不同人工晶状体植入对年龄相关性白内障患者客观视觉质量及视觉相关生活质量的影响
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摘要
目的比较不同人工晶状体植入对年龄相关性白内障患者客观视觉质量及视觉相关生活质量的影响及相互关系。方法采用前瞻性非随机对照研究设计,收集2018年1月至8月在西南医科大学附属医院眼科行白内障超声乳化吸出联合人工晶状体植入术的年龄相关性白内障患者66例(90眼),其中植入单焦点人工晶状体34例(52眼)患者为单焦点组,植入衍射型多焦点人工晶状体32例(38眼)患者为多焦点组。测量2组患者术前及术后3个月术眼裸眼远近视力(uncorrected distance visual acuity,UCDVA;uncorrected near visual acuity,UCNVA),最佳矫正远、近视力(best-corrected distance visual acuity,BCDVA;best-corrected near visual acuity,BCNVA),采用中文版25项美国国家眼科研究所视觉功能问卷调查(25-item national eye institute visual function questionnaire,NEI-VFQ-25)评估患者手术前后的视觉相关生活质量,结合双通道视觉质量分析仪OQAS II对患者术眼手术前后客观散射指数(objective scatter index,OSI)、调制传递函数截止频率(modulation transfer function cut off,MTF cut off)、斯特列尔比(strehl ratio,SR)、对比度为100%、20%及9%的OQAS值(OV100、OV20、OV9)以及伪调节力进行测量。结果两组患者术后UCDVA及BCDVA均较术前明显提高(t=-27.763、-16.772、-13.429、-12.936,均为P<0.01),多焦点组患者术后UCNVA及BCNVA均较术前明显提高(均为P<0.05),多焦点组术后UCNVA较单焦点组高(t=-6.364,P<0.01),2组间术后UCDVA、BCDVA、BCNVA差异均无统计学意义(均为P>0.05)。多焦点组术后总体视觉、近距离工作评分均较单焦点组好(均为P<0.05),单焦点组术后色彩视觉评分较多焦点组好(P<0.05),2组患者术后的独立性及精神健康均较术前改善(均为P<0.05),2组间术后差异均无统计学意义(均为P>0.05)。多焦点组术后OSI、调节幅度较单焦点组均高(均为P<0.05),MTF cut off、OV20、OV9较单焦点组均低(均为P<0.05)。结论植入单焦点人工晶状体及衍射型多焦点人工晶状体均能有效改善年龄相关性白内障患者的客观视觉质量,从而明显改善患者术后视觉相关生活质量。
Objective To compare the differences and relationships between two type of intraocular lenses about the objective optical quality and vision related quality of life.Methods This prospective and non-randomized study included 66 patients(90 eyes) with age-related cataract who were performed phacoemulsification surgery from January 2018 to August 2018 in Southwest Medical University,of whom 34 patients(52 eyes) accepted monofocal intraocular lenses implantation(SIOL group) and 32 patients(38 eyes) underwent multifocal intraocular lenses implantation(MIOL group).Measurements were performed before operation and three-month postoperatively by standard logarithmic visual acuity chart(uncorrected distance visual acuity,UCDVA;uncorrected near visual acuity,UCNVA;best corrected distance visual acuity,BCDVA;best corrected near visual acuity,BCNVA),a 25-item version of the National Eye Institute Visual Function Questionnaire(NEI VFQ-25) and a double-pass optical quality analysis system(OQASII,Visiometrics,Spain).The objective scattering index(OSI),modulation transfer function cut off frequency(MTF cut off),Strehl ratio(SR),OQAS values(OVs) at contrasts of 100%,20%and 9%,and pseudoaccommodation were assessed.Results UCDVA and BCDVA were significantly improved after surgery in both SIOL group and MIOL group(t=-27.763,-16.772,-13.429,-12.936,all P<0.01).UCNVA and BCNVA were significantly postoperatively improved in MIOL group(both P<0.05).MIOL group had a better UCNVA than SIOL group(t=-6.364,P<0.01).But no significant difference was found between two groups in UCDVA,BCDVA,BCNVA postoperatively(all P>0.05).A better overall eyesight and near vision was found in MIOL group than SIOL group postoperatively(both P<0.05),while SIOL group had a better color vision(P<0.05).The independence and mental health significantly improved in both groups after surgery(both P<0.05),but there was no significant difference between the two groups(both P>0.05).MIOL group had a higher OSI and accommodative range than SIOL group postoperatively,while MIOL group had a lower MTF cut off,OV20 and OV9 than SIOL group(all P<0.05).Conclusion Both monofocal intraocular lenses implantation and multifocal intraocular lenses implantation can effectively improve objective visual quality,as well as to be beneficial in improving the postoperativevision related quality of life.
Objective To compare the differences and relationships between two type of intraocular lenses about the objective optical quality and vision related quality of life.Methods This prospective and non-randomized study included 66 patients(90 eyes) with age-related cataract who were performed phacoemulsification surgery from January 2018 to August 2018 in Southwest Medical University,of whom 34 patients(52 eyes) accepted monofocal intraocular lenses implantation(SIOL group) and 32 patients(38 eyes) underwent multifocal intraocular lenses implantation(MIOL group).Measurements were performed before operation and three-month postoperatively by standard logarithmic visual acuity chart(uncorrected distance visual acuity,UCDVA;uncorrected near visual acuity,UCNVA;best corrected distance visual acuity,BCDVA;best corrected near visual acuity,BCNVA),a 25-item version of the National Eye Institute Visual Function Questionnaire(NEI VFQ-25) and a double-pass optical quality analysis system(OQASII,Visiometrics,Spain).The objective scattering index(OSI),modulation transfer function cut off frequency(MTF cut off),Strehl ratio(SR),OQAS values(OVs) at contrasts of 100%,20%and 9%,and pseudoaccommodation were assessed.Results UCDVA and BCDVA were significantly improved after surgery in both SIOL group and MIOL group(t=-27.763,-16.772,-13.429,-12.936,all P<0.01).UCNVA and BCNVA were significantly postoperatively improved in MIOL group(both P<0.05).MIOL group had a better UCNVA than SIOL group(t=-6.364,P<0.01).But no significant difference was found between two groups in UCDVA,BCDVA,BCNVA postoperatively(all P>0.05).A better overall eyesight and near vision was found in MIOL group than SIOL group postoperatively(both P<0.05),while SIOL group had a better color vision(P<0.05).The independence and mental health significantly improved in both groups after surgery(both P<0.05),but there was no significant difference between the two groups(both P>0.05).MIOL group had a higher OSI and accommodative range than SIOL group postoperatively,while MIOL group had a lower MTF cut off,OV20 and OV9 than SIOL group(all P<0.05).Conclusion Both monofocal intraocular lenses implantation and multifocal intraocular lenses implantation can effectively improve objective visual quality,as well as to be beneficial in improving the postoperativevision related quality of life.
引文
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[3] MAHMUD I,KELLEY T,STOWELL C,HARIPRIYA A,BOMAN A,KOSSLER I,et al.A proposed minimum standard set of outcome measures for cataract surgery[J].JAMA Ophthalmol,2015,133(11):1247-1252.
[4] LI S,JIE Y.Cataract surgery and lens implantation[J].Curr Opin Ophthalmol,2019,30(1):39-43.
[5] De SILVA S R,EVANS J R,KIRTHI V,ZIAEI M,LEYLAND M.Multifocal versus monofocal intraocular lenses after cataract extraction[J].Cochrane Db Syst Rev,2016,12:CD003169.
[6] ALIó J L,KAYMAK H,BREYER D,COCHENER B,PLAZA-PUCHE A B.Quality of life related variables measured for three multifocal diffractive intraocular lenses:a prospective randomised clinical trial[J].Clin Exp Ophthalmol,2018,46(4):380-388.
[7] MANGIONE C M,LEE P P,GUTIERREZ P R.Development of the 25-item National Eye Institute Visual Function Questionnaire[J].Arch Ophthalmol,2001,119(7):1050-1058.
[8] WANG C W,CHAN C L W,JIN H Y.Psychometric properties of the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire[J].Optom Vis Sci,2008,85(11):1091-1099.
[9] CHAN C W,WONG D,LAM C L,MCGHEE S,LAI W W.Development of a Chinese version of the National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) as a tool to study patients with eye diseases in Hong Kong[J].Br J Ophthalmol,2009,93(11):1431-1436.
[10] VENTER J A,BARCLAY D,PELOUSKOVA M.Initial experience with a new refractive rotationally asymmetric multifocal intraocular lens[J].J Refract Surg,2014,30(11):770-776.
[11] WANDELL B A.Foundations of vision[M].Sunderland,MA:Sinauer Associates,1995:157-161.
[12] WEN B W,LAN C J,LIAO X.Research progress on visual quality assessment methods[J].Rec Adv Ophthalmol,2017,37(8):793-796.文佰伟,兰长骏,廖萱.视觉质量评价方法的研究进展[J].眼科新进展,2017,37(8):793-796.
[13] CAI X G,QIAO L Y,ZHANG Y,TAN J X,GUAN Z,WAN X H,et al.Reliability evaluation of double-pass optical quality analysis system and analysis of relevant influencing factors[J].Rec Adv Ophthalmol,2013,33(7):646-650.蔡啸谷,乔利亚,张烨,谭家璿,管征,万修华,等.双通道视觉质量分析系统可靠性评价及相关影响因素分析[J].眼科新进展,2013,33(7):646-650.
[14] DíAZ-DOUTóN F,BENITO A,PUJOL J,ARJONA M,GüELL J L,ARTAL P.Comparison of the retinal image quality with a Hartmann-Shack wavefront sensor and a double-pass instrument[J].Invest Ophthalmol Vis Sci,2006,47(4):1710-1716.
[15] VILASECA M,ROMERO M J,ARJONA M,LUQUE S O,ONDATEGUI J C,SALVADOR A,et al.Grading nuclear,cortical and posterior subcapsular cataracts using an objective scatter index measured with a double-pass system[J].Br J Ophthalmol,2012,96(9):1204-1210.
[16] ALBA-BUENO F,VEGA F,MILLáN M S.Halos and multifocal intraocular lenses:origin and interpretation[J].Arch Soc Esp Oftalmol,2014,89(10):397-404.
[17] NIAN W Q,ZHOU Y F,HE Y F.Progress in the study of pseudophakic accommodation[J].Int Eye Sci,2012,12(1):72-74.年婉青,周艳峰,何亚芬.人工晶状体眼调节力的研究进展[J].国际眼科杂志,2012,12(1):72-74.
[18] NAKAZAWA M,OHTSUKI K.Apparent accommodation in pseudophakic eyes after implantation of posterior chamber intraocular lenses[J].Am J Ophthalmol,1983,96(4):435-438.
[19] SIVAK J G.Accommodation in vertebrates:a contemporary survey[J].Curr Top Eye Res,1980,3:281-330.
[20] HOLLADAY J T,PRAGER T C,CHANDLER T Y,MUSGROVE K H,LEWIS J W,RUIZ R S.A three-part system for refining intraocular lens power calculations[J].J Cataract Refract Surg,1988,14(1):17-24.
[21] ZHANG D,FAN Z,GAO X,HUANG W,YANG Q,LI Z,et al.Illness uncertainty,anxiety and depression in Chinese patients with glaucoma or cataract[J].Sci Rep,2018,8(1):11671.
[22] WANG Y X.The application research of human psychological intervention model in diffractive multifocal intraocular lens implantation[D].Luzhou:Southwest Medical University,2016.王妍茜.人性化心理干预模式在衍射型多焦点人工晶状体植入术中的应用研究[D].泸州:西南医科大学,2016.
[2] CYPEL M C,SALOM?O S R,DANTAS P E C,LOTTENBERG C L,KASAHARA N,RAMOS L R,et al.Vision status,ophthalmic assessment,and quality of life in the very old[J].Arq Bras Oftalmol,2017,80(3):159-164.
[3] MAHMUD I,KELLEY T,STOWELL C,HARIPRIYA A,BOMAN A,KOSSLER I,et al.A proposed minimum standard set of outcome measures for cataract surgery[J].JAMA Ophthalmol,2015,133(11):1247-1252.
[4] LI S,JIE Y.Cataract surgery and lens implantation[J].Curr Opin Ophthalmol,2019,30(1):39-43.
[5] De SILVA S R,EVANS J R,KIRTHI V,ZIAEI M,LEYLAND M.Multifocal versus monofocal intraocular lenses after cataract extraction[J].Cochrane Db Syst Rev,2016,12:CD003169.
[6] ALIó J L,KAYMAK H,BREYER D,COCHENER B,PLAZA-PUCHE A B.Quality of life related variables measured for three multifocal diffractive intraocular lenses:a prospective randomised clinical trial[J].Clin Exp Ophthalmol,2018,46(4):380-388.
[7] MANGIONE C M,LEE P P,GUTIERREZ P R.Development of the 25-item National Eye Institute Visual Function Questionnaire[J].Arch Ophthalmol,2001,119(7):1050-1058.
[8] WANG C W,CHAN C L W,JIN H Y.Psychometric properties of the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire[J].Optom Vis Sci,2008,85(11):1091-1099.
[9] CHAN C W,WONG D,LAM C L,MCGHEE S,LAI W W.Development of a Chinese version of the National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) as a tool to study patients with eye diseases in Hong Kong[J].Br J Ophthalmol,2009,93(11):1431-1436.
[10] VENTER J A,BARCLAY D,PELOUSKOVA M.Initial experience with a new refractive rotationally asymmetric multifocal intraocular lens[J].J Refract Surg,2014,30(11):770-776.
[11] WANDELL B A.Foundations of vision[M].Sunderland,MA:Sinauer Associates,1995:157-161.
[12] WEN B W,LAN C J,LIAO X.Research progress on visual quality assessment methods[J].Rec Adv Ophthalmol,2017,37(8):793-796.文佰伟,兰长骏,廖萱.视觉质量评价方法的研究进展[J].眼科新进展,2017,37(8):793-796.
[13] CAI X G,QIAO L Y,ZHANG Y,TAN J X,GUAN Z,WAN X H,et al.Reliability evaluation of double-pass optical quality analysis system and analysis of relevant influencing factors[J].Rec Adv Ophthalmol,2013,33(7):646-650.蔡啸谷,乔利亚,张烨,谭家璿,管征,万修华,等.双通道视觉质量分析系统可靠性评价及相关影响因素分析[J].眼科新进展,2013,33(7):646-650.
[14] DíAZ-DOUTóN F,BENITO A,PUJOL J,ARJONA M,GüELL J L,ARTAL P.Comparison of the retinal image quality with a Hartmann-Shack wavefront sensor and a double-pass instrument[J].Invest Ophthalmol Vis Sci,2006,47(4):1710-1716.
[15] VILASECA M,ROMERO M J,ARJONA M,LUQUE S O,ONDATEGUI J C,SALVADOR A,et al.Grading nuclear,cortical and posterior subcapsular cataracts using an objective scatter index measured with a double-pass system[J].Br J Ophthalmol,2012,96(9):1204-1210.
[16] ALBA-BUENO F,VEGA F,MILLáN M S.Halos and multifocal intraocular lenses:origin and interpretation[J].Arch Soc Esp Oftalmol,2014,89(10):397-404.
[17] NIAN W Q,ZHOU Y F,HE Y F.Progress in the study of pseudophakic accommodation[J].Int Eye Sci,2012,12(1):72-74.年婉青,周艳峰,何亚芬.人工晶状体眼调节力的研究进展[J].国际眼科杂志,2012,12(1):72-74.
[18] NAKAZAWA M,OHTSUKI K.Apparent accommodation in pseudophakic eyes after implantation of posterior chamber intraocular lenses[J].Am J Ophthalmol,1983,96(4):435-438.
[19] SIVAK J G.Accommodation in vertebrates:a contemporary survey[J].Curr Top Eye Res,1980,3:281-330.
[20] HOLLADAY J T,PRAGER T C,CHANDLER T Y,MUSGROVE K H,LEWIS J W,RUIZ R S.A three-part system for refining intraocular lens power calculations[J].J Cataract Refract Surg,1988,14(1):17-24.
[21] ZHANG D,FAN Z,GAO X,HUANG W,YANG Q,LI Z,et al.Illness uncertainty,anxiety and depression in Chinese patients with glaucoma or cataract[J].Sci Rep,2018,8(1):11671.
[22] WANG Y X.The application research of human psychological intervention model in diffractive multifocal intraocular lens implantation[D].Luzhou:Southwest Medical University,2016.王妍茜.人性化心理干预模式在衍射型多焦点人工晶状体植入术中的应用研究[D].泸州:西南医科大学,2016.
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