Jin Shanshan, Friedman David S, Cao Kai, Yusufu Mayinuer, Zhang Jingshang, Wang Jinda, Hou Simeng, Zhu Guyu, Wang Bingsong, Xiong Ying, Li Jing, Li Xiaoxia, He Hailong, Wan Xiuhua
Beijing Institute of Ophthalmology, Beijing Tongren Eye CenterBeijing Tongren Hospital of Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.
Dana Center for Preventive Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Ophthalmol. 2019 Mar 14;19(1):78. doi: 10.1186/s12886-019-1078-1.
To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted.
A comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction.
There were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance [MD = 0.02, 95%CI: (- 0.03,0.06)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (- 0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD = 0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (- 0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) [MD = 0.18, 95%CI: (0.12, 0.24) for UIVA and MD = 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA (UDVA) and corrected distance visual acuity (CDVA) [MD = 0.01, 95%CI: (- 0.01,0.04) for UDVA; MD = 0.00, 95%CI: (- 0.01,0.01) for CDVA]. The postoperative refraction of bifocal group was similar to that of trifocal group [MD = -0.08, 95% CI: (- 0.19, 0.03) for spherical equivalent; MD = -0.09, 95%CI: (- 0.21, 0.03) for cylinder; MD = -0.09, 95% CI: (- 0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR = 0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR = 1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR = 0.98, 5% CI: (0.86, 1.12) for patient satisfaction].
Patients receiving trifocal IOLs, especially AT LISA tri 839 M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs.
为比较双焦点和三焦点人工晶状体（IOL）在白内障手术中的临床性能，进行了一项随机对照试验的荟萃分析。
在本系统评价中对PubMed、Science Direct和EMBASE进行了全面的文献检索。临床结局包括视力（VA）、对比敏感度（CS）、脱镜率、术后屈光和手术满意度。
本研究纳入8项随机对照试验。双焦点IOL和三焦点IOL之间未矫正近视力（UNVA）的差异无统计学意义[MD = 0.02，95%CI：（-0.03，0.06）]。远距离矫正近视力（DCNVA）差异无统计学意义，MD为0.04 [95%CI（-0.02，0.10）]。与三焦点组相比，双焦点组未矫正中视力（UIVA）[MD = 0.09，95%CI：（0.01，0.17）]明显较差。两组间远距离矫正中视力（DCIVA）[MD = 0.09，95%CI：（-0.04，0.23）]无差异。对AT LISA亚组的分析表明，双焦点组的中视力比三焦点组差（AT LISA tri 839M）[UIVA的MD = 0.18，95%CI：（0.12，0.24）；DCIVA的MD = 0.19，95%CI：（0.13，0.25）]。然而，两组间未矫正远视力（UDVA）和矫正远视力（CDVA）无统计学显著差异[UDVA的MD = 0.01，95%CI：（-0.01，0.04）；CDVA的MD = 0.00，95%CI：（-0.01，0.01）]。双焦点组的术后屈光与三焦点组相似[等效球镜的MD = -0.08，95%CI：（-0.19，0.03）；柱镜的MD = -0.09，95%CI：（-0.21，0.03）；球镜的MD = -0.09，95%CI：（-0.27，0.08）]。双焦点IOL和三焦点IOL在脱镜率、后囊膜混浊（PCO）发生率和患者满意度方面无差异。[脱镜率的RR = 0.89，95%CI：（0.71，1.12）；PCO发生率的RR = 1.81，95%CI：（0.50，6.54）；患者满意度的RR = 0.98，5%CI：（0.86，1.12）]。
接受三焦点IOL，尤其是AT LISA tri 839M的患者，其获得的中视力优于接受双焦点IOL的患者。双焦点IOL在近视力和远视力表现、脱镜率、术后屈光和手术满意度方面与三焦点IOL相似。
