目的：研究两种非球面衍射型多焦点人工晶状体(IOL)视网膜成像质量。

方法：回顾性队列研究。选取2017-10/2019-10诊断为单纯性白内障，行超声乳化吸除联合IOL植入155例155眼为研究对象，植入非球面衍射双焦点IOL 54例54眼、非球面衍射三焦点IOL 54例54眼、单焦点IOL 47例47眼做对照组。随访术后6mo，双通道视觉质量分析系统测量散射指数(OSI)、调制传递函数截止频率(MTF cut off)、斯特列尔比值(SR)、100%、20%、9%模拟对比度视力(OV)； 记录术后裸眼远距离(5m)、中距离(80cm)、近距离(40cm)视力及矫正远视力、矫正远视力基础上的中距离视力和近距离视力； 利用VF-14量表进行评分。

结果：双焦组和三焦组MTF cut off均低于单焦组(P=0.007、0.043)，双焦和三焦组无差异(P=0.445)。三组OSI值无差异(F=1.143，P=0.322)，三组SR值无差异(F=3.045，P=0.051)。双焦组和三焦组模拟对比度视力无差异(OV 100%：P=0.974； OV 20%：P=0.713； OV 9%：P=0.947)，而双焦和三焦组均低于单焦点组(OV 100%：双焦vs单焦P=0.001； 三焦vs单焦P=0.012； OV 20%：双焦vs单焦P=0.002； 三焦vs单焦P=0.043； OV 9%：双焦vs 单焦P=0.011； 三焦vs单焦P=0.029)。三组术后裸眼远视力及矫正远视力均无差异(P=0.054、0.180)。双焦组与单焦组裸眼中视力有差异(P=0.010)，三焦组与单焦组、双焦组均有差异(P<0.01)。双焦组和三焦组裸眼近视力无差异(P=0.428)，双焦组和三焦组与单焦组均有差异(P<0.01)。三组患者远视力矫正基础上中视力有差异(H=67.176，P<0.01)，双焦组与单焦组有差异(P<0.01)，三焦组与单焦组和双焦组均有差异(P<0.01)。三组远视力矫正基础上近视力均有差异(H=91.292，P<0.01)，双焦组和三焦组无差异(P=0.519)，双焦组和三焦组与单焦组均有差异(P<0.01)。三组VF-14表评分有差异(H=71.342，P<0.01)，双焦组和三焦组评分无差异(P=0.055)，双焦组和三焦组与单焦组均有差异(P<0.01)。

结论：双通道视觉系统评估三焦点、双焦点衍射型人工晶状体视网膜成像质量无差别； 三焦点较双焦点人工晶状体，可提供更佳的中距离视力。

METHODS: Retrospective cohort study. Totally 155 cases of simple cataract who received phacoemulsification combined with IOLs implantation from October 2017 to October 2019. They were divided into three groups according to the types of IOL: Aspheric Bifocal Diffractive Group: 54 patients(54 eyes); Aspheric Trifocal Diffractive Group: 54 patients(54 eyes); Aspheric Monofocal Group: 47 patients(47 eyes). All patients were evaluated postoperatively at 6mo. Double-pass visual quality analysis system was used to evaluate OSI, MTF cutoff, Strehl Ratio, OV 100%, OV 20% and OV 9% respectively. Uncorrected distance visual acuity(5m), uncorrected intermediate visual acuity(80cm), uncorrected near visual acuity(40cm), corrected distance visual acuity, distance-corrected intermediate visual acuity, distance-corrected near visual acuity were measured and compared among three groups. Visual function-14 was also assessed.

RESULTS:Both of bifocal and trifocal groups had similar MTF cutoff(P=0.445), OV 100%, OV 20% and OV 9%(OV 100%: P=0.974; OV20%: P=0.713; OV 9%: P=0.947). Monofocal group had better MTF cutoff(P=0.007), OV 100%(P=0.001), OV 20%(P=0.002)and OV 9%(P=0.011)than bifocal. Besides, monofocal group had better MTF cutoff(P=0.043), OV 100%(P=0.012), OV 20%(P=0.043)and OV 9%(P=0.029)than trifocal group. There was no difference among all groups in uncorrected distance visual acuity and corrected distance visual acuity(P=0.054, 0.180). There was difference in distance-corrected intermediate(H=91.292, P<0.01)and distance-corrected near visual acuity(H=91.292, P<0.01). Uncorrected intermediate visual acuity was better in trifocal group than bifocal(P<0.01)and monofocal group(P<0.01). Distance-corrected intermediate visual acuity was better in trifocal group than bifocal(P<0.01)and monofocal group(P<0.01). Both of bifocal and trifocal groups have similar uncorrected near visual acuity(P=0.428)and distance-corrected near visual acuity(P=0.519), which was better than monofocal group(P<0.01). In terms of VF-14, score in bifocal and trifocal groups are significantly higher than the monofocal group(P<0.01). There was no difference in bifocal and trifocal groups(P=0.055).

CONCLUSION: Bfocal and trifocal diffractive IOL can provide similar retinal image. Trifocal IOL can provide better itermediate visual acuity.