Karhanová M, Marešová K, Pluháček F, Mlčák P, Vláčil O, Sín M
Cesk Slov Oftalmol. 2013 Jun;69(2):64-8.
To evaluate patient satisfaction with multifocal intraocular lens (MIOL) implants (AcrySof Restor) in relation to the size of angle kappa and precise centration of the MIOL.
Fifty-two eyes of 26 patients were included in this study. All patients underwent bilateral phacoemulsification and multifocal intraocular lens implantation (AcrySof Restor) from January 2008 to April 2010. Preoperative and postoperative examinations included slit lamp biomicroscopy, near and distance uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity and measurement of angle kappa. Precise centration of the IOL with respect to the centre of the pupil was evaluated postoperatively. Subjective photic phenomena were evaluated separately for each eye and the patients were asked to compare the perception between the right and left eye.
Angle kappa was positive in all cases, ranging from +1° to +7°. The mean angle kappa was 2.78° and 2.10° in the right and left eye, respectively. The IOL was centred exactly to the centre of the pupil in 40 eyes. In twelve eyes there was a slight decentration of the IOL (3 nasal, 4 temporal, 2 superotemporal, 2 superior, 1 inferior). Different subjective perception of photic phenomena between the two eyes was recorded only in five patients. All these patients were among those with a decentred IOL. Temporal and superotemporal decentration of the IOL caused pronounced photic phenomena in five cases - in four cases there was a greater angle kappa of +3° to +4°. In one case of temporal decentration and a small angle kappa (+1°), the patient failed to observe a difference between both eyes. In the cases of inferior, superior and nasal decentration of the IOL, no difference between both eyes was seen.
According to our results, temporal decentration of the IOL is associated with the greatest risk in multifocal IOL implantation, particularly in cases with a higher angle kappa. An evaluation of angle kappa should be a part of preoperative examination before MIOL implantation. Patients with a high angle kappa should be excluded because of a higher risk of postoperative photic phenomena. Key words: angle kappa, multifocal intraocular lens, photic phenomena.
评估患者对多焦点人工晶状体（MIOL）植入物（AcrySof Restor）的满意度，以及与角κ大小和MIOL精确对中的关系。
本研究纳入了26例患者的52只眼。所有患者在2008年1月至2010年4月期间接受了双眼超声乳化和多焦点人工晶状体植入（AcrySof Restor）。术前和术后检查包括裂隙灯生物显微镜检查、近视力和远视力的未矫正视力（UCVA）及最佳矫正视力（BCVA）、对比敏感度和角κ测量。术后评估人工晶状体相对于瞳孔中心的精确对中情况。对每只眼分别评估主观光现象，并要求患者比较左右眼的感觉。
所有病例角κ均为正值，范围为+1°至+7°。右眼和左眼的平均角κ分别为2.78°和2.10°。40只眼中人工晶状体精确对位于瞳孔中心。12只眼中人工晶状体有轻微偏心（鼻侧3只、颞侧4只、颞上侧2只、上方2只、下方1只）。仅在5例患者中记录到双眼主观光现象的不同感觉。所有这些患者均在人工晶状体偏心的患者中。人工晶状体颞侧和颞上侧偏心在5例中引起明显的光现象——4例角κ较大，为+3°至+4°。在1例颞侧偏心且角κ较小（+1°）的病例中，患者未观察到双眼之间的差异。在人工晶状体下方、上方和鼻侧偏心的病例中，未观察到双眼之间的差异。
根据我们的结果，人工晶状体颞侧偏心在多焦点人工晶状体植入中风险最大，尤其是在角κ较高的病例中。角κ评估应成为MIOL植入术前检查的一部分。由于术后光现象风险较高，角κ较高的患者应被排除。关键词：角κ、多焦点人工晶状体、光现象
