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Title: [Comparison of tolerance to decentration and tilt in the early postoperative period between the continuous range and bifocal intraocular lens implantation in myopic eyes].
Author: Cheng KW, Meng JQ, Wei L, Hu XX, Lu Y, Zhu XJ.
Journal: Zhonghua Yan Ke Za Zhi; 2022 Jul 11; 58(7):513-520. PubMed ID: 35796124.
Abstract:
Objective: To compare decentration and tilt tolerances between continuous range intraocular lens (IOL) and bifocal IOL in myopia during the early stages post intraocular implantation. Method: A retrospective cohort study was conducted using follow-up data of 145 patients (145 eyes) who underwent phacoemulsification combined with IOL implantation in the Eye & ENT Hospital of Fudan University from January 2018 to December 2020. According to whether the axial length was less than 24.5 mm, patients were divided into non-myopic and myopic groups. According to IOL type, patients were divided into extend depth of focus (EDOF) ZXR00 IOL group (myopic 38 eyes, non-myopic 41 eyes) and bifocal ZMB00 IOL group (myopic 23 eyes, non-myopic 43 eyes). The distance and near visual acuity (log of the minimum angle of resolution visual acuity), IOL tilt and decentration, intraocular high-order aberration (HOA), coma, trefoil, spherical aberrations, modulation transfer function (MTF), as well as VF-14 index and the incidence of dysphotopsia were compared between the 2 groups at 3 months after surgery. Statistics were performed using Student's t-test, χ² test, Pearson correlation analysis and multiple linear regression analysis. Results: In either the myopic or non-myopic group, no significant differences were found in age, gender, eye laterality, axial length and IOL degree between eyes with the two different types of IOLs (all P>0.05). At 3 months after surgery, there was no significant difference in uncorrected and best-corrected distance visual acuity between the ZXR00 IOL group and the ZXR00 IOL group, while uncorrected near visual acuity was better in the ZMB00 IOL group than the ZXR00 IOL group (t=10.41, P<0.01). The total postoperative IOL decentration in the ZXR00 IOL group and ZMB00 IOL group in myopic eyes were (0.32±0.17) and (0.38±0.16) mm, respectively, which were greater than those in non-myopic eyes [(0.22±0.12), (0.28±0.12) mm; t=3.16, 2.57; both P<0.05]. However, there were no significant differences in IOL tilt between myopic and non-myopic eyes in the 2 groups (both P>0.05). There were no significant differences in postoperative IOL tilt and decentration between the 2 groups regardless of myopia or non-myopia (all P>0.05). In myopic eyes, HOA, coma aberration and spherical aberration in the ZXR00 IOL group were significantly lower than those in the ZMB00 IOL group, while the total ocular MTF (38.15±10.12) was significantly higher than that in the ZMB00 IOL group (30.46±10.53) (all P<0.05). Pearson correlation analysis and multiple linear regression analysis showed a positive correlation between postoperative HOA and both IOL tilt and decentration in the ZMB00 IOL group (r=0.627, 0.726; β=0.446, 0.587; all P<0.01). However, no such relationship was found in the ZXR00 IOL group (all P>0.05). In myopic eyes, when the IOL tilt aberration and decentration were greater than the median, the HOAs in the ZXR00 IOL group [(0.33±0.14), (0.27±0.11) μm] were lower than those in the ZMB00 IOL group [(0.88±0.56), (0.96±0.45) μm], while the total ocular MTF (42.87±10.97, 40.22±9.30) were higher than those in the ZMB00 IOL group (25.02±8.99, 29.87±10.19) (all P<0.05). In myopic eyes, the proportion of patients with visual interference symptoms in the ZXR00 IOL group [42.11% (16/38)] was significantly lower than that in the ZMB00 IOL group [78.26%(18/23), χ²=7.59, P<0.05]. Conclusion: During the early stages after IOL implantation in myopic eyes, EDOF IOL is more tolerant to decentration and tilt than bifocal IOL. 目的： 比较连续视程人工晶状体（IOL）与双焦点IOL在近视眼内植入术后早期对偏心及倾斜的耐受性。 方法： 回顾性队列研究。收集2018年1月至2020年12月在复旦大学附属眼耳鼻喉科医院行超声乳化白内障吸除联合IOL植入术的145例（145只眼）患者的随访资料，根据眼轴长度是否小于24.5 mm分为非近视眼和近视眼，根据植入IOL类型分为连续视程IOL组（ZXR00 IOL，近视眼38只眼、非近视眼41只眼）和双焦点IOL组（ZMB00 IOL，近视眼23只眼，非近视眼43只眼）。比较组间术后3个月远、近距离视力（最小分辨角对数视力），IOL偏心、倾斜、眼内总高阶像差、彗差、三叶草像差、球差及调制传递函数（MTF），以及VF-14视觉质量评分和视觉干扰比例。统计学采用独立样本t检验、χ²检验、Pearson相关分析及多元线性回归分析。 结果： 无论非近视眼还是近视眼，连续视程IOL组与双焦点IOL组间年龄、性别、眼别、眼轴长度及IOL度数差异均无统计学意义（均P>0.05）。术后3个月，连续视程IOL组与双焦点IOL组间裸眼及最佳矫正远距离视力差异无统计学意义，而近距离视力双焦点IOL组优于连续视程IOL组（t=10.41，P<0.01）。近视眼中连续视程IOL组、双焦点IOL组术后IOL总偏心值分别为（0.32±0.17）、（0.38±0.16）mm，均大于非近视眼［（0.22±0.12）、（0.28±0.12）mm；t=3.16、2.57，均P<0.05］；但近视眼与非近视眼之间IOL倾斜差异均无统计学意义（均P>0.05）。无论近视眼还是非近视眼，连续视程IOL组与双焦点IOL组之间术后IOL倾斜及偏心差异均无统计学意义（均P>0.05）。近视眼中，连续视程IOL组眼内总高阶像差、彗差和球差显著低于双焦点IOL组，而全眼总MTF（38.15±10.12）显著高于双焦点IOL组（30.46±10.53），差异均有统计学意义（均P<0.05）。Pearson相关分析及多元线性回归分析显示术后双焦点IOL组眼内总高阶像差与IOL倾斜、偏心均呈正相关（r=0.627、0.726；β=0.446、0.587；均P<0.01），而连续视程IOL组无上述相关性（均P>0.05）。在近视眼中，当IOL眼内倾斜像差及总偏心值大于中位数时，连续视程IOL组眼内总高阶像差［（0.33±0.14）、（0.27±0.11）μm］低于双焦点IOL组［（0.88±0.56）、（0.96±0.45）μm］，而全眼总MTF（42.87±10.97、40.22±9.30）高于双焦点IOL组（25.02±8.99、29.87±10.19）（均P<0.05）；连续视程IOL组视觉干扰症状患者比例［42.11%（16/38）］显著低于双焦点IOL组［78.26%（18/23）；χ²=7.59，P<0.05］。 结论： 近视眼IOL植入术后早期，连续视程IOL比双焦点IOL对偏心和倾斜的耐受性更高。.

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