Funktionelle Ergebnisse nach Implantation multifokaler Intraokularlinsen (MIOL)

Comparison of visual outcomes, spectacles dependence and patient satisfaction of multifocal and accommodative intraocular lenses: innovative perspectives for maximal refractive-oriented cataract surgery

Background

The aim of this study was to evaluate visual outcomes for different working distances (far, 60 cm and 33 cm) and impact on vision quality of multifocal IOLs AcrySof ResTOR SN6AD1 and SN6AD3 (Alcon, Inc., Fort Worth, Texas, USA) as well as REVIEW FIL611PV multifocal and OPTOFLEX FIL618 accommodative IOLs (Soleko, Ltd., Rome, Italy) in patients undergoing bilateral phacoemulsification.

Methods

In this observational prospective study 63 patients undergoing binocular cataract surgery were divided into four groups for implantation of one of the IOLs under evaluation. Visual outcomes were evaluated at 1 day, 7 days, 1 month, 3 months and 6 months after surgery. Patients’ satisfaction and spectacle independence were evaluated with questionnaires administered at the 6-months follow-up.

Results

Improvements in visual acuity for the three working distances were statistically significant in all cases compared to the preoperative status, especially after binocular implantation. The AcrySof ReSTOR SN6AD1 multifocal IOL provided the best visual acuity results and tolerability for all working distances. While performing worse than SN6AD1, FIL611PV and FIL618 provided better uncorrected visual acuity and spectacles independence for intermediate/close-up and far distances respectively, in comparison with the SN6AD3 group.

Conclusions

SN6AD1 was confirmed the best choice for all working distances. However, FIL611PV IOL may represent a valid and more cost-effective alternative, especially if surgeons intend to prioritize spectacle independence and patient autonomy at intermediate and close-up distances, in accordance to specific needs and requests.

Trial registration

Trial retrospectively registered in ISRCTN Registry on 02/02/2017. TRN: ISRCTN14145737.

Functional outcomes after implantation of Tecnis ZM900 and Array SA40 multifocal intraocular lenses

PURPOSE

To evaluate the functional outcome after implantation of the Tecnis ZM900 multifocal intraocular lens (IOL) (AMO) and the Array SA40 multifocal IOL (AMO).

SETTING

Department of Ophthalmology, Bundesknappschaft s Hospital, Sulzbach, and the Department of Ophthalmology, Marienhospital, Aachen, Germany.

METHODS

In a prospective comparative 2-center trial, Tecnis ZM900 and the Array SA40 multifocal IOLs were bilaterally implanted in 50 patients (50 eyes Tecnis, 50 eyes Array) by 1 surgeon at each center. The following parameters were assessed 30 to 60 days and 120 to 180 days after surgery in both eyes: refraction, pupil size, uncorrected and best corrected visual acuities for distance and near at different contrast levels, and photopic and mesopic contrast sensitivity at different spatial frequencies. Patient satisfaction (spectacle independence, photic phenomena, overall satisfaction) was assessed by a questionnaire.

RESULTS

The main differences between the 2 multifocal IOLs were the better uncorrected near visual acuity (P<.001), distance-corrected near visual acuity (P<.001), the mesopic contrast sensitivity at high spatial frequencies (P<.05) as well as greater independence from spectacles in patients with the Tecnis multifocal IOL, resulting in higher levels of patient satisfaction.

CONCLUSION

The aspherical diffractive Tecnis multifocal IOL gave better outcomes than the Array multifocal IOL.

Subjektive und objektive Ergebnisse nach Implantation der apodisiert diffraktiven AcrySof ReSTOR

BACKGROUND

Our purpose in this study was to assess the postoperative subjective and objective results after implantation of the Acrysof ReSTOR lens and to evaluate the advantages and limitations of the apodized diffractive optic design of this new multifocal intraocular lens (MIOL).

METHODS

Phakoemulsification and implantation of an Acrysof ReSTOR was performed in 55 eyes of 32 patients. All patients were examined after a mean period of 7.9+/-1.9 months. The accuracy of lens calculation was evaluated for the Haigis, Holladay I, and SRK-T formulas. Uncorrected and corrected visual acuity for distance and for intermediate and near vision were assessed, as was stereoacuity. In addition, contrast sensitivity was tested under photopic and mesopic conditions, with and without glare. The patients were asked about dysphotic phenomena such as halos, glare or flare, and night vision using a standardized evaluation. The degree to which patients were able to manage without spectacles after the surgery was also documented.

RESULTS

The median monocular uncorrected visual acuity (UCVA) for distance was 20/25 (LogMAR 0.05) while the binocular UCVA was 20/20 (LogMAR 0). The monocular uncorrected acuity for near vision was 20/25 (LogMAR 0.1), the binocular near visual acuitiy was 20/20 (LogMAR 0), while the intermediate monocular visual acuity was 20/50 (LogMAR 0.4) and the binocular, 20/32 (LogMAR 0.2). Contrast sensitivity was within the normal range. Dysphotic phenomena were noted by 66% of patients but were so slight as not to cause any problem at all in 59%. For close work and distance vision 84% of all patients needed no correcting glasses, while 78% did not need to use glasses for intermediate vision.

CONCLUSION

The Acrysof ReSTOR provides excellent uncorrected visual acuity for distance and near vision and the level of patient satisfaction achieved with it is good.

[Optical performance of multifocal intraocular lenses. Investigation of the Array SA40N vs. Acri. Twin at the "physical eye" according to Reiner and Jacobi]

BACKGROUND

Reduced contrast sensitivity, glare disability and insufficient bifocality are the main drawbacks of multifocal intraocular lenses (IOL). The bilateral implantation of diffractive IOL with an asymmetrical light distribution for distance and near focus is an alternative concept that aims to improve the contrast sensitivity and bifocality of conventional multifocal IOL.

PATIENTS AND METHODS

The optical performance of monofocal (PhacoFlexII SI40) and multifocal IOL (Array SA40N; Acri. Twin 737D/733D) was quantitatively assessed in 18 healthy probands and qualitatively determined by digital photographic recording using an optical apparatus, the "physical eye", according to Reiner and Jacobi. Vision examination included standard tests of distance and near visual acuity, contrast sensitivity and low contrast visual acuity testing under varying pupil size using a video acuity tester.

RESULTS

Distance visual acuity was significantly superior with the SI40 and distant-dominant 737D compared to the SA40N and near-dominant 733D. At near, the 733D had the best performance. Contrast sensitivity was better with the 737D than the SA40N when both were compared with the SI40. No normal contrast sensitivity could be determined with the 733D because of the optical phenomenon of 'spurious resolution'. Variation in pupil size had less impact on contrast acuity with the Acri. Twin IOL compared to the SI40 and SA40N. Photographic testing revealed better edge contrast with the Acri. Twin than the SA40N.

CONCLUSIONS

The optical performance of multifocal IOL correlates with the properties of physical light distribution. Differences in edge contrast may be discerned using photographic recording.

Accommodating intraocular lenses: a critical review of present and future concepts

BACKGROUND

Significant efforts have been made to develop lens implants or refilling procedures that restore accommodation. Even with monofocal implants, apparent or pseudoaccommodation may provide the patient with substantial though varying spectacle independence. True pseudophakic accommodation with a change of overall refractive power of the eye may be induced either by an anterior shift or a change in curvature of the lens optic.

MATERIALS AND METHODS

Passive-shift lenses were designed to move forward under ciliary muscle contraction. This is the only accommodative lens type currently marketed (43E/S by Morcher; 1CU by HumanOptics; AT-45 by Eyeonics). The working principle relies on various hypothetical assumptions regarding the mechanism of natural accommodation. Dual-optic lenses were designed to increase the dioptric impact of optic shift. They consist of a mobile front optic and a stationary rear optic which are interconnected with spring-type haptics. With active-shift lens systems the driving force is provided by repulsing mini-magnets. Lens refilling procedures replace the lens content by an elastic material and provide accommodation by an increase of surface curvature.

RESULTS

Findings with passive-shift lenses have been contradictory. While uncorrected reading vision results were initially reported to be favorable with the 1CU, and excellent with the AT-45 lens, distant-corrected near vision did not exceed that with standard monofocal lenses in later studies. Mean axial shift from laser interferometric measurements under stimulation with pilocarpine showed a moderate anterior shift with the 1CU, while the AT-45 paradoxically exhibited a small posterior shift. With the 1CU, the shift-induced accommodative effect was calculated to be less than +0.5 D in most cases, while +1 D was achieved in a single case only. Ranges and standard deviations were very large in relation to the mean values. Under physiological near-point stimulation, however, no shift was seen at all. Prevention of capsule fibrosis by extensive capsule polishing did not enhance the functional performance. Dual optic lenses are under clinical investigation and are reported to provide a significant amount of accommodation. However, possible long-term formation of interlenticular opacifications remains to be excluded. Regarding magnet-driven active-shift lens systems, initial clinical experience has been promising. Prevention of fibrotic capsular contraction is crucial, and it has been effectively counteracted with a special capsular tension ring, or lens fixation technique, together with capsule polishing. Lens refilling has been extensively studied in the laboratory and in primates. Though it offers great potential for fully restoring accommodation, a variety of problems must be solved, such as achieving emmetropia in the relaxed state, adequate response to ciliary muscle contraction, satisfying image quality over the entire range of accommodation and sustained functioning. The key problem, however, is again after-cataract prevention.

CONCLUSIONS

As opposed to psychophysical evaluation techniques, laser interferometry measures what shift lenses are designed to provide: axial shift on accommodative effort. While under pilocarpine some movement was recorded, no movement at all was found under near-point stimulation with any of the lenses currently marketed. In contrast, magnetic-driven active-shift lens systems carry the potential of sufficiently topping up apparent accommodation to provide for clinically useful accommodation while using conventional lens designs with proven after-cataract performance. Dual optic implants significantly increase the impact of axial optic shift. The main potential problem, however, is delayed formation of interlenticular regenerates. Lens refilling procedures offer the potential of fully restoring accommodation due to the great impact of increase in surface curvature on refractive lens power. However, various problems remain to be solved before clinical use can be envisaged, above all, again, after-cataract prevention. The concept of passive single-optic shift lenses has failed. Concomitant poor capsular bag performance makes these lenses an unacceptable trade-off. Magnet-assisted systems potentially combine clinically useful accommodation with satisfactory after-cataract performance. Dual optic lenses theoretically offer substantial accommodative potential but may allow for interlenticular after-cataract formation. Lens refilling procedures have the greatest potential for fully restoring natural accommodation, but will again require years of extensive laboratory and animal investigations before they may function in the human eye.