The Application Research Of Human Psychological Intervention Model In Diffractive Multifocal Intraocular Lens Implantation

objective: According to the result of the Symptom Checklist 90?SCL- 90? and the concentration level of serum IL – 6 and BDNF of multifocal intraocular lens implanted patients, we expect to find the relationship between stress state and the concentration level of serum IL – 6 and BDNF. We further discuss the correlation between stress state and immune factors. In this study, we aim to:1)establish a suitable human psychological intervention mode for diffraction multifocal lenses implanted patients 2)establish standardized psychological intervention mode for cataract patients during perioperative period. We expect our research can provide significant guarantee for the management of refractive intraocular lens implant during perioperative period. Methods : 85 age-related cataract patients who were treated by surgery at our hospital during 2014.7-2015.12 were included in our study. All subjects agreed and signed the informed consent before participating the study. SCL- 90 were used to assess the mental state before the surgery. The selection of IOL was based on the result of SCL-90 and clinical examination and patients' willing. All the patients' surgery were conducted by the same doctor. The morning fasting venous blood were taken the day after surgery to test the content of IL-6 and BDNF. The subjects were divided into two groups: the trial group?multifocal group?and control group?monofocal group?.The multifocal group were divided into 2 groups randomly: group M₁?30 subjects?, group M₂?27 subjects?.The monofocal group included 28 subjects. According to the result of SCL- 90 of M₁ group, we took a series of humanity?targeted psychological intervention to the subjects. The follow-up visit which included uncorrected distance visual acuity, uncorrected near visual acuity,corrected distance visual acuity,corrected near visual acuity were conducted to all the subjects after 1 week, 1 month, 3 months. The follow-up visit which included the assessment of SCL-90,the spectacle independence, questionnaire on adverse visual symptoms?postorerative satisfaction and the serum concentration of BDNF and IL-6 were conducted to all the subjects after 1 month. Results: 1.All the patients had no serious postoperative complications occurred and no posterior capsule rupture, artificial lens shift, eccentric and backwardness cataract occurred either.2.There were no significant difference between the group M₁? M₂ and the control group in uncorrected distance visual acuity,corrected distance visual acuity and corrected near visual acuity after 1 week, 1 month, 3 months after the surgery. But uncorrected near visual acuity was better in trail group than control group and the result had significant difference?P< 0.05?; 3. There were no significant difference between the group M₁?M₂ and the control group in the spectacle independence for distant vision after 1 month after the surgery, but the spectacle independence for near vision were better in trail group than control group and the result had significant difference?P< 0.05?;There were no significant difference between the group M₁ and M₂ in Halo phenomenon?P> 0.05?, but the halo phenomenon of M₁ and M₂ group were greater than the control group?P < 0.05?;The result of Glare phenomena was:M₂ group> M₁ group > the control group?P < 0.05?;The result of the satisfaction survey was:M₁ group > M₂ group?control group?P < 0.05?. 4.?1? There was significant difference between the group M₁?M₂ and the control group except the index of hostility and horrible before the surgery. There was no significant difference between the group M₁ and M₂?P > 0.05?, but the scores of the above indexes of the group M₁ and M₂ were significantly greater than the control group?P < 0.05?.?2? There was significant difference between the group M₁?M₂ and the control group about the score of all the other indexes of SCL-90?P < 0.05? except the index of hostility and psychosis after the surgery. The result of the total score? the average total score?and the score of positive number?anxiety and other positive symptoms wa: goup M₂>group M₁>control group?P<0.05?;the result of somatization?forcing symptoms?interpersonal relationship? depression?paranoia was:group M₂>group M₁?control group?P<0.05?;The result of hostility was:group M₂?control group>group M₁?P<0.05?;The result of other was:group M₁?group M₂>control group?P<0.05?.?3?The score of terror and psychosis had no significant difference?P > 0.05?, the rest indexes were significantly lower after the surgery.?P < 0.05?.?4? The score of total score? the average total score?and the score of positive number?anxiety were significantly lower after the surgery?P<0.05?,the rest indexes had no significant difference?P > 0.05?.?5? The score of total score? the average total score?and the score of positive number?anxiety and other were significantly lower after the surgery?P<0.05?,the rest indexes had no significant difference?P> 0.05?.5.?1?The concentration level of the 3 groups before the surgery: There was no significant difference between the group M₁ and M₂ about the concentration level of BDNF?P>0.05?, but both group were lower than the control group significantly?P<0.05?. There was no significant difference between the group M₁ and M₂ in the concentrate level of IL-6?P>0.05?, but both group were higher than the control group significantly?P<0.05?.?2?There was a positive correlation between BDNF and IL-6 in group M₁, There was no correlation between BDNF and IL-6 in group M₂.?3? Three groups of factors preoperatively and BDNF and IL- 6 correlation analysis: BDNF, the score of depression?r=-0.861?, IL-6 and the score of anxiety?r=-0.953? in group M₁.BDNF,the score of depression?r=-0.865?and IL-6 and the score of anxiety?r=-0.948? in group M₂. BDNF,the score of depression?r=-0.377?and somatization?r=-0.875?and IL-6 the score of anxiety?r=-0.928? in control group;?4?The correlation between the 10 factors of SCL-90: the score of interpersonal relationship, the score of somatization?r=0.490??forcing symptoms?r=0.413? and the score of hor rible and the score of hostility?r=-0.370? in group M₁. The score of interpersonal relationship and the score of hostility?r=-0.412? and the score of horrible and the score of paranoia?r=-0.390? in group M₂. The score of horrible and the score of anxiety?r=0.443?and the score of psychosis and the score of depression?r=0.381? and the score of other and the score of nxiety?r=0.385? in control group.?5?The result after the surgery:There was no significant difference between the group M₁ and M₂ in the concentrate level of BDNF?P>0.05?, but both group were lower than the control group significantly?P<0.05?. There was no significant difference between the group M₁ and M₂ in the concentrate level of IL-6?P>0.05?, but both group were higher than the control group significantly?P<0.05?;There was a positive correlation between BDNF and IL-6 in group M₁, There was no correlation between BDNF and IL-6 in group M₂;There was no significant difference about the concentration level between the 3 groups before and after the surgery?P>0.05?;but significant lower level of IL-6 was found in group M₁?P<0.05?.No significant difference was found in group M₂ or control group. Conclusion: 1, Age-related cataract patients often comorbid with psychological disorders such as anxiety. 2, Psychological stress of cataract patients during perioperative period can affec The implanted diffractive multifocal intraocular lens patients' expectation for recovering from surgery is often overstated and they are more sensitive to vosual intervention;t the function of neuroendocrine system, The psychological health status of the implanted diffractive multifocal intraocular lens patients who has cataract can significantly be improved by targeted and personalized psychological intervention;3, The results of SCL- 90 assessment can be used as one of the important screen tool for the implanted diffractive multifocal intraocular lens patients who has cataract.