目的:Descemet膜内皮角膜移植术(DMEK)目前被认为是解决Fuchs内皮角膜营养不良(FECD)的最有效的手术方法,经常与白内障手术一起进行。在这项回顾性研究中,我们给出了视觉表现的比较,临床结果,和光学质量之间的两种类型的单焦点内透镜(IOL):一个标准和一个增强的中间视觉模型,植入接受联合超声乳化和DMEK手术的患者。
方法:这项单中心比较回顾性研究是在佛罗伦萨大学(意大利)眼科诊所进行的,共包括48例FECD和白内障患者的48只眼。所有患者均接受DMEK联合超声乳化手术。对患者数据进行分析并分为两组:一组(标准组)由24只眼组成,这些眼接受了phaco-DMEK并植入了单焦点IOL,第二组(增强单焦点组)包括24只眼,这些眼接受了phaco-DMEK并植入增强单焦点IOL.在这两组中,术后6个月评估了以下单眼视力结果:未矫正远距视力(UDVA)和最佳矫正远距视力(BCDVA)在4mts;未矫正的中级视力(UIVA),距离校正中等视力(DCIVA)在66厘米;未校正近视力(UNVA)和最佳校正近视力(BCNVA)。还评估了单眼散焦曲线。此外,在明视条件下的对比敏感度(CS)方面的光学质量,瞳孔大小为5mm时的高阶像差(HOA)。调制传递函数(MTF),客观散射指数(OSI),和斯特雷尔比率,也进行了分析。修订了患者报告的眼镜独立性问卷,以评估眼镜独立性结果。
结果:两组在UDVA方面没有统计学上的显着差异,BCDVA,UNVA和BCNVA,明视CS,HOAs,OSI,Strehl比率,MTF。然而,在phaco-DMEK增强单焦点IOL组中,在UIVA和DCIVA方面观察到明显更好的结果,以及在1.50D时不同的散焦曲线轮廓,与ZCB00IOL相比,在中间距离处提供更好的散焦结果。
结论:在我们的研究中,我们发现增强单焦点晶状体具有良好的视觉效果,即使在FECD的情况下,与标准单焦点人工晶状体相比。在Eyhance组中观察到的相当的光学质量可以使外科医生将这些晶状体视为选定的FECD患者的可行选择。
OBJECTIVE: Descemet membrane endothelial keratoplasty (DMEK) is currently regarded as the most effective surgical procedure for addressing Fuchs Endothelial Corneal Dystrophy (FECD), frequently performed in conjunction with cataract surgery. In this retrospective study, we present a comparison of visual performance, clinical outcomes, and optical quality between two types of monofocal Intraocular Lenses (IOLs): one standard and one enhanced intermediate vision model, implanted in patients who underwent combined phacoemulsification and DMEK surgery.
METHODS: This single center comparative retrospective study was conducted at the Eye Clinic of the University of Florence (Italy) and included a total of 48 eyes of 48 patients affected by FECD and cataract. All patients underwent combined DMEK with phacoemulsification procedures. The patients\' data were analyzed and divided into two groups: one group (standard group) consisted of 24 eyes that underwent phaco-DMEK with implantation of a monofocal IOL, and the second group (enhanced monofocal group) included 24 eyes that underwent phaco-DMEK with implantation of an enhanced monofocal IOL. In both groups, the following monocular visual outcomes were evaluated 6 months after surgery: Uncorrected Distance Visual Acuity (UDVA) and Best-Corrected Distance Visual Acuity (BCDVA) at 4 mts; Uncorrected Intermediate Visual Acuity (UIVA), Distance-Corrected Intermediate Visual Acuity (DCIVA) at 66 cm; Uncorrected Near Visual Acuity (UNVA) and Best Corrected Near Visual Acuity (BCNVA). Monocular defocus curves were also assessed. Furthermore, optical quality in terms of Contrast Sensitivity (CS) in photopic conditions, Higher-Order Aberrations (HOAs) at a pupil size of 5 mm. Modulation Transfer Function (MTF), Objective Scatter Index (OSI), and Strehl ratio, were also analyzed. A Patient-Reported Spectacle Independence Questionnaire was revised to evaluate spectacle independence outcomes.
RESULTS: the two groups did not exhibit statistically significant differences in terms of UDVA, BCDVA, UNVA and BCNVA, photopic CS, HOAs, OSI, Strehl ratio, and MTF. However, in the phaco-DMEK enhanced monofocal IOL group, significantly better results were observed in terms of UIVA and DCIVA as well as a different defocus curve profile at 1.50 D, providing better defocus results at intermediate distance compared with the ZCB00 IOL.
CONCLUSIONS: In our study, we found that enhanced monofocal lens performed favorable visual outcomes, even in cases of FECD, compared to standard monofocal IOLs. Comparable optical quality observed in the Eyhance group could allow surgeons to consider these lenses as a viable option for selected patients with FECD.