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目的探讨瞳孔中心定位在多焦点人工晶状体(MFIOL)植入术中的临床应用价值。设计前瞻性病例对照研究。研究对象2009年7月至2010年11月于中山医院眼科中心就诊的年龄相关性白内障患者56例(64眼)。方法根据是否使用瞳孔中心定位将入选病例按随机数字表分为定位组和对照组,每组32眼。定位组使用瞳孔中心定位,在散瞳前根据角膜反光点定位瞳孔中心,术中以中心定位点为参照连续环形撕囊,并使植入的MFIOL中心点与瞳孔中心定位点重合。两组患者常规行超声乳化白内障吸除联合多焦点人工晶状体(IQ ReSTOR+3.0 D,Alcon)植入术。术后随访3个月,检查LogMAR裸眼远视力、最佳矫正远视力、裸眼近视力和最佳矫正近视力。使用Pentacam三维眼前房测量系统采集术眼Scheimpflug图像,采用Image-pro plus 6.0图像分析得出MFIOL的倾斜度和偏心量。并对两组结果进行比较分析。主要指标视力,人工晶状体偏心值、倾斜度。结果术后3个月,定位组的裸眼远视力(0.08±0.08)和裸眼近视力(0.08±0.10)均较对照组(0.13±0.08)、(0.13±0.08)好,差异有统计学意义(t=2.293,P=0.025t;=2.102,P=0.040);定位组的最佳矫正远视力(-0.01±0.04)和最佳矫正近视力(-0.01±0.04)均与对照组(0.01±0.04)、(0.01±0.04)相当,差异无统计学意义(t=1.512,P=0.136t;=1.149,P=0.255)。定位组的MFIOL水平偏心值(0.19±0.09 mm)和倾斜度(2.42°±0.53°)均较对照组(0.24±0.11 mm)、(2.68°±0.47°)小,差异均有统计学意义(t=2.010,P=0.049;t=2.043,P=0.045);定位组的垂直偏心值(0.18±0.07 mm)和倾斜度(2.32°±0.53°)均较对照组(0.22±0.09 mm)、(2.59°±0.47°)小,差异均有统计学意义(t=2.021,P=0.048;t=2.166,P=0.034)。定位组水平和垂直方向上IOL的偏心量和倾斜度均呈线性正相关(r=0.693,P=0.000r;=0.693,P=0.000);对照组水平和垂直方向上IOL的偏心量和倾斜度也均呈线性正相关(r=0.844,P=0.000r;=0.743,P=0.000)。结论瞳孔中心定位有助于保证MFIOL居中性植入和良好的术后视觉质量,并减少MFIOL术后倾斜和偏中心。
Objective To investigate the clinical application of pupil centering in multifocal intraocular lens (MFIOL) implantation. Design prospective case-control study. Participants 56 patients (64 eyes) with age-related cataract who were treated at Zhongshan Hospital Eye Center from July 2009 to November 2010. Methods According to whether the use of pupil center positioning of the selected cases according to random number table is divided into positioning group and control group, 32 eyes per group. Positioning group using the pupil center positioning in the mydriasis according to the corneal retroreflective point to locate the pupil center, intraoperative centering point for the reference continuous annular capsulorhexis, and the implantation of the MFIOL center coincides with the pupil centering point. Two groups of patients underwent phacoemulsification combined with multifocal intraocular lens implantation (IQ ReSTOR + 3.0 D, Alcon). After 3 months of follow-up, LogMAR visual acuity, best corrected distance vision, near-vision and best-corrected near vision were examined. The eye of Scheimpflug was collected using the Pentacam 3D anterior chamber measurement system and the tilt and eccentricity of the MFIOL were analyzed using Image-pro plus 6.0 image analysis. And two groups of results for comparative analysis. The main indicators of visual acuity, intraocular lens eccentricity, tilt. Results Compared with the control group (0.13 ± 0.08) and (0.13 ± 0.08), the visual acuity of the naked eye (0.08 ± 0.08) and the visual acuity of the naked eye in the positioning group at 3 months postoperatively were significantly different The best corrected distance vision (-0.01 ± 0.04) and best corrected myopic (-0.01 ± 0.04) in the positioning group were significantly higher than those in the control group (0.01 ± t = 2.293, P = 0.025t; 0.04), (0.01 ± 0.04), the difference was not statistically significant (t = 1.512, P = 0.136t; = 1.149, P = 0.255). Compared with the control group (0.24 ± 0.11 mm) and (2.68 ° ± 0.47 °), the MFIOL level eccentricity (0.19 ± 0.09 mm) and the inclination (2.42 ° ± 0.53 °) in the locating group were all significantly different t = 2.010, P = 0.049; t = 2.043, P = 0.045). The vertical eccentricity (0.18 ± 0.07 mm) and inclination (2.32 ° ± 0.53 °) of the positioning group were significantly higher than those of the control group (0.22 ± 0.09 mm) (2.59 ° ± 0.47 °), the differences were statistically significant (t = 2.021, P = 0.048; t = 2.166, P = 0.034). There was a linear positive correlation between the eccentricity and inclination of IOL in horizontal and vertical directions (r = 0.693, P = 0.000r; = 0.693, P = 0.000). The eccentricity and inclination of IOL in horizontal and vertical directions Degree also showed a linear positive correlation (r = 0.844, P = 0.000r; = 0.743, P = 0.000). Conclusions Pupillary centering helps to ensure a neutral MFIOL implantation and good postoperative visual quality and to reduce postoperative MFIOL tilt and eccentricity.