[Comparative study on in vitro optical characteristics between refractive and other types of extended depth of focus intraocular lenses].

内容摘要

Objective: To investigate the differences in optical performance between the novel refractive extended depth of focus (EDof) intraocular lens (IOL), other types of EDof IOLs, and conventional IOLs. Methods: Experimental study. Three non-diffractive EDof IOLs (refractive EDof IOL, wavefront-shaped EDof IOL, rotationally asymmetric regional refractive EDof IOL), an enhanced monofocal IOL, and a monofocal IOL with a power of 20.0 D were included. Using an in vitro IOL optical performance tester, the modulation transfer function (MTF) at far, intermediate and near foci was measured under 3.0 mm and 4.5 mm pupil apertures, different spatial frequencies and corneal spherical aberration models. United States Air Force (USAF) resolution tests were performed, and simulated visual acuity (logarithm of the minimum angle of resolution) was calculated. Results: At 3.0 mm aperture and 50 line pairs (lp)/mm spatial frequency, the far-focus MTF values in descending order were: monofocal IOL (0.73), enhanced monofocal IOL (0.61), rotationally asymmetric regional refractive EDof IOL (0.43), refractive EDof IOL and wavefront-shaped EDof IOL (both 0.36). The intermediate-focus MTF values in descending order were: rotationally asymmetric regional refractive EDof IOL and wavefront-shaped EDof IOL (both 0.15), enhanced monofocal IOL (0.13), refractive EDof IOL (0.06) and monofocal IOL (0.06). At 4.5 mm aperture, the far-focus MTF values in descending order were: monofocal IOL (0.66), enhanced monofocal IOL (0.61), refractive EDof IOL (0.60), wavefront-shaped EDof IOL (0.36), rotationally asymmetric regional refractive EDof IOL (0.22). The far-focus MTF peak of the refractive EDof IOL was higher at 4.5 mm than at 3.0 mm aperture. The intermediate-focus MTF values in descending order were: rotationally asymmetric regional refractive EDof IOL (0.14), wavefront-shaped EDof IOL (0.09), enhanced monofocal IOL (0.07), refractive EDof IOL (0.06), monofocal IOL (0.02). USAF resolution test showed that at 3.0 mm aperture, the far-focus image clarity was the best in the monofocal IOL and enhanced monofocal IOL groups, followed by rotationally asymmetric regional refractive EDof IOL, while refractive EDof IOL and wavefront-shaped EDof IOL were similar; the intermediate-focus image clarity was the best in the wavefront-shaped EDof IOL group. At 4.5 mm aperture, the far-focus image clarity was the best in the monofocal IOL and enhanced monofocal IOL groups, followed by refractive EDof IOL; the intermediate-focus image clarity was the best in the wavefront-shaped EDof IOL and rotationally asymmetric regional refractive EDof IOL groups. Simulated visual acuity analysis showed that at 3.0 mm aperture, the distance visual acuity of the three EDof IOLs was similar, and the intermediate visual acuity of wavefront-shaped EDof IOL and rotationally asymmetric regional refractive EDof IOL was better. At 4.5 mm aperture, the distance visual acuity of refractive EDof IOL was significantly improved and higher than that of the other two EDof IOLs. The MTF of refractive EDof IOL and wavefront-shaped EDof IOL remained stable under decentration and tilt, and refractive EDof IOL showed better stability at 5° tilt. When the simulated visual acuity was 0.2, the depth of focus of monofocal IOL was -2.33 D, and the depth of focus of all three EDof IOLs increased by more than 0.5 D compared with the monofocal IOL, while the intermediate-focus (-1.5 D) visual acuity was higher than 0.2. Conclusions: The three non-diffractive EDof IOLs exhibit differential optical performance under different pupil diameters and defocus conditions, all meeting the minimum visual requirements for EDof IOLs proposed by the American Academy of Ophthalmology. The refractive EDof IOL provides stable distance vision unaffected by pupil size and maintains favorable distance image clarity even under large corneal spherical aberration. 目的： 探讨新型纯折射型及其他类型景深延长型（EDof）人工晶状体（IOL）的光学性能与其他IOL的差异。 方法： 实验研究。纳入3种非衍射型EDof IOL（纯折射型EDof IOL、波前重塑型EDof IOL、旋转非对称区域折射型EDof IOL）、单焦增强型IOL及单焦点IOL 20.0 D的样本，应用体外IOL光学性能测试设备分别在3.0和4.5 mm孔径、不同空间频率及角膜球差模型下，测量各IOL远、中、近焦点的调制传递函数（MTF），进行美国空军（USAF）分辨力测试图检查，并推算模拟视力（最小分辨角对数）。 结果： 3.0 mm孔径下，50 线对（lp）/mm空间频率远焦点MTF值由高至低依次为：单焦点IOL（0.73）、单焦增强型IOL（0.61）、旋转非对称区域折射型EDof IOL（0.43）、纯折射型EDof IOL与波前重塑型EDof IOL（均为0.36）；中焦点MTF值由高至低依次为：旋转非对称区域折射型EDof IOL与波前重塑型EDof IOL（均为0.15）、单焦增强型IOL（0.13）、纯折射型EDof IOL（0.06）与单焦点IOL（0.06，二者相等）。4.5 mm孔径下，50lp/mm空间频率远焦点MTF值由高至低依次为：单焦点IOL（0.66）、单焦增强型IOL（0.61）、纯折射型EDof IOL（0.60）、波前重塑型EDof IOL（0.36）、旋转非对称区域折射型EDof IOL（0.22），其中纯折射型EDof IOL远焦点MTF峰值较3.0 mm孔径时增高；中焦点MTF值由高至低依次为：旋转非对称区域折射型EDof IOL（0.14）、波前重塑型EDof IOL（0.09）、单焦增强型IOL（0.07）、纯折射型EDof IOL（0.06）、单焦点IOL（0.02）。USAF分辨力测试显示，3.0 mm孔径下远焦点图像清晰度以单焦点IOL及单焦增强型IOL最佳，其次为旋转非对称区域折射型EDof IOL，纯折射型EDof IOL与波前重塑型EDof IOL基本持平；中焦点图像清晰度以波前重塑型EDof IOL最佳。4.5 mm孔径下远焦点图像清晰度以单焦点IOL及单焦增强型IOL最佳，其次为纯折射型EDof IOL；中焦点图像清晰度以波前重塑型EDof IOL及旋转非对称区域折射型EDof IOL最佳。模拟视力分析显示，3.0 mm孔径下3种EDof IOL远视力相近，波前重塑型EDof IOL与旋转非对称区域折射型EDof IOL中视力更优；4.5 mm孔径下纯折射型EDof IOL远视力显著提升，且高于其他2种EDof IOL。纯折射型EDof IOL与波前重塑型EDof IOL在偏心及倾斜状态下MTF保持稳定，其中纯折射型EDof IOL在倾斜5°时稳定性更佳。当模拟视力为0.2时，单焦点IOL焦深为-2.33 D，3种EDof IOL焦深均较单焦点IOL增加>0.5 D，且中焦点（-1.5 D）视力均高于0.2。 结论： 3种非衍射型EDof IOL在不同瞳孔直径及离焦状态下表现出差异化光学性能，均符合美国眼科学会提出的EDof IOL最低视觉要求标准。纯折射型EDof IOL具有不受瞳孔大小影响的稳定远距视力，且在大球差角膜下仍能保持较好的远距视觉清晰度。.