, Eccentric IOL in the capsule, changes in the capsule, IOL loops, and visual symptoms, wearing rate and surgery in patients with IOL eccentricity were observed. Questionnaire survey was conducted after satisfaction.
Results: 1. There was no significant difference in uncorrected far vision (UCDVA), best corrected far vision (BCDVA) and best corrected near vision (BCNVA) between MIOL group and SIOL group at 3 months after operation (P 0.05), but there was significant difference in uncorrected near vision (UCNVA) and best corrected near vision (DCNVA) between MIOL group and SIOL group. MIOL was significantly better than group SIOL (P0.05).
2. The results of focal depth showed that the range of focal depth in MIOL group was 4.50D and that in SIOL group was only 1.88D. There was significant difference between the two groups (P 0.05).
3. Contrast vision: the best corrected distant vision was 100%. The visual acuity of MIOL group was close to that of SIOL group at 25% contrast. The visual acuity of MIOL group at 10% contrast was lower than that of SIOL group. There was significant difference between the two groups (P 0.05). There was no significant difference in 5% contrast vision between the two groups. 14 eyes (58.3%) in the MIOL group were able to read 21 eyes (87.5%) with a 100% contrast of Chinese characters and 12 eyes (50%) with a 10% contrast of less than 8 Pt (newspaper and magazine equivalent to 9 pt, the larger the text, the larger the font size). Near vision: 100% contrast MIOL group (0.093.171) was significantly better than SIOL group (0.541.169), 10% contrast MIOL group (0.467.169) was slightly better than SIOL group (0.739.159).
4. For IOL eccentricity, there were 6 MIOL patients whose IOL eccentricity was greater than or equal to 0.5mm in 2-4 months after surgery, and 8 patients whose IOL eccentricity was greater than or equal to 1 mm in 3 SIOL patients. The results of questionnaire survey showed that all of these patients had poor vision symptoms after surgery, and some of them were not clear about hyperopia and myopia. The incidence of adverse visual symptoms in MIOL group was more obvious (PO.05). Three of them had slight discomfort when they still felt the object at 3 months after surgery, and the myopia and hyperopia were all blurred. The "wearing rate" of MIOL group was significantly lower than that of SIOL group at the near point. The difference was statistically significant (P0.05).
Conclusion: Stepped progressive diffraction aspheric multifocal intraocular lens (SN6AD1MIOL) implantation can provide good long-term, middle-term and near-term visual acuity for the majority of patients, which can significantly improve the visual function and quality of life of patients after surgery and reduce the dependence of patients on old glasses. The new generation of multifocal intraocular lens (SN6AD1MIOL) has good neutrality. The incidence of eccentricity has not been improved compared with monofocal intraocular lens of the same material, but the symptoms of poor vision are more serious and eccentric than monofocal intraocular lens. The patient's visual acuity was improved after wearing glasses, but his subjective feeling was still unsatisfactory. Therefore, we should pay attention to the choice of indications before implanting MIOL. Continuous and complete capsulorhexis and thorough absorption of lens cortex were the key factors to maintain lens neutrality.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R779.6
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