Bissen-Miyajima Hiroko, Ota Yuka, Yuki Kenya, Minami Keiichiro
Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Am J Ophthalmol Case Rep. 2022 Dec 31;29:101792. doi: 10.1016/j.ajoc.2022.101792. eCollection 2023 Mar.
Implantation of presbyopia-correcting intraocular lenses (IOLs) has not been advised for glaucomatous eyes because of the risk of decreased contrast sensitivity with progress of glaucoma. Extended depth-of-focus (EDF) IOLs have been reported to provide comparable postoperative visual function and influence on the visual field to monofocal IOLs.
This case series was a retrospective medical record review of 16 eyes of 10 patients who had normal tension glaucoma (NTG) with no central visual field defects and underwent cataract surgery with implantation of diffractive EDF IOLs. At 3 months postoperatively, distance-corrected visual acuities (DCVAs) at distances of 5, 1, and 0.5 m and photopic contrast sensitivity were examined. Automated perimetry using the 30-2 Swedish interactive threshold algorithm was also performed, and the mean variance (MD) values, mean deviation values at the central four points (central MD), and foveal threshold were recorded.
The mean age of the patients (5 men, 5 women) was 66.5 years. Over 80% of eyes obtained DCVAs of 20/20, 20/20, and 20/25 at 5 m, 1 m, and 0.5 m, respectively. Whereas 5 of 16 eyes were categorized as severe by the Hodapp-Parrish-Anderson classification, postoperative contrast sensitivity was within the normal range, except for 4 eyes at 18 cycles per degree.
In this case series, the postoperative visual functions of NTG patients with EDF IOLs were almost comparable to those of normal eyes with the same IOLs, which demonstrated that the use of EDF IOLs for controlled NTG eyes would be permissible. While careful patient selection and follow-up for NTG progress are important, further investigations are necessary for confirming the safety and exploring the selection criteria.
由于青光眼进展会导致对比敏感度下降,因此不建议在青光眼患者眼中植入矫正老花眼的人工晶状体(IOL)。据报道,扩展景深(EDF)IOL术后视觉功能与单焦点IOL相当,且对视野的影响也较小。
本病例系列是一项回顾性病历研究,纳入了10例正常眼压性青光眼(NTG)患者的16只眼,这些患者均无中心视野缺损,且接受了白内障手术并植入了衍射型EDF IOL。术后3个月时,检查了5米、1米和0.5米距离处的距离矫正视力(DCVA)以及明视对比敏感度。还使用30-2瑞典交互式阈值算法进行了自动视野检查,并记录了平均方差(MD)值、中央四点的平均偏差值(中央MD)和黄斑阈值。
患者(5名男性,5名女性)的平均年龄为66.5岁。超过80%的眼睛在5米、1米和0.5米处的DCVA分别为20/20、20/20和20/25。根据霍达普-帕里什-安德森分类,16只眼中有5只被归类为重度,但术后对比敏感度均在正常范围内,除了4只眼在每度18周波时。
在本病例系列中,植入EDF IOL的NTG患者术后视觉功能与植入相同IOL的正常眼几乎相当,这表明在眼压得到控制的NTG眼中使用EDF IOL是可行的。虽然仔细选择患者并对NTG进展进行随访很重要,但仍需要进一步研究以确认安全性并探索选择标准。