Objective: To investigate the effects of the application of a low addition refractive multifocal intraocular lens (IOL) using the micromonovision design in the non-dominant eye with different degrees of preset myopia on the visual acuity, visual function and visual quality after bilateral cataract surgery. Methods: In this randomized controlled trial, patients who were proposed to undergo bilateral phacoemulsification combined with rotational asymmetric refractive IOL (MF15 IOL) implantation at the First Affiliated Hospital of Zhengzhou University between September 2020 and August 2022 were included. All patients were divided into three groups using the random number method. The target refraction of the IOL in the dominant eye was 0.00 D. Non-dominant eyes were given different preoperative IOL reserve refractions, with the reserved near additional degree>0.20 D and≤0.40 D as the low addition,>0.40 D and≤0.60 D as the medium addition, and>0.60 D and≤0.80 D as the high addition. We compared uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) of monocular and binocular eyes at 1 day, 1 month and 3 months postoperatively in the 3 groups of patients. Furthermore, the contrast sensitivity, stereopsis, defocus curves and visual quality questionnaire results of binocular eyes were compared at 3 months postoperatively. The statistical methods mainly used were chi-square test, two-factor repeated measures ANOVA, one-way ANOVA, LSD test, Kruskal-Wallis test, and paired t-test. Results: A total of 110 patients (220 eyes) were enrolled in the study, including 48 males and 62 females, with an average age of (59.74±9.38) years. There were 40 patients (80 eyes) in the low additional degree group, 37 patients (74 eyes) in the medium additional degree group, and 33 patients (66 eyes) in the high additional degree group. The differences in distance, intermediate and near visual acuity of the dominant eyes among the three groups were not statistically significant at different measurement timepoints postoperatively (P>0.05). The differences in intermediate and near visual acuity of the non-dominant eyes were also not statistically significant (P>0.05) among the three groups. In contrast, at 3 months, the UDVA of the non-dominant eyes in the low additional degree group (0.04±0.06) and medium additional degree group (0.04±0.07) was significantly higher than that in the high additional degree group (0.08±0.09) (F=4.776, P=0.011, bias η2=0.086). There was no statistically significant difference in binocular uncorrected distance, intermediate and near visual acuity among the three groups at different postoperative timepoints (P>0.05). The binocular UDVA, UIVA and UNVA (logMAR visual acuity) at 3 months postoperatively were -0.04±0.04, 0.03±0.08, 0.10±0.13 in the low addition group, -0.01±0.05, -0.02±0.06, 0.09±0.10 in the medium addition group, and 0.02±0.07, 0.01±0.09, 0.16±0.11 in the high addition group. At 3 months postoperatively, the binocular contrast sensitivity of the low additional degree group was significantly higher than that of the high additional degree group (P<0.05), except that there was no significant difference at the spatial frequency of 6 cycles per degree in the absence of glare (P>0.05). The binocular contrast sensitivity of the medium additional degree group was significantly higher than that of the high additional degree group at the spatial frequencies of 6 and 18 cycles per degree in the glare condition (P<0.05). The difference in the binocular contrast sensitivity between the low and medium additional degree groups did not reach statistical significance (P>0.05). The peak of the binocular defocus curve in the three groups was significantly wider than that in the monocular eyes, and the decline trend was more gentle, with no trough in the middle, and the visual acuity could be maintained above 0.2 (logMAR visual acuity) in the 0.00 D to -3.00 D defocus range. There was no significant difference in the postoperative near stereopsis results among the three groups (P>0.05), with the percentage of near stereopsis sharpness≤60″ reaching 90.00% (36/40), 89.19% (33/37) and 78.79% (26/33), respectively. The proportions of VF-14 scores≥90 in the postoperative questionnaire were 90% (36/40), 91.89% (34/37) and 81.82% (27/33) for the low, medium and high additional degree groups, respectively. The differences in the probability of photic phenomena and spectacles-independent rate were not statistically significant (P>0.05). Conclusion: The use of micromonovision design for bilateral implantation of a rotational asymmetric refractive MF15 IOL, with the non-dominant eye reserved for different near additional degrees, can enable cataract patients to have significantly improved binocular full-range vision, visual function and visual quality. When the degree of reserved near additions in the non-dominant eye preoperatively is>0.20 D and≤0.60 D, it can ensure sufficient binocular UDVA, UIVA and UNVA after surgery, and meanwhile help to obtain superior contrast sensitivity and stereopsis, as well as a satisfactory spectacles-independent rate and low incidence of photic phenomena.
目的： 探讨双眼白内障摘除手术应用低附加区域折射多焦点人工晶状体（IOL）进行微单视设计中非主视眼不同预留近附加度数对术后全程视力、视功能及视觉质量的影响。 方法： 随机对照试验。纳入2020年9月至2022年8月在郑州大学第一附属医院眼科拟行超声乳化白内障吸除低附加区域折射型多焦点IOL（MF15 IOL）植入术患者，应用随机数字表法分为3组，主视眼目标屈光度数为0.00 D，非主视眼分别给予不同预留近附加度数。0.20 D<预留近附加度数≤0.40 D为低近附加度数组，0.40 D<预留近附加度数≤0.60 D为中近附加度数组，0.60 D<预留近附加度数≤0.80 D为高近附加度数组。比较3组患者术后1 d、1个月、3个月单眼和双眼的裸眼远、中、近视力（logMAR视力），术后3个月双眼的对比敏感度、立体视、离焦曲线、视觉质量问卷调查结果。采用的主要统计学方法包括卡方检验、两因素重复测量方差分析、单因素方差分析、Fisher最小显著性差异法、Kruskal-Wallis检验、配对t检验等。 结果： 纳入研究110例（220只眼）患者，其中男性48例（96只眼）患者，女性62例（124只眼）患者；年龄为（59.74±9.38）岁。低近附加度数组40例（80只眼）患者，中近附加度数组37例（74只眼）患者，高近附加度数组33例（66只眼）患者。3组之间术后不同检查时间主视眼的裸眼远、中、近视力差异均无统计学意义（均P>0.05）。3组之间术后不同检查时间非主视眼裸眼中、近视力差异亦均无统计学意义（均P>0.05），而术后3个月非主视眼裸眼远视力低近附加度数组（0.04±0.06）和中近附加度数组（0.04±0.07）显著高于高近附加度数组（0.08±0.09）（F=4.776，P=0.011，偏η2=0.086）。3组之间术后不同检查时间双眼裸眼远、中、近视力差异均无统计学意义（均P>0.05）；术后3个月双眼裸眼远、中、近视力低近附加度数组分别为-0.04±0.04、0.03±0.08、0.10±0.13，中近附加度数组分别为-0.01±0.05、-0.02±0.06、0.09±0.10，高近附加度数组分别为-0.02±0.07，0.01±0.09、0.16±0.11。术后3个月，双眼对比敏感度除在无眩光状态空间频率为6周/度（cpd）时3组之间差异无统计学意义（P>0.05）外，低近附加度数组均显著高于高近附加度数组（均P<0.05），中近附加度数组在眩光状态空间频率为6和18 cpd时显著高于高近附加度数组（均P<0.05），而低近附加度数组与中近附加度数组的差异无统计学意义（均P>0.05）。3组双眼离焦曲线形态与单眼比较，波峰明显变宽，下降趋势更为平缓，中间无波谷，在0.00~-3.00 D离焦范围内，双眼裸眼视力可保持在好于0.2（logMAR视力）。低、中、高近附加度数组术后近立体视的差异无统计学意义（均P>0.05）；近立体视锐度≤60″的比例分别达到90.00%（36/40）、89.19%（33/37）、78.79%（26/33）。低、中、高近附加度数组的术后视功能指数量表评分≥90的比例分别为90.00%（36/40）、91.89%（34/37）、81.82%（27/33）。不良视觉现象出现比例和脱镜率的差异均无统计学意义（均P>0.05）。 结论： 采用微单视设计双眼植入低附加区域折射多焦点IOL（MF15 IOL），非主视眼预留不同近附加度数均可提高术后全程视力和视觉质量；非主视眼预留近附加度数>0.20~0.60 D，可保证患者术后具有足够的裸眼远、中、近视力，同时获得更为良好的对比敏感度和近立体视以及令人满意的脱镜率和较低的不良视觉现象发生率。.