(1)希望減少術(shù)后閱讀對眼鏡的依賴(lài),對遠、中、近視力均有較高要求的患者,優(yōu)先推薦相對年輕、眼底條件較好、無(wú)合并影響視力的其他眼病的白內障患者。(2)一般要求預計術(shù)后散光度數≤1.00 D[6];對于既有術(shù)后預計散光又有全程視力需求的患者可選擇Toric MIOL[7];對于預計術(shù)后散光度數較大且堅持植入MIOL的患者,可在患者知曉手術(shù)風(fēng)險的前提下謹慎選用MIOL,術(shù)后可通過(guò)角膜屈光手術(shù)等對殘留散光度數進(jìn)行矯正。(3)建議暗室下瞳孔自然直徑3.0~5.5 mm[8,9]。(4)Kappa角<0.5 mm或Kappa角小于MIOL中央折射光學(xué)區直徑的一半[10]。
(1)生活方式或職業(yè)原因(如夜間駕車(chē)、駕駛飛機等)對視覺(jué)質(zhì)量要求過(guò)高、具有戴鏡閱讀習慣、年齡過(guò)大適應能力有限的患者[13]。(2)術(shù)前有畏光癥狀的患者。(3)同時(shí)需要接受其他眼科手術(shù)的患者,如青光眼白內障聯(lián)合手術(shù)、白內障摘除聯(lián)合玻璃體視網(wǎng)膜手術(shù)等。(4)既往眼外傷或眼部手術(shù)史等可能影響視覺(jué)效果的患者等,不作首選推薦,若術(shù)前檢查眼部條件允許,且患者本人有較高的脫鏡需求并堅持植入MIOL,可在告知患者手術(shù)風(fēng)險的前提下謹慎選用MIOL。已進(jìn)行過(guò)放射狀角膜切開(kāi)術(shù)、準分子激光屈光性角膜切削術(shù)、準分子激光原位角膜磨鑲術(shù)等角膜屈光手術(shù)的患者雖不作為絕對禁忌證,但需告知患者術(shù)后將承受對比敏感度明顯降低導致的視覺(jué)質(zhì)量較差的風(fēng)險[14]。(5)焦慮型人格、極端完美主義性格特征患者,過(guò)分挑剔及對術(shù)后視力有不切實(shí)際期望的患者不作為MIOL植入的禁忌證,但術(shù)前須對患者進(jìn)行充分教育和溝通后謹慎選用MIOL。(6)在白內障摘除手術(shù)前建議對干眼、瞼緣炎、瞼板腺功能障礙等眼表疾病進(jìn)行診斷和治療,對既往有相關(guān)病史的患者,建議在充分溝通和告知術(shù)后可能出現相關(guān)癥狀的前提下謹慎選用MIOL[15]。(7)兒童不建議過(guò)早植入MIOL,待屈光狀態(tài)穩定后再行評估[16,17]。
[6]HayashiK, ManabeS, YoshidaM, et al. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens[J]. J Cataract Refract Surg, 2010, 36(8): 1323-1329. DOI:10.1016/j.jcrs.2010.02.016.
[7]GarzónN, PoyalesF, de ZárateBO, et al. Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses[J]. J Refract Surg, 2015, 31(2): 90-97. DOI: 10.3928/1081597X-20150122-03.
[8]HayashiK, HayashiH, NakaoF, et al. Correlation between pupillary size and intraocular lens decentration and visual acuity of a zonal-progressive multifocal lens and a monofocal lens[J]. Ophthalmology, 2001, 108(11): 2011-2017.
[9]De VriesNE, WebersCA, TouwslagerWR, et al. Dissatisfaction after implantation of multifocal intraocular lenses[J]. J Cataract Refract Surg, 2011, 37(5): 859-865. DOI: 10.1016/j.jcrs.2010.11.032.
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[11]Braga-MeleR, ChangD, DeweyS, et al. Multifocal intraocular lenses: relative indications and contraindications for implantation[J]. J Cataract Refract Surg, 2014, 40(2): 313-322. DOI:10.1016/j.jcrs.2013.12.011.
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備注:上述內容為專(zhuān)家意見(jiàn),為臨床醫療服務(wù)提供指導,不是在各種情況下都必須遵循的醫療標準,也不是為個(gè)別特殊個(gè)人提供的保健措施;本文內容與相關(guān)產(chǎn)品的生產(chǎn)和銷(xiāo)售廠(chǎng)商無(wú)經(jīng)濟利益關(guān)系