| Objective:To observe and compare the visual quality of patients with multifocal and monofocal intraocular lens implantation,and to investigate whether the measurement and analysis of wavefront aberration has a evaluating effect on the visual quality of the two intraocular lens.Methods:1 Study objects: This study collected cataract patients who need surgery from March 2016 to September 2016 at the second hospital of hebei medical university eye centre treatment.All patients respectively implant the diffractive aspheric multifocal intraocular len of Diffractiva-a A or the aspheric monofocal intraocular lens of Aspira-Aay.2 Study content: Preoperative ocular examination including uncorrected distance visual acuity,uncorrected near visual acuity,intraocular pressure,slit lamp microscope,indirectophthalmoscopy,ultrasound,OCT,Non-contact specular microscop,IOL-master.1day,1week,1 months postoperativve ocular examination including uncorrected distance visual acuity,uncorrected near visual acuity,intraocular pressure,slitlamp microscope,indirect ophthalmoscopy.Record uncorrected distance visual acuity,uncorrected near visual acuity of two groups,Photopic and mesopic contrast sensitivity function with and without glare were tested at 1 months after operation.Aberrations were recorded postoperatively.The rank sum test and the independent-samples t test was used to compare the meastlre data.Analysing a certain relationship between of the data.Results: This study collected 59 eyes of 56 patients with cataract surgery,Multifocal intraocular lens group including 16 male and 8 female,9 were in the left eye and 15 in the right eye,aged 44-68 years,average age 57.25 ± 6.76 years,monofocal intraocular lens group including 22 males and 13 females,19 eyes in the left eye and 16 eyes in the right year,aged 58-83 years,average age 69.66 ± 7.02 years.The follow-up time was 3 months.1 Postoperative visual acuity1.1 Postoperative distance visual acuityThe uncorrected distance visual acuity of multifocal intraocular lens group and monofocal intraocular lens group at 1 day after surgery are 0.31 ± 0.12 and 0.21 ± 0.12,(t =-3.366,P = 0.001),the difference was statistically significant.The uncorrected distance visual acuity of 1 week after surgery are 0.20 ± 0.11 and 0.10 ± 0.11,(t =-3.348,P = 0.002),the difference was statistically significant.The uncorrected distance visual acuity of 1 month after surgery are 0.09 ± 0.12 and 0.05 ± 0.10,(t =-1.137,P = 0.260),the difference was not statistically significant.Using the international E visual chart to have a test,Patients with uncorrected distance visual acuity ≥ 0.5 were 24 eyes(100%),one month after multifocal intraocular lens implantation.Uncorrected distance visual acuity ≥ 0.5 were 35 eyes(100%),one month after monofocal intraocular lens implantation.1.2 Postoperative near visual acuityThe uncorrected near visual acuity of multifocal intraocular lens group and monofocal intraocular lens group at 1 day after surgery are 0.53±0.13 and 0.70±0.11,(t=5.389,P=0.000),the difference was statistically significant.The uncorrected near visual acuity of 1 week after surgery are 0.36±0.13 and 0.66±0.13,(t= 8.786,P=0.000),the difference was statistically significant.The uncorrected near visual acuity of 1 month after surgery are 0.19±0.12 and 0.63±0.15,(t=12.104,P=0.000),the difference was statistically significant.The uncorrected near visual acuity of 1 month after surgery on multifocal intraocular lens group was significantly better than that of monofocal intraocular lens group.Using the international E visual chart to have a test,after surgery,in the multifocal intraocular lens group,there were 22 eyes(91.7%)with uncorrected near visual acuity ≥0.5,and 2 eyes(5.7%)≥0.5 in the monofocal intraocular lens group.2 The percentage of spectacle independence focus on near in patients after surgeryTwenty-one eyes in the multifocal group(87.5%),4 eyes in the monofocal group(11.4%)do not need to wear glasses to perform daily reading and close work,completely get rid of glasses.3 The contrast sensitivity of 1 day,1 week,1 month after surgeryBecause corneal is edematous and refractive media is unclear in 1 day,1 week after surgery,contrast sensitivity data have great acceleration,so record and analysis contrast sensitivity data in 1 month after surgery.Photopic contrast sensitivity function with glare at 1.5c/d,the median was 1.40(0.27)and 1.85(0.15)(Z =-5.155,P = 0.000),and the difference was statistically significant.At 3.0c/d,the median was 1.76(0.44)and 1.90(0.20)(Z =-3.815,P = 0.000),the difference was statistically significant.Photopic contrast sensitivity function without glare at 1.5c/d,the mean were 1.40(0.30)and 1.70(0.30)(Z =-3.116,P = 0.002),the difference was statistically significant.At 3.0c/d,the median was 1.68(0.29)and 1.76(0.15)(Z =-3.072,P = 0.002),the difference was statistically significant.At 6.0c/d,the median was 1.59(0.29)and 1.65(0.29)(Z =-2.221,P = 0.026),the difference was statistically significant.At 18c/d,the median was 0.00(0.96)and 0.78(1.08)(Z =-1.985,P = 0.047),the difference was statistically significant.Mesopic contrast sensitivity function with glare at 1.5c/d,the median was 1.26(0.14)and 1.56(0.30)(Z =-3.829,P = 0.000),the difference was statistically significant.At 3.0c/d,the median was 1.09(0.63)and 1.46(0.42)(Z =-2.856,P = 0.004),the difference was statistically significant.Mesopic contrast sensitivity function without glare at 6.0c/d,the median was 1.20(0.28)and 1.52(0.45)(Z =-2.519,P = 0.012).The difference was statistically significant.Other spatial frequencies were not statistically significant.At all effective spatial frequencies,contrast sensitivity of monofocal intraocular lenses were larger than multifocal intraocular lenses.Generally the difference in low frequency or high frequency is obvious,the intermediate frequency difference is not obvious.4 The wavefront aberration of 1 day,1 week,1 month after surgeryBecause corneal is edematous and refractive media is unclear in 1 day,1 week after surgery,can not accurately collected wavefront difference image,so record and analysis wavefront aberration data in 1 month after surgery.Total aberrations of multifocal and monofocal were 1.13 ± 0.19 μm and 0.92 ± 0.26 μm(t =-3.499,P = 0.001),the difference was statistically significant.Total high grade aberrations were 0.61 ± 0.13μm and 0.38 ± 0.10μm,(t=-7.527,P=0.000),the difference was statistically significant.Spherical aberration was 0.26 ± 0.12μm and 0.16 ± 0.09μm,(t =-3.557,P=0.001),the difference was statistically significant.Coma was 0.32 ± 0.13μm and 0.22 ± 0.09μm,(t=-3.616,P=0.001),the difference was statistically significant.Defocus of multifocal and monofocal were 0.32 ± 0.64μm and 0.12 ± 0.66μm,(t=-1.183,P=0.242),the difference was not statistically significant.Astigmatism were 0.67 ± 0.23μm and 0.64 ± 0.26μm,(t= 0.447,P=0.656),the difference was not statistically significant.Trefoil were 0.36 ± 0.15μm and 0.29 ± 0.15μm,(t=-1.717,P= 0.091),the difference was not statistically significant.5 PSF of 1 month after surgery The three-dimensional image of PSF is waved mountain as high and sharp,but the base of PSF image of multifocal intraocular lens is wider and lower sharpness than monofocal intraocular lens.The bimodal phenomenon is mainly presents a main peak and a second peak with slightly lower height peak.Compared with the bimodal phenomenon of multifocal intraocular lens,monofocal intraocular lens mainly presents with a high and sharp unimodal phenomenon.There were 3 cases(12.5%)of the PSF images with the multifocal intraocular lens Diffractiva-a A showing a bimodal phenomenon,and the PSF images of the monofocal intraocular lens Aspira-Aay did not show a bimodal phenomenon(0%).Conclusions: 1 Compared with monofocal lenses,multifocal IOL provide better uncorrected near visual acuity,the contrast sensitivity of multifocal intraocular lens decline,the high-order aberration of multifocal intraocular lens is more higher.2 The measurement of wavefront aberration still need further study. |
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