多焦点IOL分析课件.pptVIP

讨论 术后主觉验光：用于评估MIOL术后的等效球镜 随着时间的延长，大脑通过学习与适应，从而导致视力与对比敏感度的提高。 Restor IOL的夜间近视力尤其是阅读能力差，与IOL的光学区设计相关。 和Hartman-shack波前像差仪WASCA相比，视网膜镜双通道波前像差仪OPDscan，对MIOL术后的像差检测准确性更高 结论 衍射型多焦点IOL均可提高远、近视力 在阅读速度和中距离视力TMF优于Restor，而Restor的近视力优于TMF 明显负球差设计的TMF的视觉功能指标优于Restor 非球面Restor IOL的上市，将和TMF IOL展开更为激烈的竞争 几个问题 IOL度数的测量 术前散光 眼底病变 黄斑囊样水肿 精确的IOL度数计算-术前关键 同时使用浸润式A超和非浸润式 IOL Master 使用新一代的IOL度数计算公式：SRK/T、Holladay 2或 Haigis 累积一定的经验后，可得到个性化A常数、前房深度和医生指数 术后理想的屈光状态：正视或轻度远视；轻度近视（+3D） 散光 切口大小, 位置和伤口的愈合情况都会对术后散光造成影响 尽量避免产生医源性散光（术前角膜地形图引导） 1.5D散光？ 个体化病例 某男，36岁，术前散光-3.50D 强烈要求植入多焦点IOl 术后1M：裸眼视力0.6/j3，矫正视力1.0/j1， 术后1M：散光-2.5D，高阶像差和总眼球差并不比其它患者增加 术后散光的治疗：Lasik，后裸眼视力1.0/j1 眼底病变 术前眼底检查 视神经和黄斑功能的检测 一患者术前眼底检查尚可，术后视力差，难以矫正 黄斑水肿 一患者术后第3周开始出现视力下降伴中央暗区 术中无任何并发症 OCT检查示CME 提示：血眼屏障差患者慎重TMF * Until recently, most patients had their vision improved with a monofocal IOL which can only focus at one point, usually at distance. Although the quality of their distance vision was excellent, most patients still needed reading glasses to see near objects. * 在渐变晶体的能量平衡中 环状阶梯的高度决定分配到视近的能量 衍射环的距离决定近焦点 * * Based on the experience of all diffractive and refractive lenses, it is vital that proper patient selection and screening be employed. Age, functional and occupational requirements, degree of general alertness, and ocular pathology must all be taken into account. Before choosing a lens, it is recommended that consideration be made on the patients visual demands, and their expectation on near vision needs. Patients with pre-existing ocular pathology, or those with high degrees of pre-operative astigmatism, are likely to NOT be ideal candidates. Our recommendation is to choose active, alert patients without existing pathology who have 1.0 diopter or less of pre-operative astigmatism. Bilateral implants are also strongly recommended, to ensure optimal results. * To provide the best post-operative vision for multifocal patients, the amount of pre-operative and surgically induced astigmatism must be