Hessemer V, Eisenmann D, Jacobi K W
Univ.-Augenklinik Giessen.
Klin Monbl Augenheilkd. 1993 Jul;203(1):19-33. doi: 10.1055/s-2008-1045645.
Besides the diffractive multifocals, which produce a second focus for near vision by means of diffraction rings, there are different refractive multifocal IOL types with 2-7 refractive zones or an aspheric/spherical construction principle. Long-term results: 2 years after implantation of diffractive multifocal IOLs, the corrected distance and near acuities were unchanged compared to the 3-month results. The uncorrected distance acuity was, however, slightly decreased due to a minus shift of refraction to -1.2 D. The contrast sensitivity was improved after 2 years. Multi- versus monofocal IOLs: After diffractive multifocal IOL implantation, the near acuity with distance correction only was markedly improved compared to monofocal IOLs. All other acuity data did not differ between multi- or monofocal lenses. The contrast sensitivity (at low contrasts and high spatial frequencies) and mesopic visual acuity (without and with glare) were reduced compared to monofocal pseudophakic eyes. Near aniseikonia and binocular functions: In unilateral multifocal pseudophakia (monofocal IOL in fellow eye), a near aniseikonia up to 8% was found. The width of fusion was significantly lower than in bilateral multifocal pseudophakia, whereas the stereopsis showed no difference. Determinants of bifocal function: In 7.1% of our cases, no bifocal function (BFF) was present after implantation of diffractive multifocal IOLs. These patients exhibited a significantly higher age as well as higher pre- and postoperative astigmatism, when compared to patients with good BFF. Optical performance of different multifocal IOLs: By means of an optical system, described by Reiner, images of intraocular lenses can be projected into the eye ("optical implantation"); thus, the optical performance of IOLs can be judged subjectively. Using this method, the refractive 2- and 3-zone models performed best within the multifocal group (contrast sensitivity not significantly worse than that of monofocal IOL), when viewing a low-contrast chart (Regan 4%). All other multifocal lenses (diffractive, aspheric/spherical, refractive 5- and 7-zone models) were significantly inferior to the monofocal IOL.
Implantation of multifocal IOLs should presently be restricted to special indications, particularly to the distinct patient request to dispense with wearing near or bifocal glasses, if possible. Because of the reduction in contrast sensitivity and mesopic vision and the increased glare sensibility, multifocal IOLs should not be implanted especially in professional car drivers. There are, however, differences in optical performance between the various multifocal IOL types. Further improvements, in particular concerning lens technology, will presumably extend the present spectrum of indications.
除了通过衍射环产生近视力第二焦点的衍射多焦点人工晶状体外，还有不同的折射多焦点人工晶状体类型，具有2 - 7个折射区或非球面/球面构造原理。长期结果：植入衍射多焦点人工晶状体2年后，与3个月时的结果相比，矫正远视力和近视力没有变化。然而，由于屈光度负向偏移至 - 1.2 D，未矫正远视力略有下降。2年后对比敏感度有所改善。多焦点与单焦点人工晶状体：植入衍射多焦点人工晶状体后，仅矫正远视力时的近视力与单焦点人工晶状体相比有显著改善。所有其他视力数据在多焦点或单焦点晶状体之间没有差异。与单焦点人工晶状体眼相比，对比敏感度（在低对比度和高空间频率下）和中间视觉视力（无眩光和有眩光时）有所降低。近像不等和双眼功能：在单侧多焦点人工晶状体植入（对侧眼为单焦点人工晶状体）中，发现近像不等可达8%。融合宽度明显低于双侧多焦点人工晶状体植入，而立体视没有差异。双焦点功能的决定因素：在我们7.1%的病例中，植入衍射多焦点人工晶状体后不存在双焦点功能（BFF）。与具有良好BFF的患者相比，这些患者年龄显著更大，术前和术后散光也更高。不同多焦点人工晶状体的光学性能：借助Reiner描述的光学系统，可以将人工晶状体的图像投射到眼睛中（“光学植入”）；因此，可以主观判断人工晶状体的光学性能。使用这种方法，在观察低对比度图表（Regan 4%）时，折射2区和3区模型在多焦点组中表现最佳（对比敏感度不比单焦点人工晶状体差很多）。所有其他多焦点晶状体（衍射型、非球面/球面型、折射5区和7区模型）明显不如单焦点人工晶状体。
目前多焦点人工晶状体的植入应限于特殊适应症，特别是患者明确要求尽可能不戴近用或双焦点眼镜的情况。由于对比敏感度和中间视觉降低以及眩光敏感度增加，多焦点人工晶状体尤其不应植入职业汽车驾驶员眼中。然而，各种多焦点人工晶状体类型在光学性能上存在差异。进一步的改进，特别是在晶状体技术方面，可能会扩大目前的适应症范围。
