摘要目的:对双眼植入三焦点人工晶状体(IOL)或双焦点IOL术后早期的视觉质量进行比较研究.方法:前瞻性临床研究.选择武汉爱尔眼科医院2017年4月至2018年5月收治的双眼单纯年龄相关性白内障患者52例(104眼),依据患者选择的IOL进行分组,双眼均植入双焦点IOL 26例(52眼)作为双焦点组,双眼均植入三焦点IOL 26例(52眼)患者作为三焦点组,术后随访3个月,观察2组间裸眼远视力(UDVA)、裸眼中视力(UIVA)、裸眼近视力(UNVA)、矫正远视力(BCDVA)、矫正远中视力(DCIVA)、矫正远近视力(DCNVA)、离焦曲线、对比敏感度、波前像差、调制传递函数等,并进行VF-14-CN生活质量问卷满意度及脱镜率调查.数据采用独立样本t检验、Mann-Whitney U检验及χ2检验进行统计分析.结果:三焦点组UIVA明显优于双焦点组(Z=-2.347,P=0.019),而2组间UDVA、UNVA、BCDVA、DCIVA、DCNVA差异均无统计学意义.三焦点组在-1.0、-3.0、-3.5、-4.0 D离焦下视力明显优于双焦点组(Z=-2.619、-2.452、-2.452、-2.147,P=0.009、0.014、0.014、0.032).2组间明视及明视眩光对比敏感度差异均无统计学意义.3、5 mm瞳孔直径时,三焦点组眼内总高阶像差、眼内彗差、眼内三叶草差以及全眼总高阶像差、全眼三叶草差均明显低于双焦点组,差异均有统计学意义(P＜0.05).5 mm瞳孔直径时,三焦点组眼内球差明显低于双焦点组(Z=-3.053, P=0.002),余指标组间差异无统计学意义.2组在3、5 mm瞳孔直径时的调制传递函数差异均无统计学意义.2组间VF-14-CN得分、日常生活脱镜率以及患者满意度差异均无统计学意义.结论:与双眼植入双焦点IOL相比,双眼植入三焦点IOL能够为患者带来更好的中间距离视力,但二者在远近视力、视觉质量以及术后生活质量方面相近.

abstractsObjective: To compare visual performance after bilateral implantation of a bifocal (ReSTOR +3.0 D) or trifocal (AT Lisa tri. 839MP) intraocular lens (IOL). Methods: This prospective clinical study involved patients who had cataract surgery that included the bilateral implantation of a bifocal or trifocal IOL from April 2017 to May 2018 at Wuhan Aier Eye Hospital. Fifty-two eyes (26 patients) were implanted with a trifocal IOL (AT Lisa tri. 839MP) as trifocal group and fifty-two eyes (26 patients) with a bifocal IOL (ReSTOR+3.0 D) as bifocal IOL group. The follow-up was 3 months. Near, intermediate, and distance visual acuities, defocus curve, optical quality, including modulation transfer functions and intraocular aberrations, ocular aberrations with 3 mm and 5 mm pupil diameters, National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence and patient satisfaction were assessed in all patients. Data were assessed with a Student's t test, Mann-Whitney U test, and Chi-square test. Results: No statistically significant difference was found in distance, near, best corrected distance, distance-corrected intermediate, or distance-corrected near visual acuity between the two groups. Uncorrected intermediate visual acuity was significantly better in the trifocal IOL group (Z=-2.347, P=0.019). In the binocular defocus curve, visual acuity was also significantly better for defocus at -1.0, -3.0, 3.5 and 4.0 diopters (Z=-2.619, -2.452, -2.452,-2.147; P=0.009, 0.014, 0.014, 0.032). No significant difference was found between the two groups for mean postoperative contrast sensitivity function under photopic conditions with or without glare. With a 3 mm or 5 mm pupil diameter, intraocular higher-order aberrations, coma, trefoil and total higher-order aberrations, and trefoil aberrations were significantly lower in the trifocal IOL group (P＜0.05). With a 5 mm pupil diameter, intraocular spherical aberrations were significantly lower in the trifocal IOL group (Z=-3.053, P=0.002), but no statistically significant difference was found in modulation transfer function at 3 mm and 5 mm pupil diameters between the two groups. The level of overall satisfaction was similarly high for both groups. Conclusions: Trifocal IOLs can provide significantly better intermediate vision and equivalent distance and near visual performance compared to bifocal IOLs and have the same level of overall satisfaction.