| ObjectiveStudy the indication of multifocal intraocular lens implanted in pediatric cataractpatients and the preliminary clinical effect after opreration, in order to provide areference for clinical therapy of pediatric cataract patients.MethodsProspective study.Collected27eyes of22cases in our hospital from January2011to January2013.All the patients were diagnosed congenital cataract or developmentalcataract.13cases of male,9cases of female,aged6-14years old,average9.5years old.Allthe patients underwent cataract phacoemulsification and foldable intraocular lensimplantation.The cases were divided into multiple focal group and single focal groupaccording to the type of lens that implanted.Multiple focal group had15eyes of12cases,implanted with diffractive multifocal intraocular lens AMO Tecnis ZMB00,singlefocal group had12eyes of10cases implanted with spherical single focal intraocular lensBausch＆Lomb Akreos Adapt. Before opertation,we examinated corneal curvature,axiallength,corneal endothelium,pupil diameter,the diopter of intraocular lens,B-scanultrasound,visual evoked potential,ect.After the follow-up of12mons,we compared theuncorrected distance visual acuity,the uncorrected near visual acuity, the intermediavisual acuity,the best corrected distance visual acuity, the best corrected near visualacuity, distance corrected near visual acuity, multi-function vision acuity,astigmatism, axial length,pupil diameter,stereopsis, accommodation power，spectacle dependency,issued questionnaires about visual symptom and satisfaction and recorded postoperativecomplications.SPSS17.0statistical software for data analysis, two group data werecompared by2independent-samples t test(Mann-Whitney U test) if they were notsymmetrical,or used the independent-samples t test.Groups data were compared by Kindependent sample test(Kruskal-Wallis H test),rates were compared by chi-square test（Fisher’s test）.The difference was statistically significant (P <0.05).Results1. The differences of preoperative age,visual acuity,axial length,cornealastigmatism,the diameter of the pupil,IOLdiopter of multiple focal group and single focalgroup had no statistically significant (respectively t=0.00, z=-0.074, t=0.081, t=-0.472,t=-0.458, t=1.296), p>0.05(shown in table2). Difference of gender composition had nostatistically significant(shown in table3).2. The differences of preoperative the uncorrected near visual acuity,theintermedia visual acuity,the distance corrected near visual acuity,the nearly additionaldiopter of multiple focal group and single focal group had statisticallysignificant(respectively z=-3.725,z=-2.327,z=-2.735,z=-4.431）,p<0.05.While differencesof the uncorrected distance visual acuity,the best corrected distance visual acuity, thebest corrected near visual acuity had no statistically significant, p>0.05(shown in table4).3. Vision of the patients in two groups was on the decline with decliningcontrast.Vision changed a little with the declining background luminance (shown in table5-table8).3.1Compared patients of multiple focal group and singe focal group in eachcontrast (100%,25%,10%,5%) under the same background brightness （250cd/m2and25cd/m~2）.Comparison in the group used Kruskal Wallis test,all differences hadstatictacal significance,p<0.05(X~2respectively46.86,34.59,47.38,34.99).Two independent samples nonparametric test(Mann-Whitney) was used for comparing thetwo groups.Results showed that the differences were not statisticallysignificant,p>0.05(respectively t=-0.586，t=-1.649，z=-1.026，z=-1.691，t=-0.625，t=-1.531，z=-0.781，z=-1.222）.shown in table5,table6.3.2Compared the visual acuity under different background brightness but thesame contrast,results showed that the differences were not statistically significant,p>0.05.shown in table7,table8.4. Differences of the change of astigmatism,axial length,pupil diameter in twogroups of patients were not statistically significant,p>0.05.(respectivelyz=-1.868,t=-2.021,z=-0.476）shown in table95. Difference of the preoperative uncorrected distance stereopsis between the twogroups of patients was not statistically significant,p>0.05.But good stereopsis ratio ofmultiple focal group (41.7%) was higher than single focal group (30%).Differences ofuncorrected near stereopsis and best corrected near stereopsis between the two groups ofpatients were statistically significant,p<0.05. shown in table10,116.The average accommodation of multiple focal group was2.50±0.37D,and thesingle focal group was0.92±0.31D. The difference of the two group was statisticallysignificant,p<0.05.7.The distance spectacle dependency of multiple focal group was75%, and thesingle focal group was60%.There was no statistically significant difference, p>0.05. Thenear spectacle dependency of multiple focal group was91.7%, and the single focal groupwas10%.There was statistically significant difference, p<0.05. The complete spectacledependency of multiple focal group was75%, and the single focal group was10%.Therewas statistically significant difference, p<0.05. shown in table128.Questionnaire was done after12mons,visual adverse symptom scores anddistance vision satisfaction scores between the two groups had no statistically significantdifference, p>0.05.While near satisfaction scores between the two groups had statistically significant difference, p<0.05. shown in table139.3eyes(20%) occurred posterior capsual opacity in multiple focal group,whichwas lower than the single focal group(4eyes,33%).But there was no statisticallysignificant difference, p>0.05. shown in table14,15ConclusionPediatric cataract patients implanted with multifocal intraocular lens have betterdistance visual acuity, intermedia visual acuity,and near visual acuity.Stereopsis andspectacle dependency are better than the single focal group. So it is visable to Pediatriccataract patients aged from6to14years old implanted with multiple focal intraocularlens.But as the number of the case is less and follow-up time is short,long-term effectremains to be proven.After the operation,children implanted with multiple focalintraocular lens still need a long learning process.Both the strict indication and the highprice of the multiple focal intraocular lens limit the wide application in pediatric cataractpatients. |
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