目的:为了评估视觉质量,主观和客观,对PanOptix三焦点人工晶状体(IOL)植入后眼轴长度(AL)变化的白内障患者进行了研究,并研究了晶状体倾斜及其与视觉结果的相关性。
方法:从2020年7月至2022年6月,70例(140只眼)在重庆眼科和视力保健医院诊断为年龄相关性白内障并接受PanOptix植入的患者,爱尔眼科医院集团,包括在内。患者被分配到观察组(35例,70只眼PanOptix三焦IOL)或对照组(35例,70只眼双焦点IOL)。根据AL进一步细分为AL<24mm(观察组:23眼;对照组:26眼)和AL≥24mm(观察组:47眼;对照组:44眼)。术后随访3个月。视力(远处,中间,near),客观视觉质量(斯特雷尔比率:SR,全眼调制传递函数(MTF)),术前和术后3个月测量视觉像差。
结果:术后,所有组的非矫正视力(UCDVA)均有显着改善,未矫正视力(UCIVA),未矫正近视力(UCNVA)与术前值(T0)比较(均P<0.05)。值得注意的是,观察组UCIVA明显优于对照组(P<0.05)。在三个月(T1),总高阶像差(THOA)的减少,内部高阶像差(iHOA),昏迷,与基线相比,两组均观察到三叶像差,观察组下降更明显(均P<0.05)。从T0到T1,SR和MTF截止值均有明显改善,观察组增强幅度更大(均P<0.05)。观察组的散焦曲线在+0.5D至-3.0D之间呈平缓斜率,保持优于对照组的视力(P<0.05)。两组患者T1时主观视觉质量评分均显著高于T0时(P<0.05),在所有AL类别中,观察组患者的评分均高于对照组(P<0.05)。Spearman相关分析显示PanOptix三焦IOL植入术后倾斜与tHOA相关(r=0.273,P=0.022),iHOA(r=0.433,P<0.001),三叶(r=0.360,P=0.002)和昏迷(r=0.688,P<0.001)。
结论:PanOptix三焦点人工晶体植入术在不同AL的白内障患者中与双焦点人工晶体相比,显著提高了视觉质量,为其临床应用提供了强有力的理由。
OBJECTIVE: To assess the visual quality, both subjective and objective, of cataract patients with varying axial lengths (AL) after PanOptix trifocal intraocular lens (IOL) implantation and investigated the lens tilt and its correlation with visual outcomes.
METHODS: From July 2020 to June 2022, 70 patients (140 eyes) diagnosed with age-related cataracts and undergoing PanOptix implantation at Chongqing Eye and Vision Care Hospital, Aier Eye Hospital Group, were included. Patients were assigned to either the observation group (35 cases, 70 eyes with PanOptix trifocal IOL) or the control group (35 cases, 70 eyes with bifocal IOL). Patients were further subdivided based on AL into AL < 24 mm (observation group: 23 eyes; control group: 26 eyes) and AL ≥ 24 mm (observation group: 47 eyes; control group: 44 eyes). Postoperative follow-up lasted three months. Visual acuity (distant, intermediate, near), objective visual quality (Strehl ratio: SR, total eye modulation transfer function (MTF)), and visual aberrations were measured preoperatively and at 3 months post-operation.
RESULTS: Postoperatively, all groups saw significant improvements in uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA) compared to preoperative values (T0) (all P < 0.05). Notably, UCIVA was significantly better in the observation group than in the control group (P < 0.05). At three months (T1), reductions in total high-order aberration (tHOA), internal high-order aberration (iHOA), coma, and trefoil aberrations were observed in both groups compared to baseline, with more significant decreases in the observation group (all P < 0.05). Both SR and MTF cutoff showed marked improvement from T0 to T1, with the observation group experiencing greater enhancements (both P < 0.05). The defocus curve of the observation group showed a gentle slope between +0.5 D and -3.0 D, maintaining superior visual acuity compared to the control group (P < 0.05). Subjective visual quality scores at T1 were significantly higher than at T0 for both groups (P < 0.05), with patients in the observation group scoring higher than those in the control group across all AL categories (P < 0.05). Spearman correlation analysis indicated that the tilt after PanOptix trifocal IOL implantation was associated with tHOA (r = 0.273, P = 0.022), iHOA (r = 0.433, P < 0.001), Trefoil (r = 0.360, P = 0.002) and coma (r = 0.688, P < 0.001).
CONCLUSIONS: PanOptix trifocal IOL implantation in cataract patients across different AL significantly enhances visual quality compared to bifocal IOLs, suggesting a strong case for its clinical adoption.