Leccisotti Antonio
Ophthalmic Surgery Unit, Casa di Cura Rugani, Piazza 5o Bersaglieri 2, 53100 Siena, Italy.
J Cataract Refract Surg. 2004 Jul;30(7):1461-5. doi: 10.1016/j.jcrs.2003.11.056.
To assess the indications, incidence, and outcome of secondary procedures after presbyopic lens exchange (PRELEX).
Private practice, Siena, Italy.
This prospective nonrandomized single-surgeon study comprised 52 patients having PRELEX by phacoemulsification and multifocal intraocular lens (IOL) implantation. The preoperative mean spherical equivalent (SE) was +2.50 diopters (D) +/- 1.38 (SD) (range 0 to +6.0 D).
Monocular PRELEX was performed in 8 patients who canceled the fellow-eye surgery because of halos; in this group, the residual refractive error was corrected by photorefractive keratectomy (PRK) in 4 eyes, but this did not alleviate halos and IOL exchange was ultimately needed in 7 eyes. Binocular PRELEX was completed in 44 patients; in this group, 14 eyes (8 patients) had PRK for a residual error. The postoperative mean absolute SE in the 18 PRK-treated eyes was 0.33 D (95% confidence interval [CI] of improvement, 0.57-1.32) and the mean uncorrected visual acuity, 0.8 (95% CI of improvement, 0.32-0.45). The final SE was within +/-0.5 D in 15 eyes (83.0%) and within +/-1.0 D in 18 eyes. Halos after PRK were unchanged in 6 patients, slightly improved in 4, and improved in 2. Photorefractive keratectomy or IOL exchange was needed in eyes with a preoperative SE between plano and +1.75 D (15/40 eyes, 38%) and not needed in eyes with a preoperative SE greater than +1.75 D (0%) (95% CI of difference, 23%-53%).
Presbyopic lens exchange in eyes with emmetropia and low hyperopia was associated with a significantly higher percentage of secondary procedures. Photorefractive keratectomy enhancement can improve distance vision but has a limited effect on halos.
评估老视晶状体置换术（PRELEX）后二次手术的适应证、发生率及预后。
意大利锡耶纳的私人诊所。
这项前瞻性非随机单术者研究纳入了52例行PRELEX（通过超声乳化及多焦点人工晶状体植入）的患者。术前平均球镜等效度（SE）为+2.50屈光度（D）±1.38（标准差）（范围0至+6.0 D）。
8例患者因眩光取消了对侧眼手术，接受了单眼PRELEX；在该组中，4只眼通过准分子激光角膜切削术（PRK）矫正残余屈光不正，但这并未减轻眩光，最终7只眼需要更换人工晶状体。44例患者完成了双眼PRELEX；在该组中，14只眼（8例患者）因残余误差接受了PRK。18只接受PRK治疗的眼中，术后平均绝对SE为0.33 D（改善的95%置信区间[CI]，0.57 - 1.32），平均未矫正视力为0.8（改善的95% CI，0.32 - 0.45）。最终SE在±0.5 D范围内的有15只眼（83.0%），在±1.0 D范围内的有18只眼。PRK后，6例患者的眩光无变化，4例略有改善，2例改善。术前SE在平光至+1.75 D之间的眼（15/40只眼，38%）需要PRK或更换人工晶状体，而术前SE大于+1.75 D的眼（0%）则不需要（差异的95% CI，23% - 53%）。
正视眼和低度远视眼中的老视晶状体置换术与二次手术的比例显著更高相关。准分子激光角膜切削术强化可改善远视力，但对眩光的作用有限。
