Objective: To evaluate the safety and efficacy of cataract extraction combined with multifocal intraocular lens (IOL) optic implantation in Berger space in school-age children with cataracts. Methods: It was a prospective study. The clinical data of school-age children with cataract who underwent cataract extraction combined with multifocal IOL implantation at Qingdao Eye Hospital of Shandong First Medical University from January 2019 to June 2023 were collected. Preoperatively, the examinations of best corrected distance, intermediate and near visual acuity, intraocular pressure, eye position, slit lamp microscopy, and fundus examination were carried out. The optical quality analysis system was used to obtain the objective visual quality indexes such as modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), and objective scattering index (OSI), and stereopsis was examined. All patients underwent cataract extraction combined with multifocal IOL optic implantation in Berger space. During the follow-up, visual acuity, intraocular pressure, stereopsis, objective visual quality, anterior segment and fundus conditions were examined, and optical coherence tomography (OCT) was used to determine whether there was macular edema and other fundus abnormalities. Results: A total of 43 cataract patients (86 eyes) were included, with an age of (9.4±3.0) years. Among them, 81 eyes completed cataract extraction combined with multifocal IOL optic implantation in Berger space. The follow-up time was (20.6±13.1) months. During the follow-up, the visual axis remained clear in all eyes. Transient postoperative intraocular hypertension occurred in 5 eyes (25-30 mmHg, 1 mmHg=0.133 kPa), which mostly occurred within 1 week after surgery and could be controlled to the normal range within 2 weeks after drug treatment. During the follow-up, no posterior synechia, secondary glaucoma, IOL decentration, pigmentary IOL deposits, retinal detachment, cystoid macular edema, proliferation of the vitreous anterior boundary membrane, capsular contraction and proliferation, etc. were observed. The preoperative and postoperative best corrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.74±0.56 and 0.07±0.14, respectively, with a statistically significant difference (P<0.001). The best corrected distance visual acuity was≥20/40 in 77 eyes (95.06%), and≥20/29 in 73 eyes (90.12%). The postoperative spectacle independence rate was 77.8% (63/81), and the remaining patients only needed to wear a pair of glasses to correct the reserved or residual refractive error. A total of 5 patients (11.6%) had myopia drift after surgery. The MTF cut-off and SR increased and the OSI decreased after surgery (all P<0.001); the stereopsis was significantly improved (P<0.05). Conclusions: Multifocal IOL optic implantation in Berger space showed no significant complications and can effectively improve the visual function of school-age children with cataracts. After the correction of distance visual acuity, glasses for near visual acuity are not required.
目的： 评估学龄期儿童白内障摘除联合多焦点人工晶状体（IOL）光学区Berger间隙植入术的安全性和有效性。 方法： 前瞻性研究。收集2019年1月至2023年6月于山东第一医科大学附属青岛眼科医院行白内障摘除联合多焦点IOL植入术治疗的学龄期儿童白内障患者的临床资料。术前进行最佳矫正远、中、近视力的检查，以及眼压、眼位、裂隙灯显微镜检查、眼底检查，采用光学质量分析系统获取调制传递函数截止频率（MTF cut-off）、斯特列尔比（SR）及客观散射指数（OSI）等客观视觉质量指标，检查立体视。所有患者行白内障摘除联合多焦点IOL光学区Berger间隙植入术。随访时检查视力、眼压、立体视、客观视觉质量、眼前节及眼底情况，采用相干光层析成像术（OCT）判断有无黄斑水肿及其他眼底异常。 结果： 共纳入43例（86只眼）白内障患者，年龄为（9.4±3.0）岁。其中81只眼完成白内障摘除联合多焦点IOL光学区Berger间隙植入术。随访时间为（20.6±13.1）个月。随访期间所有术眼视轴区保持透明。5只眼术后因糖皮质激素滴眼液的不良反应出现短暂性高眼压（25~30 mmHg，1 mmHg=0.133 kPa），高眼压多在术后1周内发生，术后2周内可药物控制降至正常范围。随访期间未发生虹膜后粘连、继发性青光眼、IOL移位、IOL色素沉积、视网膜脱离、黄斑囊样水肿、玻璃体前界膜的增生、囊袋收缩增生等并发症。术前和术后最佳矫正远视力（最小分辨角的对数）分别为0.74±0.56和0.07±0.14，差异有统计学意义（P<0.001）。77只眼（95.06%）最佳矫正远视力≥20/40，73只眼（90.12%）最佳矫正远视力≥20/29。术后脱镜率为77.8%（63/81），其余患者只需配戴1副眼镜用于矫正预留或残留的屈光不正。术后共5例（11.6%）出现近视漂移。术后MTF cut-off和SR升高，OSI下降（均P<0.001）；立体视功能明显改善（P<0.05）。 结论： 多焦点IOL光学区Berger间隙植入术未见明显的并发症，能有效改善学龄期白内障儿童的视功能，矫正远视力后无须视近眼镜。.