| 【摘要】 目的 与可折叠单焦点AKREOS ADAPT 人工晶状体（IOL）比较，通过检测视力和药物诱导下前房深度（ACD）、瞳孔直径（PD）的变化，评价1CU可调节IOL（AIOL）植入术后的调节效果。设计 非随机化临床试验。研究对象 44例（53眼）老年性白内障患者分为两组：1CU AIOL组20例（23眼），对照组24例（30眼）。方法 全部患者行白内障超声乳化吸除联合IOL植入术，术后3个月观察远、近视力，使用OCULUS Pentacam三维前房分析仪测量2%匹罗卡品眼液诱导前后的ACD和PD值。主要指标 非矫正远近视力、最佳矫正远视力、远视力矫正下的近视力，药物诱导前后的ACD、PD差值和ACD差值与远视力矫正下的近视力的相关关系。结果 术后3个月1CU AIOL组与对照组矫正或非矫正远、近视力均无统计学差异。药物诱导下的ACD变化值1CU AIOL组与对照组分别为0.07±0.02 mm、0.05±0.03mm（P=0.04）；PD变化值1CU AIOL组与对照组分别为0.32±0.19 mm、0.57±0.30 mm（P=0.00）。药物诱导下的ACD变化值与远视力矫正下的近视力无相关关系（r=0.1，P=0.5）。结论 本研究显示1CU AIOL在眼内仅有0.07mm移动度，虽优于对照组但仍不足以产生明显的调节。需要以科学的态度采用客观的检测方法（如OCULUS Pentacam三维前房分析仪）评估AIOL的调节效果。未来的研究应考虑包括PD在内的鉴别假性调节的因素。
【Abstract】Objective To evaluate pseudophakic accommodation in subjects implanted with the 1CU accommodative intraocular lens (AIOL) by measuring the visual acuity, the changes in anterior chamber depth (ACD) and pupillary diameter (PD) under drug-induced stimulation in comparison with a foldable monofocal AKREOS ADAPT IOL. Design non- randomized clinical trial. Participants and Controls 44 age-related cataract patients (53 eyes) were divided into two groups: 1CU group included 20 patients (23 eyes), the reference Group included 24 patients(30 eyes).Methods All the patients accepted phacoemulsification and IOL implantation. At 3 months postoperatively, Distance and near visual acuity were observed, and ACD and PD were measured with OCULUS Pentacam three-dimension anterior segment analysis system before or after 2% pilocarpine-stimulated ciliary muscle contraction. Main Outcome Measures Uncorrected distance visual acuity (UCDVA),Best corrected distance visual acuity(BCDVA), Uncorrected near visual acuity (UCNVA), Distance corrected near visual acuity (DCNVA), change values of ACD and PD under drug-induced ciliary muscle stimulation, correlation between the change of ACD and DCNVA.Results Three months after surgery no difference was found in UCDVA,BCDVA,UCNVA and DCNVA between the two IOLs. The measured change of ACD with 1CU IOL under drug-induced stimulation was 0.07±0.02 mm, that with the reference IOL was 0.05±0.03mm (P=0.04); change of PD with 1CU IOL was 0.32±0.19 mm, that with the reference IOL was 0.57±0.30 mm. (P=0.00). There has not been found any correlation between the change of ACD and DCNVA(r=0.1，P=0.5). Conclusions This investigations indicate a mean anterior 1CU shift of only 0.07mm,which is better than the reference group under the same condition, but this shift can not produce apparent accommodation. Objective accommodation measurements, such as OCULUS Pentacam three-dimension anterior segment analysis system, are needed to evaluate AIOL in a scientific manner. Future studies should also consider to identify factors of pseudoaccommodation including pupillary diameter. |
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