clear lens extractionfor presbyopia（清晰的镜头extractionfor老花眼）.docVIP

Issues related to the appropriate trial design for evaluation of Clear Lens Extraction for the correction of Presbyopia Clear-lens extraction (CLE) is a surgical procedure in which the non-cataractous crystalline lens is removed and replaced with an intraocular lens for refractive purposes. This paper is written in an attempt to delineate issues specific to the correction of presbyopia with multifocal intraocular lenses (MIOLs) in a cohort of subjects whose crystalline lens is clear. Our literature review revealed very limited published information specific to clear lens extraction for the correction of presbyopia. Dick et al.1 report on a prospective study of 25 patients undergoing bilateral CLE followed by posterior chamber multifocal intraocular lens (MIOL) implantation. These patients ranged from 44 to 62 years of age with the average age of 51 years. Their preoperative refractive spherical equivalent (SE) error ranged from -15.50 to +5.75 diopters (D). The follow-up period of this study was limited to 6 months. During this time there were no eyes with any potential sight threatening complication or posterior capsular opacification (PCO). However, 48% (12/25) of patients reported starbursts and 36% (9/25) had halos. Efficacy appeared acceptable in all patients with binocular uncorrected visual acuity (UCVA) of 20/30 and J4 or better in all patients Packer et al.2 report on a retrospective study of 68 eyes in 36 patients with CLE followed by posterior chamber MIOL implantation. Thirty four percent (23/68) of the eyes had an additional refractive procedure to correct preoperative astigmatism. Only short term follow-up (3 and 6 months) is available for this study. Efficacy outcomes were acceptable with 94% (64/68) having UCVA of 20/40 and J5 or better. YAG capsulotomies were performed in 5.9% (4/68) of the patients who had symptomatic PCO. This article did not provide complication rates or assessment of visual symptoms. Due to the lack of g