| Abstract:Objective:To observe and analyze the pseudo-accommodation with implantation of monofocal and multifocal intraocular lens in middle-aged and senile cataract patients at different age groups.Methods:According to their ages the160eyes(128cases) of cataract were divided into4groups:group Ⅰ:40-49years,35cases40eyes;group Ⅱ:50-59years,33cases40eyes;group Ⅲ:60-69years,30cases40eyes;group Ⅳ:70-79years,30cases40eyes.Each age group was divided into three subgroups:A was cataract extraction combined multifocal intraocular lens inplantation;28cases40eyes,each age group separately was8cases9eyes、8cases12eyes、7cases12eyes、5cases8eyes;B was reserved (0～-0.25/emmetropization)diopter in monofocal intraocular lens,48cases60eyes,each age group separately was10cases14eyes、12cases13eyes、11cases16eyes、15cases17eyes;C was reserved (-1.0～-1.25/mild myopia)diopter in monofocal intraocular lens,52cases60eyes,each age group separately was11cases17eyes、13cases15eyes、12cases12eyes、10cases15eyes.Uncorrected distance,best-corrected distance,uncorrected near and best-corrected near visual acuities were measured on a week and3months postoperation; using the pushing-up test and negative lens method to measure the amplitude of accommodation,changes of anterior chamber depth(ACD) by droped2%pilocapine measured using the A-ultrasonic scan and pentacam on3months postoperation.Results using SPSS20.0statistical software analysis,measurement data and normally distributed statistical description using mean standard deviation,using randomized block design anlysis of variane(Two way Anova),LSD method compare multiple samples mean,P<0.05, the difference was statistically significant.Correlation between two variables by linear correlation analysis,r>0was positive correlation,r<0was negative correlation,r=0is zero,0<r<0.3was low,0.3<r<0.6was medium,0.6≤r<1was significant correlation.Results:1.Uncorrected distance visual acuity:one week postoperative:the difference of group Ⅰ、Ⅱ、Ⅲ and Ⅳ was statistically significant(F=23.10, P<0.05);using the LSD method was concluded:Group Ⅰ was better than Ⅱ、Ⅲ、Ⅳ(P<0.05);Ⅱwas better than Ⅲ、Ⅳ(P<0.05);group Ⅲ and Ⅳ had no significant statistical difference((P>0.05).The difference was statistically significant between three subgroups (F=60.93, P<0.05), LSD method was concluded:group A and B had no significant statistical difference((P>0.05),group A and B were better than group C(P<0.05).3months postoperative:the difference of group Ⅰ、Ⅱ、Ⅲ and Ⅳ was statistically significant(F=24.17, P<0.05);using the LSD method was concluded:group I and II were better than Ⅲ、Ⅳ(P<0.05), I and Ⅱhad no significant statistical difference((P >0.05),Ⅲ and Ⅳhad no significant statistical difference((P>0.05).The difference was statistically significant between three subgroups (F=48.83, P<0.05), LSD method was concluded:group A and B had no significant statistical difference((P>0.05),group A and B were better than group C(P<0.05).2.Best corrected distance visual acuity:the difference between a week and3months had no statistical significance (P>0.05),and the difference of all age groups and subgroups had no statistical significance (P>0.05).3.Uncorrected near visual acuity:one week postoperative:the difference of group Ⅰ、Ⅱ、Ⅲ and Ⅳ was statistically significant (F=19.59, P<0.05);using the LSD method was concluded:Group Ⅰ was better than Ⅱ、Ⅲ、Ⅳ(P<0.05);Ⅱwas better than Ⅲ、Ⅳ(P<0.05);group Ⅲ and Ⅳ had no significant statistical difference((P>0.05).The difference was statistically significant between three subgroups (F=126.79, P<0.05), LSD method was concluded:among group A、B and C were statistically significant (P<0.05), group A was better than group B and C(P<0.05),group C was better than group B(P<0.05).3months postoperative:the difference between different age groups had statistically significant (F=13.39, P<0.05);LSD method was concluded:group I was better than group Ⅱ Ⅲ、 Ⅳ(P<0.05),group Ⅱ was better than group Ⅲ、Ⅳ(P<0.05),group Ⅲwas better than group Ⅳ(P<0.05).The difference was statistically significant between three subgroups (F=128.9, P<0.05), LSD method was concluded:among group A、B and C were statistically significant (P <0.05), group A was better than group B and C(P<0.05),group C was better than group B(P<0.05).4.Best corrected near visual acuity:the difference between a week and3months had no statistical significance (P>0.05),and the difference of all age groups and subgroups had no statistical significance (P>0.05).The amplitude of pseudophakic accommodation on3months postoperation:the results of the pushing-up test and negative lens method wad similar,the difference between different age groups had statistically significant (F=11.12, P<0.05, F=10.92, P<0.05);LSD method was concluded:group I was better than group Ⅲ、Ⅳ(P<0.05),group Ⅱ and Ⅲ were better than group Ⅳ(P<0.05),the difference between group Ⅰ and Ⅱand groupⅡand Ⅲ had no statistical significance(P>0.05).The difference among A、B and C had statistically significant (F=153.73, P<0.05, F=144.69, P<0.05,), LSD method was concluded:group A was better than group B and C,group C was better than group B.6.Changes of anterior chamber depth(ACD) by droped2%pilocapine measured using the A-ultrasonic scan and pentacam on3months postoperation.the results of the A-ultrasonic:the difference between different age groups had statistically significant (F=5.84, P<0.05),LSD method was concluded:group Ⅰ、Ⅱ、Ⅲwas better than group Ⅳ(P<0.05),the difference between group Ⅰ and Ⅱ Ⅲ and group Ⅱ and Ⅲ had no statistical significance(P>0.05),the results of the pentacam:the difference of the all age groups and subgroups had no statistically significant difference.7.The connection between age, number of reserved diopter and the displacement of intraocular lens and pseudo-accommodation:pseudo-accommodation gradually diminished with age (r=-0.501, P<0.001), positively related with reserved diopter (r=0.763, P<0.001) and IOL displacement (r=0.804, P<0.001).Conclusion:1.Pseudophakic accommodation was closely related to the patient’s age,monofocal or multifocal intraocular lens impantation and preoperative reserved diopter,etc,we should choose suitable operation method,intraocular lens and preoperative reserved diopter according to the demand of the patients.2.The uncorrected distance and near visual acuities and pseudo-accommodation was inordinately declined as the growth of age,pseudo-accommodation was positively related with IOL displacement, reserved myopic-1.0--1.25diopter can increased the range of pseudophakic accommodation,but couldn’t satisfied with requirement of the patient’s near vision.3.Multifocal intraocular lens provided a wide range of pseudo-accommodation than monofocal intraocular lens,the patient who implanted it was satisfied with distance and near visual acuities. |
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