Liekfeld A, Friederici L, Rieck P
Universitäts-Augenklinik, Charité, Campus Virchow-Klinikum, Humboldt-Universität, Augustenburger Platz 1, 13353 Berlin, Deutschland.
Ophthalmologe. 2008 Sep;105(9):832-5. doi: 10.1007/s00347-008-1780-5.
Good functional results with multifocal lenses need exact postoperative emmetropia. Therefore, it seems reasonable to perform additional refractive surgery to correct minimal spherical or cylindrical postoperative ametropia (bioptics). But concerns could arise about additional photoptic phenomena or loss of contrast. The literature contains only a few reports about bioptics after multifocal lens implantation.
In eight eyes of seven patients, laser subepithelial keratomileusis (Lasek) was done after multifocal lens implantation. Pre-Lasek and 6 months postoperatively, we performed the following examinations in addition to visual acuity: contrast sensitivity (Pelli-Robson charts), low-contrast visual acuity (Humphrey AR 570), glare visual acuity (Humphrey AR 570), and night-driving ability (Mesoptometer II, Oculus).
Preoperative contrast sensitivity was 1.2-1.65; postoperatively it was 1.35-1.65. Low-contrast visual acuity measured 50-70% preoperatively and 57-70% postoperatively. Glare visual acuity measured 12.5-50% preoperatively and 28.5-57% postoperatively. Mesoptometer measurements did not change after Lasek; they revealed night-driving ability under strict criteria for four patients.
Bioptics as a combination of multifocal lens implantation and Lasek does not cause a functional decline in low-contrast or glare visual acuity, but it minimizes postoperative ametropia. It seems superior to exclusive multifocal lens implantation.
多焦点人工晶状体要获得良好的功能效果需要术后精确的屈光状态。因此，进行额外的屈光手术以矫正术后最小的球镜或柱镜屈光不正（联合屈光手术）似乎是合理的。但可能会担心出现额外的光学现象或对比度下降。文献中关于多焦点人工晶状体植入术后联合屈光手术的报道很少。
对7例患者的8只眼在多焦点人工晶状体植入术后进行了准分子激光上皮瓣下角膜磨镶术（Lasek）。在Lasek术前及术后6个月，除视力检查外，我们还进行了以下检查：对比敏感度（佩利-罗布森图表）、低对比度视力（Humphrey AR 570）、眩光视力（Humphrey AR 570）和夜间驾驶能力（Mesoptometer II，Oculus）。
术前对比敏感度为1.2 - 1.65；术后为1.35 - 1.65。术前低对比度视力为50% - 70%，术后为57% - 70%。术前眩光视力为12.5% - 50%，术后为28.5% - 57%。Lasek术后Mesoptometer测量结果未改变；根据严格标准，4例患者的测量结果显示了夜间驾驶能力。
联合屈光手术作为多焦点人工晶状体植入与Lasek的组合，不会导致低对比度或眩光视力的功能下降，但能将术后屈光不正降至最低。它似乎优于单纯的多焦点人工晶状体植入。
