非球面多焦点人工晶状体（SN6AD1）囊袋内植入术后的临床研究
发布时间：2018-08-22 15:13
【摘要】：目的：比较阶梯渐进衍射型非球面多焦点人工晶体SN6AD1(Multifocal intraocular lens, MIOL)和非球面单焦点人工晶体SN60WF (Monofocal intraocular lens, SIOL)囊袋内植入术后人工晶状体眼(intraoeularlens IOL)的视力、对比度视力、焦点深度(Depth of focus)、患者满意度以及人工晶体的偏心(Eccentric)状况和囊袋变化,探讨非球面多焦点人工晶体SN6AD1(SN6AD1MIOL)囊袋内植入术后的临床效果、MIOL偏心的发生率、发生机理和预防措施。 方法：在符合条件的单纯性年龄相关性白内障(Age-related Cataract)患者中选择36例52眼来进行观察：术中植入多焦点人工晶体者为MIOL组,共18例24眼；术中植入单焦点人工晶体者为SIOL组,共18例28眼。观察2组患者术后2-4月的视力并进行统计学分析：包括未矫正远视力(Uncorrected distance vision acuity,UCDVA)、最佳矫正远视力(Best corrected distance visual acuity,BCDVA)、未矫正近视力(uncorrected near visual acuity,UCNVA)、最佳矫正近视力(best corrected near visual acuity,BCNVA)、最佳矫正远视力下的近视力(distant corrected near visual acuity, DCNVA)、中间距离视力(intermediate vision acuity,IVA),对比度视力、角膜曲率、焦点深度(Depth of focus)、囊袋内IOL的偏心(Eccentric)状况,观察IOL偏心者的囊袋变化、IOL襻的情况,并对患者的视觉不良症状、戴镜率和术后满意度进行问卷调查。 结果：1、术后3月,MIOL组在未矫正远视力(UCDVA)、最佳矫正远视力(BCDVA)、最佳矫正近视力(BCNVA)方面与SIOL组相比差异无统计学意义(P0.05);但在未矫正近视力(UCNVA)、最佳矫正远视力下的近视力(DCNVA)方面,MIOL组与SIOL组相比差异有统计学意义,MIOL明显优于SIOL组(P0.05)。 2、焦点深度结果显示：MIOL组的焦点深度范围为4.50D,SIOL组范围仅为1.88D,两组比较差异有统计学意义(P0.05)。 3、对比度视力：最佳矫正远视力100%、25%对比度下MIOL组的视力与SIOL组基本接近,10%对比度下MIOL组的视力低于SIOL组,两组相比差异有统计学意义(P0.05),5%对比度视力两组患者无明显差别。中距离视力高低对比度比较,MIOL组相差三行及以下者14眼(58.3%)(正常视力人群近视力高低对比度相差三行左右)。近视力MIOL组汉字视力100%对比度能阅读字号8pt以下的21眼(87.5%),10%对比度能阅读字号8pt以下的12眼(50%)(报纸正文和杂志相当于9pt,文字越大其字号也越大)。最佳矫正远视力下的近视力：100%对比度MIOL组(0.093±0.171)明显好于SIOL组(0.541±0.169),10%对比度MIOL组(0.467±0.169)稍好于SIOL组(0.739±0.159)(以上视力均为logMAR视力)。 4、人工晶体偏心方面,MIOL有6例在术后2-4月偏心值≥0.5mm,其中3例≥1mm。SIOL组有8例患者偏心值≥0.5mm,通过问卷调查发现这些患者术后均存在着视觉不良症状,部分患者视远视近均不清楚。两组患者术后的视觉不良症状,均主要表现为眩光、光晕、视物模糊、视物晃动等,且两组患者发生率相当。不良视觉症状方面MIOL组患者表现更明显(PO.05),其中3例患者在术后3个月时仍然觉视物时有轻微不适感,视远视近均较模糊。在看近处时MIOL组的“戴镜率”明显低于SIOL组,两组相比差异有统计学意义(P0.05)。 结论：阶梯渐进衍射型非球面多焦点人工晶体(SN6AD1MIOL)完全囊袋内植入术后能为大多数患者提供良好的远、中、近全程视力,使患者术后的视功能和生活质量得到了明显的改善,降低了患者对老视镜的依赖。随着MIOL临床应用的日益广泛,部分患者表现出视物模糊、偏心等问题,也引起了人们的广泛关注。新一代多焦点人工晶体(SN6AD1MIOL)居中性良好,偏心的发生率与同种材质的单焦点人工晶体相比无提高,但其偏心时表现出的视觉不良症状明显比单焦组更严重,偏心时患者视远、视近均不清楚,戴眼镜后患者视力有所提高但其主观感觉仍然不满意,故在植入MIOL前应注意对适应症的选择,术中保证撕囊连续、完整,彻底吸净晶体皮质是保持晶体居中性的关键因素。
[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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6
本文编号：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.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6
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