連続焦点型眼内レンズ挿入眼における自覚屈折値と他覚屈折値

Subjective and objective refractions of the eyes with continuous range of vision intraocular lenses

要約　目的：エシェレット回折格子を用いた焦点深度拡張型眼内レンズ（EDF IOL）と回折型2焦点IOLの技術を融合した連続焦点型IOL挿入眼において，自覚・他覚屈折値が一致するかを後ろ向きに検討した。

対象と方法：東京歯科大学水道橋病院にて連続焦点型IOL（DFR00VまたはDFW150, 225, 300, 375）が挿入された症例に対し，術後1か月の自覚屈折値（球面度数・円柱度数・等価球面度数）と，オートレフラクトメータ（TONOREF^®Ⅱ）で測定した他覚屈折値との差，相関関係，系統誤差の有無を評価した。

結果：症例は23例33眼（平均年齢：62.7±11.3歳）で，球面度数，円柱度数，等価球面度数は，平均自覚屈折値で0.15±0.47D，−0.23±0.36D，0.03±0.46D，平均他覚屈折値は−0.30±0.52D，−0.52±0.33D，−0.56±0.52Dであった。他覚屈折値が有意に近視化しており（p＜0.001：t検定），屈折値の差は，それぞれ−0.45±0.28D，−0.28±0.23D，−0.59±0.30Dであった。両者に有意な相関があり（p＜0.001，R²＝0.71，0.63，0.67，β＝−0.44，−0.35，−0.59：単回帰分析），ブランド・アルトマン分析で系統誤差が存在した。

結論：連続焦点型IOL挿入眼における等価球面度数の自覚および他覚屈折値の差は0.59Dで，EDF IOLの結果とは異なった。

Abstract　Purpose：Regarding subjective and objective refractions, 0.84D myopic shift of objective refraction was found with diffractive extended depth of focus intraocular lens（EDF IOL）. To retrospectively evaluate the differences of subjective and objective refractions in eyes with continuous range of vision IOL that merges the technology of diffractive bifocal IOL and diffractive EDF IOL using echelette optics.

Methods：This clinical trial included cataract patients who received continuous range of vision IOL（DFR00V or DFW150, 225, 300）at Tokyo Dental College Suidobashi Hospital. Subjective refractions（sphere, cylinder, spherical equivalent）, objective refractions measured value by autorefractometer（TONOREF^®Ⅱ, Nidek）, difference between subjective and objective refractions, correlation and agreement between both methods were evaluated at 1 month postoperatively.

Results：Thirty-three eyes of 23 subjects underwent surgeries. The mean subjective refractions were 0.15±0.47D, −0.23±0.36D, 0.03±0.46D（spherical, cylindrical, spherical equivalent）, and objective refractions were −0.30±0.52D, −0.52±0.33D, and −0.56±0.52D. The mean differences were −0.45±0.28D, −0.28±0.23D, and −0.59±0.30D, which indicated the significant myopic shift of the objective refraction（P＜0.001：t-test）. The significant correlation between subjective and objective refractions was found as well（P＜0.001, R²＝0.71, 0.63, 0.67, β＝−0.44, −0.35, −0.59：Simple regression analysis）. Systematic errors were found by using the Bland-Altman analysis.

Conclusion：The difference between subjective and objective refractions in eyes with continuous range of vision IOLs was 0.59D, which was different from the result of EDF IOLs using echelette optics.