Estudio de la calidad visual y de las curvas de desenfoque en pacientes con lentes intraoculares refractivas

Résumé

Introduction Intraocular lenses have been implanted during cataract surgery forty years ago. For many years, the monofocal intraocular lenses were used. These lenses provide the patient with optimal distance vision without glasses, but require optical correction for near and intermediate vision. In the last decade the monofocal plus lenses have been introduced and can provide the patient with optimal distance vision and acceptable intermediate vision. Multifocal lenses can provide good distance, intermediate and near visual acuity. Objectives To evaluate quality of vision and quality of life in patients who underwent cataract surgery with three different types of intraocular lens: the monofocal intraocular lens (Tecnis ZCB00), the monofocal plus intraocular lens (Tecnis Eyhance) and the multifocal intraocular lens (Mplus LS-313). Material and Methods There were three groups that comprised 25 patients each that had the same lens type implanted in both eyes: group 1 (Tecnis ZCB00), group 2 (Tecnis Eyhance) and group 3 (Mplus LS-313). The patients group 3 wore the Mplus LS-313 lens with +2.00D addition in the dominant eye and the Mplus LS-313 lens with +3.00D addition in the non-dominant eye. Three months after the operation of the second eye, an examination was performed to examine, different visual quality parameters: uncorrected and corrected distance visual acuity, corrected intermediate and near visual acuity, defocus curve, contrast sensitivity, stereopsis, optical aberrations, dysphotopsia and quality of life. Results All the three study groups had similar best corrected visual acuity for near and far vision. However, the best corrected intermediate visual acuity was significantly higher in groups 2 and 3. The defocus curves of groups 1 and 2 showed a similar morphology with good far visual acuity, although the intermediate visual acuity was higher in group 2. In group 3 the defocus curve of the eyes with the +2.00D addition lens showed a higher visual acuity in intermediate and far vision, while the eyes with the +3.00D addition Mplus lens showed good visual acuity in near and far vision. Contrast sensitivity values in mesopic and photopic conditions showed no significant differences between groups 1 and 2, but were significantly lower in group 3. Stereopsis values were also significantly lower in group 3. The incidence of dysphotopsias was significantly higher in group 3. The subscale "general vision" had significantly higher values in group 3. Total coma aberration was higher in the group 3 eyes implanted with the Mplus LS-313 lens with the +3.00 D addition. Conclusions The three lenses used: Tecnis ZCB00, Tecnis Eyhance and Mplus LS-313 provide similar best distance visual acuity and similar best distance-corrected near visual acuity. The best distance-corrected intermediate visual acuity was higher with the Tecnis Eyhance and Mplus LS-313 lenses. At the defocus values for distance vision, all three lenses provided a similar visual acuity. In the defocus values for intermediate and near vision, the Mplus LS-313 lenses with addition +2.00 D and the Mplus LS-313 lenses with addition +3.00 D, provided a higher visual acuity, respectively. Both contrast sensitivity and stereopsis values were higher with the Tecnis ZCB00 and Tecnis Eyhance lenses than with the Mplus LS-313 lens. In addition, patients who received the Tecnis ZCB00 and Tecnis Eyhance lenses showed less dysphotoptic phenomena than those implanted with the Mplus LS-313 lens. However, patients implanted with the Mplus LS-313 lens scored higher on the "general vision" subscale of the NEI VFQ-25 questionnaire. Finally, total coma aberration was higher in eyes implanted with the Mplus LS-313 lens with +3.00 D addition.