0.2%酒石酸溴莫尼定对连续视程人工晶体植入术后伴有光学干扰患者夜间视觉质量的影响

doi:10.6040/j.issn.1673-3770.0.2022.220

摘要/Abstract

摘要： 目的通过连续视程人工晶体(EDOF IOL)植入术后伴有光学干扰的患者应用0.2%酒石酸溴莫尼定滴眼液,观察患者瞳孔大小、视力和视觉质量的变化,探讨0.2%酒石酸溴莫尼定滴眼液对EDOF IOL植入术后视觉质量的影响。方法选取行白内障超声乳化联合EDOF IOL植入术后伴有光学干扰的年龄相关性白内障患者21例(21只眼),EDOF IOL植入术后患者1个月复查时,术眼应用0.2%酒石酸溴莫尼定滴眼液,分别于给药前、给药后2 h、给药后4 h,中间视觉条件下应用OPD-Scan Ⅲ视觉质量分析仪测量EDOF IOL植入眼的客观视觉质量,包括斯特列尔比(SR)、高阶像差(HOA)、球差(SA)、彗差及三叶草像差等。分别于给药前、给药后2 h、给药后4 h,测量眼压(IOP),测量中间视觉条件下的瞳孔直径。在主观视觉质量方面测量术眼远视力(UDVA)及最佳矫正远视力(CDVA)。利用视功能指数量表(VF-14)对患者进行问卷调查。结果应用0.2%酒石酸溴莫尼定滴眼液后,术眼客观视觉质量如:SR、HOA、SA及Trefoil得到明显改善,分别在用药后2 h达到最佳值,与给药前相比,差异均具有统计学意义(P<0.05)。效果可以持续到用药后4 h。而Coma无明显改善,差异不具有统计学意义(P=0.570)。应用0.2%酒石酸溴莫尼定滴眼液后,术眼IOP降低,给药后2 h、给药后4 h与给药前IOP比较,差异具有统计学意义(P<0.001)。中间视觉瞳孔直径在给药后开始缩小,并在2 h达到最低值,给药后2 h、给药后4 h与给药前比较,差异具有统计学意义(P<0.001)。应用0.2%酒石酸溴莫尼定滴眼液后,UDVA及CDVA,差异无统计学意义(P=0.051,P=0.063)。问卷调查显示,应用0.2%酒石酸溴莫尼定滴眼液后,67%的患者眩光或光晕的症状消失,24%的患者症状得到缓解,9%的患者症状没有得到改善。结论 EDOF IOL植入术后应用0.2%酒石酸溴莫尼定滴眼液可以抑制术眼夜间瞳孔散大,降低术眼HOA、SA和Trefoil,提高术眼SR,减轻患者眩光或光晕等症状,改善夜间视觉质量。

关键词: 连续视程人工晶体, 视觉质量, 酒石酸溴莫尼定滴眼液, 视觉干扰

Abstract: Objective To investigate the effect of brimonidine tartrate 0.2% ophthalmic solution on visual quality after phaco and extended depth of focus intraocular lens(EDOF IOL)implantation with dysphotopsia under mesopic conditions. Methods This prospective non-randomized study enrolled 21 eyes with dysphotopsia from 21 age-related cataract patients who underwent phacoemulsification and EDOF IOL implantatiosn. The pseudophakic eye was topically administered bromonidine tartrate 0.2% at 1 month follow-up after EDOF IOL implantation. Before and 2 hours, 4 hours after brimonidine tartrate drops was administered topically. Under mesopic conditions, OPD-Scan III was used to measure the objective visual quality, including the strehl ratio(SR), higher-order aberrations(HOA), spherical aberration(SA), coma and trefoil aberration. Intraocular pressure(IOP)was further measured with a non-contact tonometer. The pupil size was evaluated under mesopic conditions. Uncorrected distance visual acuity(UDVA)and the best corrected distance visual acuity(CDVA)were measured using a high-contrast projected logMAR chart. The Visual Functioning-14(VF-14)scale was used to assess visual functioning and vision-related functional impairment. Results Significant differences were observed in ocular HOA, SA and Trefoil, as well as in optical quality parameters(all P<0.05)after brimonidine tartrate 0.2% administration compared to baseline,. The visual quality improved and reached its optimum value 2 h after 0.2% brimonidine 0.2% administration, which lasted beyond 4 h after administration. The ocular Coma after administration did not significantly differ(P=0.570). Significant differences were observed in the mesopic pupil size at 2 and 4 hours after brimonidine administration compared with baseline(P<0.001). The mesopic pupil size reached its minimum value 2 h after brimonidine administration. IOP reduction was observed at 2 and 4 hours after brimonidine administration, showing significant differences compared with the baseline IOP(P<0.001). UDVA and CDVA did not significantly differ after brimonidine administration(P=0.051,P=0.063). The VF-14 scale demonstrated that symptoms of glare or halos could be eliminated after brimonidine administration in 67% of pseudophakic eyes, and was alleviated in 24% and did not improve in 5%. Conclusion Brimonidine tartrate 0.2% ophthalmic solution exerts an antimydriatic effect under mesopic conditions in patients with EDOF IOL implantation. Brimonidine tartrate 0.2% may be applied to improve night visual quality in pseudophakic eyes through reducing ocular HOA, SA and Trefoil, increasing SR, and alleviating symptoms of glare or halos in pseudophakic eyes.

Key words: Extended depth of focus intraocular lens, Visual quality, Brimonidine tartrate, Dysphotopsia

中图分类号:

R776.1

于腾飞,李彦松,刘振,周维维,朱艳,朱玉广. 0.2%酒石酸溴莫尼定对连续视程人工晶体植入术后伴有光学干扰患者夜间视觉质量的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 45-50.

YU Tengfei, LI Yansong, LIU Zhen, ZHOU Weiwei, ZHU Yan, ZHU Yuguang. Effect of brimonidine tartrate 0.2% on visual quality after phaco and extended depth of focus intraocular lens implantation with dysphotopsia under mesopic condition[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 45-50.

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