(1)希望减少术后阅读对眼镜的依赖,对远、中、近视力均有较高要求的患者,优先推荐相对年轻、眼底条件较好、无合并影响视力的其他眼病的白内障患者。(2)一般要求预计术后散光度数≤1.00 D[6];对于既有术后预计散光又有全程视力需求的患者可选择Toric MIOL[7];对于预计术后散光度数较大且坚持植入MIOL的患者,可在患者知晓手术风险的前提下谨慎选用MIOL,术后可通过角膜屈光手术等对残留散光度数进行矫正。(3)建议暗室下瞳孔自然直径3.0~5.5 mm[8,9]。(4)Kappa角<0.5 mm或Kappa角小于MIOL中央折射光学区直径的一半[10]。
(1)生活方式或职业原因(如夜间驾车、驾驶飞机等)对视觉质量要求过高、具有戴镜阅读习惯、年龄过大适应能力有限的患者[13]。(2)术前有畏光症状的患者。(3)同时需要接受其他眼科手术的患者,如青光眼白内障联合手术、白内障摘除联合玻璃体视网膜手术等。(4)既往眼外伤或眼部手术史等可能影响视觉效果的患者等,不作首选推荐,若术前检查眼部条件允许,且患者本人有较高的脱镜需求并坚持植入MIOL,可在告知患者手术风险的前提下谨慎选用MIOL。已进行过放射状角膜切开术、准分子激光屈光性角膜切削术、准分子激光原位角膜磨镶术等角膜屈光手术的患者虽不作为绝对禁忌证,但需告知患者术后将承受对比敏感度明显降低导致的视觉质量较差的风险[14]。(5)焦虑型人格、极端完美主义性格特征患者,过分挑剔及对术后视力有不切实际期望的患者不作为MIOL植入的禁忌证,但术前须对患者进行充分教育和沟通后谨慎选用MIOL。(6)在白内障摘除手术前建议对干眼、睑缘炎、睑板腺功能障碍等眼表疾病进行诊断和治疗,对既往有相关病史的患者,建议在充分沟通和告知术后可能出现相关症状的前提下谨慎选用MIOL[15]。(7)儿童不建议过早植入MIOL,待屈光状态稳定后再行评估[16,17]。
[6]HayashiK, ManabeS, YoshidaM, et al. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens[J]. J Cataract Refract Surg, 2010, 36(8): 1323-1329. DOI:10.1016/j.jcrs.2010.02.016.
[7]GarzónN, PoyalesF, de ZárateBO, et al. Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses[J]. J Refract Surg, 2015, 31(2): 90-97. DOI: 10.3928/1081597X-20150122-03.
[8]HayashiK, HayashiH, NakaoF, et al. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens[J]. Ophthalmology, 2001, 108(11): 2011-2017.
[9]De VriesNE, WebersCA, TouwslagerWR, et al. Dissatisfaction after implantation of multifocal intraocular lenses[J]. J Cataract Refract Surg, 2011, 37(5): 859-865. DOI: 10.1016/j.jcrs.2010.11.032.
[10]De VriesNE, FranssenL, WebersCA, et al. Intraocular straylight after implantation of the multifocal AcrySof ReSTOR SA60D3 diffractive intraocular lens[J]. J Cataract Refract Surg, 2008, 34(6): 957-962. DOI: 10.1016/j.jcrs.2008.02.016.
[11]Braga-MeleR, ChangD, DeweyS, et al. Multifocal intraocular lenses: relative indications and contraindications for implantation[J]. J Cataract Refract Surg, 2014, 40(2): 313-322. DOI:10.1016/j.jcrs.2013.12.011.
[12]赵云娥.多焦点人工晶状体的研究进展及临床应用[J].中华眼科杂志, 2006, 42(10): 942-945. DOI:10.3760/j:issn:0412-4081.2006.10.021.
[13]HendersonB, SharifZ, GenevaI. Presbyopia correcting IOLs: patient selection and satisfaction[M]//BradleyR, AhmedIIK. Intraocular lens surgery: selection, complications, and complex cases. Stuttgart: Thieme Medical, 2016: 72-77.
[14]AlioJL, Plaza-PucheAB, Férnandez-BuenagaR, et al. Multifocal intraocular lenses: an overview[J]. Surv Ophthalmol, 2017, 62(5): 611-634. DOI: 10.1016/j.survophthal.2017.03.005.
[15]de VriesNE, NuijtsRM. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects[J]. J Cataract Refract Surg, 2013, 39(2): 268-278. DOI:10.1016/j.jcrs.2012.12.002.
[16]AbouzeidH, MoetteliL, MunierFL. New-generation multifocal intraocular lens for pediatric cataract[J]. Ophthalmologica, 2013, 230(2): 100-107. DOI: 10.1159/000351653.
[17]HunterDG. Multifocal intraocular lenses in children[J]. Ophthalmology, 2001, 108(8): 1373-1374.
备注:上述内容为专家意见,为临床医疗服务提供指导,不是在各种情况下都必须遵循的医疗标准,也不是为个别特殊个人提供的保健措施;本文内容与相关产品的生产和销售厂商无经济利益关系