目的：研究散光矫正型双焦点人工晶状体与双焦点人工晶状体混搭植入术后的双眼视觉质量。

方法：横断面研究。纳入2020-01/2021-01收治的年龄相关性白内障患者54例108眼，按植入人工晶状体及术前角膜散光不同分为3组，A组21例42眼术前角膜散光均<1.0D，双眼植入双焦点人工晶状体； B组15例30眼术前角膜散光均≥1.0D，双眼植入散光双焦点人工晶状体； C组18例36眼，一眼术前角膜散光<1.0D，另一眼术前角膜散光≥1.0D，前者植入双焦点人工晶状体，后者植入散光双焦点人工晶状体。比较三组患者术前单眼视力，术后双眼视力、残余散光、双眼离焦曲线、对比敏感度(CS)，三组患者术后进行问卷调查评估视觉质量。

结果：三组患者术前视力、术前眼压均无差异(P>0.05)。A组术后残余散光显著高于另两组(P=0.012，<0.05)。B组和C组双眼远视力优于A组(均P<0.05)； B组和C组双眼近视力优于A组(均P<0.01)； A组双眼中视力优于B组和C组(均P<0.01)。明视眩光6、12c/d，暗视6、12、18c/d，以及暗视眩光1.5、3、6、12、18c/d的空间频率下A组CS较B组和C组显著降低(均P<0.05)。术后视功能调查表三组间无差异(P>0.05)。

结论：散光双焦人工晶状体与双焦人工晶状体混搭植入可改善患者术后视觉质量。矫正散光有助于提高术后患者的视觉CS，但是散光全矫后，可能会导致患者术后中视力的下降。

METHODS: A cross-sectional study. One hundred and eight eyes of 54 cases were included from January 2020 to January 2021. All participants were divided into three groups according to preexist corneal astigmatism and IOL type. In group A, cornea astigmatism was less than 1.0D in both eyes of 21 cases and bifocal IOLs were implanted. In group B, cornea astigmatism was more than 1.0D in both eyes of 15 cases and toric bifocal IOLs were implanted. In group C, 18 cases of one eye with cornea astigmatism less than 1.0D were implanted with bifocal IOLs, and the other eye with astigmatism more than 1.0D were implanted with toric bifocal IOLs. Preoperative intraocular pressure(IOP), monocular uncorrected distance visual acuity(UDVA), equivalent spherical, postoperative binocular corrected distance visual acuity(CDVA), UDVA, uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), residual astigmatism, defocus curve and contrast sensitivity were compared among the three groups. Postoperative questionnaire was conducted to evaluate the visual quality of the three groups.

RESULTS: There were no significant differences in preoperative UDVA and IOP among the three groups(P>0.05). The postoperative residual astigmatism in group A was significantly higher than the other two groups(P=0.012, P<0.05). Binocular UDVA of group B and group C were better than those of group A(all P<0.05), binocular UNVA of group B and group C were better than those of group A(all P<0.01), but the binocular UIVA of group A was better than that of group B and group C(all P<0.01). Contrast sensitivity of group A was significantly lower than that of groups B and C in bright light glare of 6, 12c/d, dark light of 6, 12, 18c/d and dark light glare of 1.5, 3, 6, 12, 18c/d(all P<0.05). There was no statistical difference in the postoperative visual function questionnaire among the three groups(P>0.5).

CONCLUSION: Mix-and-match implantation of a toric bifocal IOL and nontoric bifocal IOL can effectively improve postoperative binocular visual quality in cataract patients. Correcting astigmatism helps improve the visual contrast sensitivity, however, when astigmatism is completely corrected, it may result in a loss of intermediate vision in patients after surgery.