飞秒激光辅助白内障手术联合三焦点人工晶状体植入术的疗效观察
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摘要
目的:观察飞秒激光辅助白内障手术联合三焦点人工晶状体(IOL)植入术后的临床疗效。方法:回顾性自身前后对照研究。选择2016-09/2017-11就诊于山西省眼科医院植入三焦点IOL的白内障患者42例59眼,随访至术后6mo,分别观察术前、术后1wk,1、3、 6mo单眼裸眼远、中、近距离视力(LogMAR)、离焦曲线、屈光稳定性、高阶像差、患者满意度和脱镜率。结果:所有患者在术后各随访时间点远、中、近距离均可获得优于0.1LogMAR的良好视力,术后各距离视力与术前相比显著提高(P<0.05)。术后6mo离焦曲线在0～-2.5D之间曲线过渡平缓,术眼达到优于0.8的视力水平。术后6mo,63%(37眼)的患眼SE位于±0.25D之间,88%(52眼)的患眼SE则位于±0.50D之间。术后各时期全眼的总高阶像差、彗差、球差、三叶草像差明显低于术前(P<0.05)。结论:飞秒激光辅助白内障手术联合三焦点IOL植入术可以为患者提供舒适自然的全程视力,实现真正的脱镜,患者术后满意度高。
?AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens(IOL) implantation.?METHODS:From September 2016 to November 2017, 42 cases(59 eyes) of cataract patients receiving trifocal IOL implantation in Shanxi Eye Hospital were retrospectively enrolled in this study. Moreover, the visual and refractive outcomes, defocus curve, refractive stability, high order aberrations, patient satisfaction, and spectacle independence were evaluated at 1 wk, 1 mo, 3 mo and 6 mo after surgery, respectively.?RESULTS: All patients had attained good visual acuity of >0.1 LogMAR at different distances during the follow-up period; besides, the visual acuity at each distance was remarkably higher compared with that before surgery(P<0.05). The defocus curve had displayed no significant decrease between 0 D to-2.5 D at 6 mo postoperatively, with the visual acuity better than 0.8. At 6 mo postoperatively, 63%(37 eyes) eyes had a spherical equivalent(SE) of ±0.25 D, and 88%(52 eyes) eyes had a SE of ±0.50 D. The incidences of high order aberrations, coma, spherical aberration and trefoil of all eyes were evidently lower than those before surgery, and the difference was statistically significant(P<0.05). ?CONCLUSION: Femtosecond laser-assisted cataract surgery combined with trifocal IOL implantation can provide patient with a comfortable and natural full-range vision, which can greatly improve the postoperative satisfaction of patients.
?AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens(IOL) implantation.?METHODS:From September 2016 to November 2017, 42 cases(59 eyes) of cataract patients receiving trifocal IOL implantation in Shanxi Eye Hospital were retrospectively enrolled in this study. Moreover, the visual and refractive outcomes, defocus curve, refractive stability, high order aberrations, patient satisfaction, and spectacle independence were evaluated at 1 wk, 1 mo, 3 mo and 6 mo after surgery, respectively.?RESULTS: All patients had attained good visual acuity of >0.1 LogMAR at different distances during the follow-up period; besides, the visual acuity at each distance was remarkably higher compared with that before surgery(P<0.05). The defocus curve had displayed no significant decrease between 0 D to-2.5 D at 6 mo postoperatively, with the visual acuity better than 0.8. At 6 mo postoperatively, 63%(37 eyes) eyes had a spherical equivalent(SE) of ±0.25 D, and 88%(52 eyes) eyes had a SE of ±0.50 D. The incidences of high order aberrations, coma, spherical aberration and trefoil of all eyes were evidently lower than those before surgery, and the difference was statistically significant(P<0.05). ?CONCLUSION: Femtosecond laser-assisted cataract surgery combined with trifocal IOL implantation can provide patient with a comfortable and natural full-range vision, which can greatly improve the postoperative satisfaction of patients.
引文
1 Shen Z,Lin Y,Zhu Y,et al.Clinical comparison of patient outcomes following implantation of trifocal or bifocal intraocular lenses:a systematic review and meta-analysis.Sci Rep 2017;7:45337
2王文莹,王军,张晶,等.多焦点与单焦点非球面人工晶状体植入后视觉质量的临床观察.中华眼科杂志 2010;46(8):686-690
3 Torun Acar B,Duman E,Simsek S.Clinical outcomes of a new diffractive trifocal intraocular lens with Enhanced Depth of Focus (EDOF).BMC Ophthalmol 2016;16(1):208
4 Kretz FT,Müller M,Gerl M,et al.Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens.BMC Ophthalmol 2015;15(1):110
5 Rick P,Gunnar GK.Comparison of visual outcomes and subjective visual quality after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of apodized diffractive bifocal intraocular lenses.Clin Ophthalmol 2016;10:805-811
6 Rabsilber TM,Kretz FTA,Holzer MP,et al.Bilateral implantation of toric multifocal additive intraocular lenses in pseudophakic eyes.J Cataract Refract Surg 2012;38(8):1495-1498
7肖雪冰,乌兰,栾多,等.三焦点人工晶状体植入术后的早期临床效果.中华眼视光学与视觉科学杂志2017;19(5):311-314
8中华医学会眼科学分会白内障及人工晶状体学组.我国飞秒激光辅助白内障摘除手术规范专家共识(2018年).中华眼科杂志2018;54(5):328-333
9 Mojzis P,Pena-García P,Liehneova I,et al.Outcomes of a new diffractive trifocal intraocular lens.J Cataract Refract Surg 2014;40(1):60-69
10 Cochener B,Vryghem J,Rozot P,et al.Visual and refractive outcomes after implantation of a fully diffractive trifocal lens.Clin Ophthalmol 2012;6:1421-1427
11王思聪,朱怡,袁景,等.三焦点与双焦点人工晶状体临床应用效果的Meta分析.中华眼外伤职业眼病杂志 2017;39(3):232-237
12 Nagy Z,Takacs A,Filkorn T,et al.Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery.J Refract Surg 2009;25(12):1053-1060
13田芳,张红,李筱荣.飞秒激光辅助超声乳化白内障吸除术的初步观察.中华眼科杂志 2014;50(2):133-136
14 Conradhengerer I,Hengerer FH,Schultz T,et al.Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery.J Refract Surg 2012;28(12):879-883
15 Palanker DV,Blumenkranz MS,Andersen D,et al.Femtosecond Laser-Assisted Cataract Surgery with Integrated Optical Coherence Tomography.Sci Transl Med 2010;2(58):58-85
16 Nagy Z,Takacs A,Filkorn T,et al.Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery.J Refract Surg 2009;25(12):1053-1060
17 Kránitz K,Miháltz K,Sándor GL,et al.Intraocular lens tilt and decentration measured by scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy.J Refract Surg 2012;28(4):259-263
18张哲,张素华,曹伟芳,等.飞秒激光超声乳化白内障吸除术与2.2mm同轴微切口超声乳化白内障吸除术早期临床效果对比.中华眼视光学与视觉科学杂志2015;17(11):679-684
19 Kretz FT,Choi CY,Mailer M,et al.Visual outcomes,patient satisfaction and spectacle independence with a trifocal diffractive intraocular lens.Korean J Ophthalmol 2016;30(3):180-191
20 Mojzis P,Kukuckova L,Majerova K,et al.Comparative Analysis of the Visual Performance After Cataract Surgery With Implantation of a Bifocal or Trifocal Diffractive IOL.J Refract Surg 2014;30(10):666-672
21 Xu Z,Cao D,Chen X,et al.Comparison of clinical performance between trifocal and bifocal intraocular lenses:A meta-analysis.PloS One 2017;12(10):e0186522
22 Lindstrom RL,Macrae SM,Pepose JS,et al.Corneal inlays for presbyopia correction.Curr Opin Ophthalmol 2013;24(4):281-287
23周星延,王静,赵江月,等.三焦点人工晶状体术后早期临床观察.中华眼视光学与视觉科学杂志 2018;20(6):360-364
24 de Vries NE,Webers CA,Montés-Micó R,et al.Long-term follow-up of a multifocal apodized diffractive intraocular lens after cataract surgery.J Cataract Refract Surg 2008;34(9):1476-1482
25 Kosaki R,Kozaki J,Maeda N.Higher-order aberrations in eye implanted with aspherical intraocular lenses.Nippon Ganka Gakkai Zasshi 2013;117(1):27-34
26 Vilarrodona L,Barrett GD,Johnson B.High-order aberrations in pseudophakia with different intraocular lenses.J Cataract Refract Surg 2004;30(3):571-575
27曾凡超,司马晶,杨浩江,等.飞秒激光白内障手术术源性散光及术后角膜像差的变化研究.临床眼科杂志2016;24(2):97-100
28 Miháltz K,Knorz MC,Alió JL,et al.Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery.J Refract Surg 2011;27(10):711-716
29 Kretz FTA,Breyer D,Diakonis VF,et al.Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens.J Ophthalmol 2015;2015:962891
30 Law EM,Aggarwal RK,Hosam K.Clinical Outcomes with a New Trifocal Intraocular Lens.Eur J Ophthalmol 2014;24(4):501-508
31 Wang X,Zhang Z,Li X,et al.Evaluation of Femtosecond Laser Versus Manual Clear Corneal Incisions in Cataract Surgery Using Spectral-Domain Optical Coherence Tomography.J Refract Surg 2018;34(1):17-22
32 Mendicute J,Kapp A,Lévy P,et al.Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens.J Cataract Refract Surg 2016;42(2):203-210
33 Voskresenskaya A,Pozdeyeva N,Pashtaev N.et al.Initial results of trifocal diffractive IOL implantation.Graefes Arch Clin Exp Ophthalmol 2010;248(9):1299-1306
2王文莹,王军,张晶,等.多焦点与单焦点非球面人工晶状体植入后视觉质量的临床观察.中华眼科杂志 2010;46(8):686-690
3 Torun Acar B,Duman E,Simsek S.Clinical outcomes of a new diffractive trifocal intraocular lens with Enhanced Depth of Focus (EDOF).BMC Ophthalmol 2016;16(1):208
4 Kretz FT,Müller M,Gerl M,et al.Binocular function to increase visual outcome in patients implanted with a diffractive trifocal intraocular lens.BMC Ophthalmol 2015;15(1):110
5 Rick P,Gunnar GK.Comparison of visual outcomes and subjective visual quality after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of apodized diffractive bifocal intraocular lenses.Clin Ophthalmol 2016;10:805-811
6 Rabsilber TM,Kretz FTA,Holzer MP,et al.Bilateral implantation of toric multifocal additive intraocular lenses in pseudophakic eyes.J Cataract Refract Surg 2012;38(8):1495-1498
7肖雪冰,乌兰,栾多,等.三焦点人工晶状体植入术后的早期临床效果.中华眼视光学与视觉科学杂志2017;19(5):311-314
8中华医学会眼科学分会白内障及人工晶状体学组.我国飞秒激光辅助白内障摘除手术规范专家共识(2018年).中华眼科杂志2018;54(5):328-333
9 Mojzis P,Pena-García P,Liehneova I,et al.Outcomes of a new diffractive trifocal intraocular lens.J Cataract Refract Surg 2014;40(1):60-69
10 Cochener B,Vryghem J,Rozot P,et al.Visual and refractive outcomes after implantation of a fully diffractive trifocal lens.Clin Ophthalmol 2012;6:1421-1427
11王思聪,朱怡,袁景,等.三焦点与双焦点人工晶状体临床应用效果的Meta分析.中华眼外伤职业眼病杂志 2017;39(3):232-237
12 Nagy Z,Takacs A,Filkorn T,et al.Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery.J Refract Surg 2009;25(12):1053-1060
13田芳,张红,李筱荣.飞秒激光辅助超声乳化白内障吸除术的初步观察.中华眼科杂志 2014;50(2):133-136
14 Conradhengerer I,Hengerer FH,Schultz T,et al.Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery.J Refract Surg 2012;28(12):879-883
15 Palanker DV,Blumenkranz MS,Andersen D,et al.Femtosecond Laser-Assisted Cataract Surgery with Integrated Optical Coherence Tomography.Sci Transl Med 2010;2(58):58-85
16 Nagy Z,Takacs A,Filkorn T,et al.Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery.J Refract Surg 2009;25(12):1053-1060
17 Kránitz K,Miháltz K,Sándor GL,et al.Intraocular lens tilt and decentration measured by scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy.J Refract Surg 2012;28(4):259-263
18张哲,张素华,曹伟芳,等.飞秒激光超声乳化白内障吸除术与2.2mm同轴微切口超声乳化白内障吸除术早期临床效果对比.中华眼视光学与视觉科学杂志2015;17(11):679-684
19 Kretz FT,Choi CY,Mailer M,et al.Visual outcomes,patient satisfaction and spectacle independence with a trifocal diffractive intraocular lens.Korean J Ophthalmol 2016;30(3):180-191
20 Mojzis P,Kukuckova L,Majerova K,et al.Comparative Analysis of the Visual Performance After Cataract Surgery With Implantation of a Bifocal or Trifocal Diffractive IOL.J Refract Surg 2014;30(10):666-672
21 Xu Z,Cao D,Chen X,et al.Comparison of clinical performance between trifocal and bifocal intraocular lenses:A meta-analysis.PloS One 2017;12(10):e0186522
22 Lindstrom RL,Macrae SM,Pepose JS,et al.Corneal inlays for presbyopia correction.Curr Opin Ophthalmol 2013;24(4):281-287
23周星延,王静,赵江月,等.三焦点人工晶状体术后早期临床观察.中华眼视光学与视觉科学杂志 2018;20(6):360-364
24 de Vries NE,Webers CA,Montés-Micó R,et al.Long-term follow-up of a multifocal apodized diffractive intraocular lens after cataract surgery.J Cataract Refract Surg 2008;34(9):1476-1482
25 Kosaki R,Kozaki J,Maeda N.Higher-order aberrations in eye implanted with aspherical intraocular lenses.Nippon Ganka Gakkai Zasshi 2013;117(1):27-34
26 Vilarrodona L,Barrett GD,Johnson B.High-order aberrations in pseudophakia with different intraocular lenses.J Cataract Refract Surg 2004;30(3):571-575
27曾凡超,司马晶,杨浩江,等.飞秒激光白内障手术术源性散光及术后角膜像差的变化研究.临床眼科杂志2016;24(2):97-100
28 Miháltz K,Knorz MC,Alió JL,et al.Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery.J Refract Surg 2011;27(10):711-716
29 Kretz FTA,Breyer D,Diakonis VF,et al.Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens.J Ophthalmol 2015;2015:962891
30 Law EM,Aggarwal RK,Hosam K.Clinical Outcomes with a New Trifocal Intraocular Lens.Eur J Ophthalmol 2014;24(4):501-508
31 Wang X,Zhang Z,Li X,et al.Evaluation of Femtosecond Laser Versus Manual Clear Corneal Incisions in Cataract Surgery Using Spectral-Domain Optical Coherence Tomography.J Refract Surg 2018;34(1):17-22
32 Mendicute J,Kapp A,Lévy P,et al.Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens.J Cataract Refract Surg 2016;42(2):203-210
33 Voskresenskaya A,Pozdeyeva N,Pashtaev N.et al.Initial results of trifocal diffractive IOL implantation.Graefes Arch Clin Exp Ophthalmol 2010;248(9):1299-1306