高度近视合并白内障患者不同IOL植入方案的术后视觉质量评估

Postoperative visual acuity assessment of different intraocular lens implantation regimens in patients with high myopia and cataract

摘要:

目的：对双眼微单视植入Tecnis Symfony人工晶状体(IOL)、混合植入Tecnis Symfony IOL与Tecnis ZMB00多焦点IOL、双眼植入AcrySof IQ PanOptix IOL的高度近视合并白内障患者，进行视觉质量评估。方法：采用前瞻性非随机对照研究，选取2020-08/2022-03于包头医学院第一附属医院行双眼超声乳化吸除联合IOL植入术的高度近视合并白内障患者。依据患者所选植入IOL方案不同，分为微单视组、混搭组及三焦组。术后随访3mo，观察指标：术后3mo未矫正远(5m)、中(80、60cm)、近(33cm)距离视力，对比敏感度(CS)，未矫正远视力下的离焦曲线，主观视觉质量评分，术后1、3mo光干扰现象。结果：术后3mo三组未矫正远(5m)、中(60cm)距离视力均无差异(P>0.05)； 微单视组未矫正中(80cm)距离视力与混搭组相近，且均优于三焦组(P<0.05)； 混搭组未矫正近(33cm)距离视力表现最好，三焦组次之，微单视组最低(均P<0.05)。三焦组暗光加眩光CS(12、18c/d)最优秀，混搭组次之，微单视组最低(均P<0.05)。术后3mo离焦曲线显示在+1.00～-3.00D跨度上，三组视力均优于0.3LogMAR； 在-1.00～-1.25D跨度上，混搭组和微单视组视力优于三焦组(均P<0.05)； 在-3.00～-3.50D跨度上，混搭组视力最好，三焦组次之，微单视组最低(均P<0.05)。术后3mo三组主观视觉质量评分均无差异(P>0.05)。术后1mo微单视组光干扰现象高于其它两组(P<0.05)，术后3mo三组光干扰现象均降低，但差异无统计学意义(P>0.05)。结论：三种IOL植入方案均能为高度近视合并白内障患者提供优秀的视觉质量，微单视组和混搭组在-1.00～-1.25D跨度上，中视力更优秀，并且混搭组在-3.00～-3.50D跨度上，表现出最佳的近视力。虽然通过微单视设计可以弥补Symfony IOL近视力不足的弱点，但仍较混搭组及三焦组差。

Abstract:

AIM: To evaluate the visual quality of patients with high myopia and cataract who received micro binocular single vision implantation of Tecnis Symfony intraocular lens(IOL), hybrid implantation of Tecnis Symfony IOL and Tecnis ZMB00 multifocal IOL, and binocular implantation of AcrySof IQ Panoptix IOL.METHODS: A prospective non-randomized controlled study was conducted to select patients with high myopia and cataract who underwent phacoemulsification combined with IOL implantation in the First Affiliated Hospital of Baotou Medical College from August 2020 to March 2022. According to the different IOL implantation schemes selected by patients, they are divided into micro single vision group, hybrid group and trifocal group. The postoperative follow-up was 3mo. The observation indexes included uncorrected far(5m), middle(80, 60cm)and near(33cm)visual acuity at 3mo after operation, contrast sensitivity(CS), uncorrected defocus curve under far vision, subjective visual quality score and light interference at 1 and 3mo after operation.RESULTS: There was no significant difference among the three groups in uncorrected far(5m)and middle(60cm)visual acuity at 3mo after operation(P<0.05); Uncorrected middle(80cm)distance visual acuity in the micro single vision group was similar to that in the hybrid group, and both were better than that in the trifocal group(P<0.05); Uncorrected near(33cm)distance vision of the hybrid group showed the best, followed by the trifocal group, and the lowest was in the micro single vision group(all P<0.05). The CS of dark light plus glare(12, 18c/d)was the best in the trifocal group, followed by the hybrid group, and the lowest was in the micro single vision group(all P<0.05). The defocus curve at 3mo after operation showed a span of +1.00～-3.00D, and the visual acuity of the three groups was better than 0.3 LogMAR; In the span of -1.00～-1.25D, the visual acuity of the hybrid group and micro single vision group was better than that of the trifocal group(all P<0.05); In the span of -3.00～-3.50D, the visual acuity of the hybrid group was the best, followed by trifocal group, and the lowest was in the micro single vision group(all P<0.05). At 3mo after operation, there was no significant difference in subjective visual quality scores among the three groups(P<0.05). Light interference in the micro single vision group was higher than that of the other two groups at 1mo after operation(P<0.05), and it decreased in the three groups at 3mo after operation, with no statistical significance(P<0.05).CONCLUSION: The three IOL implantation schemes can provide excellent visual quality for patients with high myopia and cataract. The vision of the micro single vision group and the hybrid group is better in the span of -1.00～-1.25D, and the hybrid group performs the best near vision in the span of -3.00～-3.50D. Although the design of micro single vision can make up for the weakness of Symfony IOL's lack of near vision, it is still worse than the hybrid group and the trifocal group.