Long-term clinical observation of aspheric multifocal intraocular lens implantation

Abstract

Objective: To observe the clinical effect of long term visual quality after the implantation of the aspheric diffractive multifocal intraocular lens. Methods: This was a retrospective cohort study.One hundred and thirty cases of age-related cataract (170 eyes) after phacoemulsification cataract extraction combined with IOL implantation were collected from September of 2009 to January of 2011 in the First Affiliated Hospital of Zhengzhou University.There were 42 patients (57 eyes) with aspheric multifocal group, 43 patients (57 eyes) in the aspheric group and 45 patients (56 eyes) in the spherical group according to the different types of IOL implanted.At 1 year, 3 years and 5 years after operation, the following parameters were assessed: uncorrected and best corrected distance, medium and near vision acuity, contrast sensitivity, wavefront aberrations, modulation transfer functions (MTF), stereopsis, visual function and quality of life (VF/QOL) questionnaire survey. Results: At 1 year, 3 years and 5 years after operation, the uncorrected medium visual acuity in aspheric diffractive multifocal IOL group(0.30(0.10, 0.50), 0.30(0.10, 1.00), 0.30(0.10, 0.50)) was better than that of eyes in aspheric IOL group(0.40 (0.10, 0.0), 0.40 (0.20, 1.00), 0.40 (0.20, 0.50)) (Z(1)=-3.32,-1.73,-3.01, P(1)=0.00, 0.01, 0.00) and spherical IOL group (0.40(0.30, 1.00), 0.40(0.20, 1.00), 0.40(0.20, 1.00)) (Z(2)=-5.77,-3.19,-4.49, P(2)=0.00, 0.00, 0.00).And the near vision in aspheric diffractive multifocal IOL group(0.25(0.00, 1.00), 0.30(0.00, 1.00), 0.30(0.00, 1.00)) was also obviously better than that of eyes in aspheric IOL group (0.50(0.18, 1.00), 0.50(0.18, 1.00), 0.50(0.18, 1.00)) (Z(1)=-5.57,-5.37,-4.93, P(1)=0.00, 0.00, 0.00) and spherical IOL group(0.60(0.18, 1.00), 0.60(0.18, 1.00), 0.60(0.18, 1.00)) (Z(2)=-7.00,-6.91,-6.53, P(2)=0.00, 0.00, 0.00). At 5 years after operation, the mean higher-order aberration for 3.0mm and 5.0mm optical zone in aspheric diffractive multifocal IOL group (0.21(0.03, 0.46), 0.37(0.12, 2.01)) were significantly lower than that in spherical IOL group (0.43(0.10, 1.91), 0.46 (0.10, 1.91) ) (Z(2)=-4.81,-1.97, P(2)=0.00, 0.01).But there was no statistical difference between the aspheric diffractive multifocal and aspheric IOL group (0.21(0.03, 1.17), 0.34(0.06, 1.74)) (Z(1)=-0.10,-1.81, P(1)=0.92, 0.07).The mean spherical aberration for 3.0mm and 5.0mm optical zone in aspheric diffractive multifocal IOL group (0.01(-0.01, 0.20), 0.03(-0.10, 0.20)) were significantly lower than that in spherical IOL group (0.29(0.10, 0.99), 0.32(0.10, 0.99)) (Z(2)=-8.48,-8.54, P(2)=0.00, 0.01).But there was no statistical differences between the aspheric diffractive multifocal and aspheric IOL group (0.02(-0.09, 0.37), 0.04(-0.09, 0.37)) (Z(1)=-0.60,-0.73, P(1)=0.55, 0.46).About 86% of patients in aspheric diffractive multifocal IOL group do not need to wear glasses, it was better than the other two groups (χ(2)=17.83, 24.45, P=0.00, 0.00).The incidence of night glare and halo in aspheric diffractive multifocal IOL group 16/50(32%) was higher than that of aspherical IOL group 5/50(10%) and spherical IOL group 3/50(6%), and the difference was statistically significant (χ(2)=7.29, 10.98, P=0.00, 0.00).The overall satisfaction in aspheric diffractive multifocal IOL group was 45/50 (90%), better than that of aspherical IOL group 29/50(58%) and spherical IOL group 20/50(40%), and the difference was statistically significant (χ(2)=13.31, 27.47, P=0.00, 0.00). Conclusions: The aspheric diffractive multifocal IOL can provide patients with good and stable far, medium and near vision, to meet the needs of patients without glasses.At the same time, it can effectively reduce the high order aberrations and spherical aberration, improve visual quality.But due to night glare and glow, it does not apply to professional drivers and nighttime drivers. (Chin J Ophthalmol, 2017, 53: 599-609).