Aging changes in apparent accommodation in eyes with a monofocal intraocular lens

PURPOSE: To examine the aging changes in the amplitude of apparent accommodation in eyes with a monofocal intraocular lens (IOL). DESIGN: Prospective comparative observational study. METHODS: Two hundred eyes of 200 patients who were scheduled for phacoemulsification and monofocal IOL implantation were studied. Forty patients in each of five age groups-younger than 40 years of age or in their 50s, 60s, 70s, and 80s-were prospectively recruited. Using an accommodopolyrecorder, the amplitude of apparent accommodation of these patients was measured approximately 1 month after surgery. Visual acuities from far to near distances after best-corrected distance were examined using an all-distance vision tester, and the region of accommodation at which each patient achieved a visual acuity of 20/29 or 20/40 was determined and converted to the diopteric range. Contrast sensitivity was also examined using a vision contrast test system. RESULTS: The amount of apparent accommodation as measured with the accommodopolyrecorder was decreased significantly in proportion to patient age (P <.0001). Furthermore, significant negative correlation was found between the amount of apparent accommodation and actual age of each patient (r = -.491). The diopteric range of accommodation at which the patients achieved 20/29 or 20/40 also reduced in proportion to the age. Although no significant differences were found in the mean far visual acuities between age groups, the intermediate and near visual acuities worsened significantly with age. The contrast sensitivity was also reduced in proportion to the age. CONCLUSIONS: The amplitude of apparent accommodation in eyes with a monofocal IOL decreases significantly in proportion to age, resulting in worsening of best-corrected intermediate and near visual acuities.     

三种单焦点人工晶状体植入术后拟调节力比较

目的：比较三种单焦点人工晶状体植入术后人工晶状体眼的拟调节力大小。 方法：白内障患者78例78眼根据自愿的原则,采用非随机方式分成三组,Ⅰ组23例23眼植入AcrySof Natural人工晶状体;Ⅱ组24例24眼植入Canon staa人工晶状体;Ⅲ组31例31眼植入聚甲基丙烯酸甲酯(PMMA)人工晶状体。术后3mo检测最佳矫正远视力及在最佳矫正远视力基础上获得的近视力,以及33cm处在最佳矫正近视力基础上获得的近附加值及拟调节力(PAC)。 结果：三组术后3mo最佳矫正远视力差异无统计学意义(F=0.317,P=0.729);最佳矫正远视力基础上获得的近视力差异有统计学意义(F=3.377,P=0.039);术后3mo,33cm处在最佳矫正近视力基础上获得的近附加值及拟调节力(PAC)比较差异均有统计学意义(F=10094,P=0.000;F=16.806,P=0.000)。 结论：白内障术后植入三种单焦点人工晶状体拟调节力比较,软性推注式折叠晶状体可获得更高的拟调节力及令人满意的近视力。     

OCT测量近视眼在不同调节状态下眼前段结构变化

目的:探讨不同程度近视眼在不同调节状态下OCT(optic coherence tomography,OCT)测量的眼前段结构的变化。方法:招募60例近视患者,年龄:18～39岁,按近视程度分为轻中度近视组和高度近视组,用眼前段OCT对测试眼分别在调节放松(0D)、诱发3.00D和5.00D调节三种调节状态下进行眼前段扫描分析,分别测量不同调节状态下角膜后表面曲率(posterior corneal curvature,PCC)、前房深度(anterior chamber depth,ACD)、晶状体厚度(lens thickness,LT)和暗瞳直径的大小,采用重复测量的方差分析比较不同调节状态下上述参数的差异以及不同程度近视在相同调节状态下各参数的差异。结果:在调节放松情况下,轻中度近视组眼前段OCT测得的平均PCC,ACD,LT和瞳孔直径(pupil diameter,PD)分别为:6.92±0.91mm,2.67±0.19mm,4.17±0.21mm和6.21±0.56mm;高度近视组的平均PCC,ACD,LT和PD分别为:6.83±0.81mm,2.92±0.23mm,4.22±0.24mm和5.95±0.42mm。轻中度近视组与高度近视组在PCC和LT方面的差异均无显著性(t=0.401,-0.742;P=0.690,0.461),而ACD方面,高度近视组显著大于轻中度近视组(t=-4.637,P=0.000),高度近视组的PD则小于轻中度近视组(t=2.011,P=0.049)。两不同程度近视组中,在0.0D,3.00D和5.00D三种不同的调节状态下测得的PCC的差异均无显著性(F=0.084,0.047;P=0.920,0.954);ACD随调节的逐渐增大而均变浅(F=19.44,8.455;P=0.000,0.001);LT随调节的逐渐增大而均增厚(F=31.149,15.245;P=0.000,0.000);PD随调节的逐渐增大而均减小(F=83.634,53.429;P=0.000,0.000)。结论:眼前段OCT可以定量观察近视眼调节时眼前段各部分的变化,高度近视眼前房较轻中度近视深,而瞳孔较小;发生不同程度调节时,角膜的形状相对稳定,LT,ACD及PD随调节量的增加其变化量逐渐增大。     

Ultrasound biomicroscopic changes during accommodation in eyes with accommodating intraocular lenses: pilot study and hypothesis for the mechanism of accommodation

PURPOSE: To document ciliary body constriction and movement with the Crystalens AT-45 intraocular lens (IOL) (eyeonics) using ultrasound biomicroscopy. SETTING: Eye Clinic, Department of Neurological and Visual Sciences, University of Verona, Verona, Italy. METHODS: Patients with no preexisting ocular conditions other than cataract who agreed to return for follow-up were considered. Twenty eyes of 14 patients with a best corrected visual acuity of 5/10 or worse and a refractive error (spherical equivalent) of +/-1.0 diopter (D) had implantation of a Crystalens AT-45 accommodating IOL. Six patients had bilateral implantation. Ultrasound biomicroscopy was performed postoperatively at 1 and 6 months. Before and during accommodation, the anterior chamber depth (ACD) was measured to assess the endothelium-IOL distance and measure the scleral-ciliary process angle to determine whether there was anterior rotation of the ciliary body. The uncorrected distance acuity, best corrected distance acuity, uncorrected near acuity, distance corrected near acuity, best corrected near acuity, and accommodative amplitude were determined. Analysis was done to determine whether there was a correlation between the accommodative amplitude and the percentage variation in the ACD and scleral-ciliary process angle. RESULTS: All surgical procedures were uneventful. The mean uncorrected distance acuity at 1 month was 0.8 +/- 0.14 (SD) and remained stable at 6 months. Three of 20 eyes (15%) and 8 of 20 eyes (40%) had a Jaeger acuity of J1 and J3, respectively, without additional power correction. During accommodation, the mean reduction in ACD was 0.32 +/- 0.16 mm at 1 month and 0.33 +/- 0.25 mm at 6 months. The mean narrowing of the scleral-ciliary process angle was 4.32 +/- 1.87 degrees at 1 month and 4.43 +/- 1.85 degrees at 6 months. There was a correlation between accommodative amplitude and a decrease in the ACD (r=0.404) and a decrease in scleral-ciliary process angle (r=0.773). CONCLUSIONS: Anterior displacement of the Crystalens IOL and corresponding anterior rotation of the ciliary body occurred during near vision. The IOL displacement and rotation were proportional to the accommodation capacity.     

Anterior segment changes with age and during accommodation measured with partial coherence interferometry

PURPOSE: To evaluate anterior segment alterations with age and during accommodation in different age groups. SETTING: Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. METHODS: Fifty-three subjects (101 normal eyes) were enrolled in this study and divided into 3 age groups: younger than 30 years (Group 1), between 31 years and 44 years (Group 2), and older than 45 years (Group 3). The total amplitude of accommodation was determined with a defocusing technique, and anterior segment measurements were performed by partial coherence interferometry. RESULTS: Group 1 comprised 32 eyes; Group 2, 37 eyes; and Group 3, 32 eyes. The total amplitude of accommodation decreased with age (P<.0001). With the target position at infinity, the lens thickness (LT) and anterior segment length (ASL) increased and the anterior chamber depth (ACD) decreased significantly with age (P<.0001). During accommodation in the youngest group, the mean change in LT was 36.3 mum/diopter (D) and in ACD, -26.7 mum/D. The mean accommodation-induced ACD change was -0.08 mm +/- 0.06 (SD) in Group 1, -0.064 +/- 0.087 mm in Group 2, and -0.03 +/- 0.06 mm in Group 3 (P = .0004). The mean LT change during near fixation was 0.109 +/- 0.063 mm in Group 1, 0.103 +/- 0.136 mm in Group 2, and 0.006 +/- 0.05 mm in Group 3 (P<.0001). The mean ASL change during accommodation was 0.029 +/- 0.037 mm, 0.039 +/- 0.114 mm, and -0.023 +/- 0.051, respectively (P<.0001). CONCLUSIONS: In addition to forward movement of the anterior lens surface with age, the posterior surface moved backward. Alterations in LT and ACD sufficient for a unit of refractive power change during accommodation might be smaller than previously thought. Anterior shifting of the lens may also participate in the accommodative response.     

Anterior segment optical coherence tomography for evaluation of changes in anterior chamber angle and depth after intraocular lens implantation in eyes with glaucoma

PURPOSE: To examine anterior chamber depth (ACD) and anterior chamber angle (ACA) in patients with glaucoma after cataract extraction with an anterior optical coherence tomography (OCT) system. METHODS: A new commercially available 1310 nm infrared light anterior segment OCT system was used for anterior chamber evaluation. Sixty patients (n=20 with primary open angle glaucoma [POAG], n=20 with angle closure glaucoma [ACG], and n=20 with no known glaucoma as control group) with a mean age of 68.8+/-13.9 years undergoing cataract surgery were enrolled. RESULTS: Before cataract surgery, ACD and ACA of the ACG group were significantly lower compared to the POAG and control groups (ACD p<0.005; ACA p<0.005). After cataract extraction, ACD and ACA increased significantly in the ACG group (3.1+/-0.4 mm vs 1.8+/-0.2 mm, p<0.005 and 32.3 degrees +/-7.7 degrees vs 16.0 degrees +/-4.7 degrees , p<0.005). In the POAG and control groups, ACD and ACA also increased postoperatively, but not as much as in the ACG group. After cataract extraction, IOP decreased significantly in the glaucoma groups (ACG: 15.6+/-6.1 vs 18.6+/-5.7 mm Hg, p=0.008; POAG: 16.2+/-3.4 vs 20.7+/-8.0 mmHg, p=0.02) and was almost the same in all three groups after surgery (control group after surgery: 15.2+/-2.8 mmHg). CONCLUSIONS: Both ACD and ACA increased significantly after cataract extraction and IOL implantation. IOP reduction after surgery was higher in the glaucoma groups compared to the control group.     

非球面多焦点人工晶状体眼的波前像差及拟调节力研究

目的评价白内障超声乳化摘出联合非球面衍射型多焦点人工晶状体（MIOL）植入术后患者的波前像差及拟调节力。方法将进行白内障超声乳化联合人工晶状体植入术且年龄45～70岁的36例50眼患者随机分为2组,MIOL组患者17例25眼植入AcrysofReSTORMIOL,单焦点人工晶状体（SIOL）组患者19例25眼植入AcrysofSIOL。术后3个月检查裸眼及矫正远近视力,最佳矫正远视力下的近视力（DCNVA）、波前像差、调制传递函数（MTF）、拟调节力,并比较脱近用镜率。结果术后3个月,2组患者术后裸眼远视力和最佳矫正远视力差异均无统计学意义（P〉0.05）;MIOL组术后裸眼近视力和DCNVA明显优于SIOL组（P〈0.05）;球面像差ZernikeC12、4阶高阶像差及总体高阶像差比较MIOL组与SIOL组间差异均无统计学意义（P〉0.05）;MTF值在各空间频率2组间差异均无统计学意义（P〉0.05）。视近拟调节力：MIOL组为（0.925±0.549）D,SIOL组为（0.390±0.235）,差异有统计学意义（P〈0.05）。脱近用镜率：MIOL组（80%）优于SIOL组（24%）（P=0.000）。结论 ReSTOR衍射型MIOL眼能提供良好的远近视力,拟调节幅度较SIOL大,能有效改善白内障患者术后的视觉质量。     

Wavefront aberrations in eyes with Acrysof monofocal intraocular lenses

PURPOSE: To characterize and measure the ocular aberrations in eyes implanted with monofocal intraocular lenses (IOLs) and to study any correlation between postoperative aberrations and surgical factors. METHODS: A Tscherning aberroscope was used to measure the wavefront aberrations of 62 eyes that had undergone phacoemulsification with the implantation of foldable monofocal Acrysof MA60BM IOLs (Alcon Laboratories Inc, Ft Worth, Tex). The Zernike coefficients, measured with a pupil diameter of 6 mm, were compared with those of a normal dataset of 82 eyes of healthy young myopes. RESULTS: Spherical aberration (Z(0)4) was the most predominant higher order aberration, with a mean value of 0.37 +/- 0.16 microm. A statistically significant linear relationship was noted between the magnitude of postoperative spherical aberration and the dioptric power of the IOL. The mean spherical aberration was 33 times more in the pseudophakic group than in normal young myopic eyes. The other major higher order aberrations were trefoil (Z(-3)3) with a mean of -0.13 +/- 0.22 microm and vertical coma (Z(-1)3) with a mean value of -0.11 +/- 0.23 microm. On average, the root-mean-square of higher order aberrations in pseudophakic eyes was 2.1 times that in a normal population of young myopic eyes. CONCLUSIONS: Eyes that undergo cataract surgery with monofocal IOL implantation suffer from significant higher order aberrations. The optical design of the IOL is most likely responsible for the increase in spherical aberration, the magnitude of which is a function of the dioptric power of the IOL.     

单眼白内障患者植入多焦点人工晶状体与单焦点人工晶状体后的双眼视功能比较

目的比较单眼白内障患者植入多焦点人工晶状体（IOL）或单焦点IOL后的双眼视功能。方法前瞻性非随机对照研究。2013年6月至2014年12月期间,在我院行白内障超声乳化联合IOL植入术的单眼白内障患者80例（80眼）,根据植入的IOL类型分为2组,各40例（40眼）。观察组植入多焦点IOL,对照组植入单焦点IOL。术后随访3个月,观察指标包括术眼单眼及双眼远（5 m）、中（70 cm）、近（40 cm）视力,双眼对比敏感度,近立体视,脱镜率,视觉干扰现象及患者满意度。术后视力及对比敏感度比较采用独立样本t检验;脱镜率及光干扰现象发生率的比较采用χ²检验;近立体视、视力满意度评分比较采用Mann-Whitney U检验。结果观察组双眼裸眼远、中、近视力分别为0.03±0.04、0.17±0.07、0.15±0.06,对照组双眼裸眼远、中、近视力分别为0.05±0.05、0.27±0.08、0.31±0.09,观察组双眼裸眼中视力和近视力优于对照组（t=3.925、3.429,P＜0.01）,而2组间双眼裸眼远视力差异无统计学意义（t=0.356,P＞0.05）。双眼在空间频率为3、6、12、18 c/d时,观察组无眩光对比敏感度和有眩光对比敏感度均低于对照组（无眩光：t=3.463、3.361、2.198、2.574,P＜0.05;有眩光：t=3.105、2.432、2.758、3.207,P＜0.05）。观察组近立体视优于对照组（Z=2.578,P＜0.05）,脱镜率（88%）高于对照组（28%）（χ²=8.240,P＜0.05）,2组间视远满意度评分差异无统计学意义（Z=0.598,P＞0.05）,而观察组视中和视近满意度评分均高于对照组（Z=2.314、3.137,P＜0.05）。2组间视觉干扰眩光现象差异无统计学意义（χ²=0.602,P＞0.05）,而观察组光晕现象多于对照组（χ²=8.807,P＜0.05）。结论单眼白内障患者植入多焦点IOL相比单焦点IOL能提供更好的双眼中、近视力,双眼立体视,脱镜率及患者满意度,但对比敏感度有所降低。     

Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome

AIMS—To examine the extent of anterior capsule contraction as well as intraocular lens (IOL) decentration and tilt following implant surgery in eyes with pseudoexfoliation syndrome (PE).
METHODS—53 eyes from 53 patients with PE and 53 control eyes from 53 age matched patients, undergoing phacoemulsification and implant surgery, were recruited. The anterior capsule opening area and the amounts of IOL decentration and tilt after undergoing continuous curvilinear capsulorhexis were measured using the Scheimpflug videophotography system at 1 week and 1, 3, 6, 9, and 12 months postoperatively.
RESULTS—The mean area of the anterior capsule opening in the PE group was significantly smaller than that in the control group at 1 month postoperatively and later. The percentage reductions in the PE group were approximately 25%, while they were less than 10% in the control group. The degree of IOL tilt was also larger in the PE group than in the control group. Five eyes (9.4%) in the PE group underwent a neodymium:YAG laser anterior capsulotomy, but none in the control group underwent a capsulotomy.
CONCLUSIONS—The contraction of the anterior capsule opening was more extensive in the PE eyes than in the control eyes, thus resulting in a high Nd:YAG laser anterior capsulotomy rate. The IOL tilt was also greater in the PE eyes than in the control eyes.

Keywords: anterior capsule contraction; intraocular lens dislocation; pseudoexfoliation syndrome; continuous curvilinear capsulorhexis     

前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。     

Early clinical outcome with a new monofocal microincision intraocular lens

The purpose of this study was to evaluate the early visual and refractive outcomes of a new aspheric monofocal microincision intraocular lens (IOL). This retrospective case series included eyes of patients who underwent implantation of a microincision IOL following 1.8 mm manual coaxial microincision cataract surgery and who attended regular postoperative follow-up visits on the first week and first, third, and sixth months. The postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and predictability, intraoperative and postoperative complications, posterior capsule opacification (PCO), IOL centration, and surgically induced astigmatism (SIA) were evaluated. Sixty-three eyes of 38 patients ranging in age from 51 to 86 were included in the study. The mean preoperative BCVA was 0.52 ± 0.42 logMAR. At the postoperative sixth month, the mean postoperative UCVA and BCVA were 0.12 ± 0.11 and 0.01 ± 0.03 logMAR, respectively. The mean postoperative spherical equivalent refraction (SER) was ?0.30 ± 0.49 D. The SER was within ± 1.00 D of the attempted correction in 95.2 % of the eyes. The mean SIA measured with vector analysis was 0.45 ± 0.28 D. Mild PCO was observed in 9 eyes (14.7 %) with none requiring Nd:Yag laser capsulotomy. On centration analysis, the IOL was found to be 0.26 mm on average to the supero-nasal position. The aspheric microincision IOL was safely implanted and provided satisfactory visual and refractive outcomes in the early postoperative period.     

Comparison of visual performance between extended depth of focus contact lens and single-vision contact lens in eyes with monofocal intraocular lens

Japanese Journal of Ophthalmology - To assess the visual performance of extended depth of focus (EDF) contact lenses (CL) in eyes that had undergone monofocal intraocular lens (IOL) implantation,...     

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye

AIM:To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens(IOL)in patients with contralateral monofocal IOL.METHODS:Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled.After 1,6,and 12 mo,uncorrected and distant corrected distant visual acuity(UCDVA and DCDVA),uncorrected and distant corrected intermediate-visual acuity(UCIVA and DCIVA),uncorrected and distant corrected near visual acuity(UCNVA and DCNVA),and contrast sensitivity were obtained.Halo/glare symptoms,spectacle dependence,and patient satisfaction were also evaluated.RESULTS:The mean age was 67.86±7.25 y and the average interval between two IOL implantations was 645.82±878.44 d.At 1 mo,binocular UCDVA was lower than 0.20 logMAR in 76%of patients(mean 0.12±0.13 logMAR),which increased to 90%by 6 and 12 mo.The binocular UCDVA was significantly better than the monocular results(P<0.05)at 1,6,and 12 mo.Additionally,UCNVA was lower than 0.40 logMAR in 82%of patients,increasing to 90%by 6 and 12 mo.Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye(P<0.05)at 1,6,and 12 mo.About 5%of patients at 1 and 6 mo,reported"severe glare or halo".Patient satisfaction rates were 95%and 91%at 6 and 12 mo,respectively.CONCLUSION:Unilateral implantation of multifocal IOL in patients with a contralateral,monofocal IOL implantation results in high patient satisfaction rate,with low severe glare or halo rate during follow-up.It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.     

Comparison of an aspheric monofocal intraocular lens with the new generation monofocal lens using defocus curve

Purpose:The aim of this study was to compare the visual outcomes of two monofocal intraocular lenses (IOLs), with emphasis on the defocus curve.Methods:A total of 116 consecutive eyes with cataract, undergoing phacoemulsification with IOL implantation were included in the observational case series, and divided into two groups. 71 eyes were implanted with Tecnis Eyhance and 45 with Tecnis 1 monofocal IOL. Eyes with ocular comorbidities, previous ocular surgeries and corneal astigmatism >1 Diopters (D) were excluded from the study. Complete ophthalmic evaluation including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected visual acuity (UNVA), corrected near visual acuity (CNVA) was noted and defocus levels ranging from - 4.00 D to + 1.00 D were plotted postoperatively in both groups.Results:Uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) was significantly better in Tecnis Eyhance group compared to Tecnis 1 monofocal. Both the IOLs have similar performance for distance vision but visual acuity at intermediate and near is significantly better with Tecnis Eyhance compared to Tecnis 1 piece IOL.Conclusion:Tecnis Eyhance IOL with its better defocus curve, not only provides good distance, but intermediate vision as well. With significantly better visual acuity across the range of near and intermediate vision, Tecnis Eyhance IOL can prove to be a viable and reasonable option for patients who are more dependent on intermediate vision in daily activities.