虹膜固定型有晶状体眼人工晶状体植入对高度近视患者睫状肌调节性微波动及调节力的影响

目的通过测量睫状肌调节性微波动高频成分(high frequency component,HFC)来分析有晶状体眼人工晶状体(phakic intraocular lens,P-IOL)植入对高度近视患者睫状肌收缩能力及调节力的影响。方法收集2004年12月～2006年3月在我院进行虹膜固定型有晶状体眼人工晶状体Verisyse植入的患者54例(54眼)。采用NIDEK ARK-730A红外验光仪中调节性微波动分析软件,分别在术后1周、3个月对该54例患者(54眼)进行睫状肌调节性微波动高频成分检查。并与患者术后调节力进行相关性分析。结果HFC与Verisys植入术后1周及3个月的调节力均正相关(术后1周r=0.628,P<0.01;术后3个月r=0.835,P<0.01);Verisyse植入术后3个月的HFC及调节力均较术后1周的HFC及调节力有明显提高。结论高度近视患者有晶状体眼人工晶状体植入有利于术后睫状肌收缩能力及调节力的提高。     

角膜散光对人工晶体眼伪调节力的影响

目的研究角膜散光对超声乳化术后人工晶体眼的伪调节力的影响。方法对154例160眼超声乳化晶体吸出、折叠人工晶体植入术患者，于术后一年进行远近视力、屈光状态测定，并在戴镜矫正屈光不正的基础上测定伪调节力，并进行分析。结果角膜散光与伪调节力呈负相关（r=-0．432，P〈0．05）。逆规散光组的伪调节力高于顺规散光组（P〈0．05）。结论低度散光及逆规散光有利于提高伪调节力。     

人工晶体在前节OCT中的位移表现与伪调节力的研究

目的 分析人工晶状体植入后生理状态下,在眼内的前后位移度及其和伪凋节力的关系.方法 选择病人46例(46只眼)行白内障超声乳化联合单焦点一体式折叠人工晶状体植入术,检测和分析术后人工晶状体在眼前节OCT图像中的位移表现,记录不同度数镜片附加时的前房深度和瞳孔直径变化值,测量患者术眼的伪凋节力,并进行相关性分析.平均随访(5.2±1.6)个月.结果 78.26%(36/46)术眼屈光矫正后近视力≥Jr5;患者术眼术后平均伪凋节力为(1.08±0.71)D.眼前节OCT图像显示附加负值镜片时人工晶状体向前位移,前房变浅,附加正值镜片时人工晶状体向后位移,前房变深,前房深度变化值为(0.26±0.09)mm;不同度数镜片附加时瞳孔直径变化值为(0.58±0.28)mm.伪凋节力与前房深度变化呈正相关(r=0.8267,P＜0.01),与瞳孔直径变化亦呈正相关(r=0.6724,P＜0.01).结论 白内障术后人工晶状体在生理状态下位置可前后移动,视近时睫状肌收缩、人工晶状体向前移动,是IOL眼产生伪凋节力的重要机制之一;瞳孔收缩也可部分补偿调节力.     

应用三维眼前节分析仪对单片式折叠型人工晶状体在眼内位置分布规律的研究

背景非球面人工晶状体（IOL）的临床应用一定程度上降低了患者的术后全眼球差,但其临床效果取决于精确的轴对位,其眼内位置的研究尤其重要。目的研究IOL植入后IOL在眼内位置的分布规律。方法采用前瞻性对照研究设计。对年龄相关性白内障40例80眼行超声乳化白内障摘出联合单片式折叠型IOL植入术,以系统光轴与IOL最大横截面交点为坐标原点将术眼分为鼻上、颞上、颞下、鼻下4个象限,术后3个月使用三维眼前节分析仪（Pentacam）中的25P／!S模式测量术眼各象限IOL的偏心量和倾斜度。结果右眼IOL植入后IOL颞侧偏心者26眼（65％）,颞下偏心16眼（40％）,水平颞侧倾斜37眼（92．5％）,垂直下方倾斜34眼（85．O％）;左眼颞侧偏心33眼（82．5％）,颞下偏心20眼（50％）,水平颞侧倾斜37眼（92．5％）,垂直下方倾斜36眼（90％）。右眼各象限水平位／垂直位偏心量的总体比较差异均无统计学意义（F=0．221、0．792,P〉0．05）;左眼颞上象限和颞下象限水平偏心量均明显高于鼻上象限,差异均有统计学意义（P〈0．05）,但左眼各象限间的垂直偏心量差异无统计学意义（F=0．576,P〉0．05）。双眼IOL植入后水平方向及垂直方向的偏心量与倾斜度均呈正相关（右眼水平方向：r=0．374,P=0．002;右眼垂直方向：r=0．402,P=0．001;左眼水平方向：r=0．377,P=0．002;左眼垂直方向：r=0．347,P=0．002）。结论单片式软性IOL植入术后多偏向颞侧,以颞下象限为著,且IOL的光轴大多偏向颞下方,IOL在双眼对应方向的偏斜具有镜像性。水平方向及垂直方向上偏心量与倾斜度表现一致。     

白内障患者手术前后辨色力的变化

目的研究白内障患者行超声乳化术＋人工晶状体（IOL）植入术手术前后辨色力的变化。方法选取46～84岁的年龄相关性白内障患者22例（30眼）,术前矫正视力为0．5～0．8,行白内障超声乳化手术＋可折叠IOL植入术。采用Farnsworth-Munsell 100（FM100）色棋盒测试患者术前及术后1个月的色觉变化,并利用其自带软件计算色觉错误评分。结果术后单组色棋盒的错误评分及总评分均较术前降低（P〈0．01）,术后绿色-蓝色色棋盒的错误评分高于其他3个组（P〈0．01）。结论利用FM100色棋盒可以定量测定白内障患者的色觉质量。     

可调节型与普通人工晶状体植入术效果对比

目的比较并分析非球面可调节IOL与普通非球面IOL植入术后早中期的临床效果差异。方法双眼老年性白内障行超声乳化IOL植入术45例（60只眼）,随机分为两组,A组植入非球面可调节IOL,20例（30只眼）;B组植入普通非球面IOL,25例（30只眼）,观察两组术后1个月和6个月的裸眼远视力、最佳矫正远视力、裸眼近视力、最佳矫正近视力、伪调节力及6个月时的对比敏感度。结果随访期间,两组患者的裸眼远视力、最佳矫正远视力及最佳矫正近视力差异均无统计学意义（P〉0．05）;裸眼近视力两组比较各时期差异均有统计学意义（P〈0．05）。术后伪调节力1个月时A组为（1．33±0．26）D,B组为（0．75±0．25）D;6个月时A组为（1．53±0．21）D,B组为（0．5±0．25）D;各期两组比较差异均有统计学意义。6个月时视远对比敏感度两组比较差异无统计学意义（P〉0．05）,但视近时在6c．d-1和12c．d-1空间频率对比敏感度两组比较差异具有统计学意义（P〈0．05）。结论非球面可调节IOL可以使白内障患者术后早期获得良好的裸眼远、近视力,提高患者视远、视近时的对比敏感度,获得良好的视觉质量。     

白内障超声乳化联合人工晶状体植入术后眼高阶像差与对比敏感度的相关性研究

目的观察白内障超声乳化联合人工晶状体（IOL）植入术后眼高阶像差与对比敏感度（CS）、眩光对比敏感度（GS）之间的关系,探讨改善白内障术后视觉质量的方法。方法采用Zywave波前像差仪检测白内障超声乳化联合IOL植入术后129例129眼的总高阶像差、球差、彗差等各高阶像差均方根值（RMS）,采用CSV-1000E对比敏感度测试仪检测其CS和GS,对白内障超声乳化联合IOL植入术后高阶像差与CS或GS间的相关性进行Spearman秩相关分析。结果白内障超声乳化联合IOL植入术后,眼高阶像差与无眩光CS之间相关性较小,总高阶像差与12 c/d CS之间（r=0.23,P〈0.05）、Z400与3 c/d CS之间（r=0.17,P〈0.05）均呈正相关;Z440与9 c/d CS之间（r=-0.21,P〈0.05）、Z550与12 c/d CS之间（r=-0.18,P〈0.05）均呈负相关。眼高阶像差与GS之间多呈负相关,包括Z331与6 c/d之间（r=-0.18,P〈0.05）,Z420与9 c/d之间（r=-0.25,P〈0.05）,Z420与12 c/d之间（r=-0.21,P〈0.05）,Z440与9 c/d之间（r=-0.21,P〈0.05）,Z440与12 c/d之间（r=-0.23,P〈0.05）,Z510与9 c/d之间（r=-0.18,P〈0.05）,Z530与12 c/d之间（r=-0.23,P〈0.05）均呈负相关,但Z441与9 c/d之间呈正相关（r=0.19,P〈0.05）,与GS相关的高阶像差主要集中在4阶,与高阶像差相关的GS主要集中在中高空间频率段。结论白内障超声乳化联合IOL植入术后眼高阶像差的变化不影响无眩光CS,但能影响GS。     

中青年复性近视散光角膜形态改变及其相关因素

目的探讨引起中青年复性近视散光角膜形态改变的相关因素。方法分别测量333例666眼18～46岁复性近视散光（-1．00DC以上）患者的角膜地形图、非接触眼压、角膜中央厚度（central corneal thickness，CCT），并进行散瞳检影验光、记录散光度数及轴位，将结果进行统计分析。结果角膜地形图的散光度与验光散光度呈正相关（r=0．68，P〈0．01），其回归方程Y=0．145±0．678X（F=569．7，P〈0．01）；角膜地形图的散光轴与验光散光轴呈正相关（r=0．229，P〈0．01）；CCT与眼压呈正相关（r=0．422．P〈0．01），其直线回归方程为Y=-3．479±0．037X（F=143．54．P〈0．01），角膜CCT大约每增加37μm，眼压上升1mmHg（1kPa=7．5mmHg）；CCT与屈光度无明显直线相关关系（r=0.003，P〉0.1）。结论中青年复性近视散光68％由角膜散光决定，对患者作出诊断及处理之前，应进行全面的眼科检查。     

单焦点、多焦点与可调节人工晶状体植入术后患者的拟调节力观察

目的 研究超声乳化白内障摘除植入不同人工晶状体（IOL）术后患者的拟调节力。方法 前瞻性队列研究。行白内障超声乳化吸除联合IOL植入术且随访资料完整的患者73例（82眼）,依据植入IOL的不同分为3组：单焦点IOL组28例（32眼）,多焦点IOL组24例 （27眼）,可调节IOL组21例（23眼）。术后3 d、1周、1个月、3个月分别测量3组患者的裸眼远、中、近视力,最佳矫正远、近视力,及拟调节力。数据采用单因素方差分析。结果 3组的最佳矫正远、近视力及裸眼远视力差异无统计学意义,而裸眼中视力可调节IOL优于单焦点与多焦点IOL（F=4.50,P＜0.05）,裸眼近视力多焦点、可调节IOL好于单焦点IOL（F=26.06,P＜0.05）。多焦IOL可以提供（2.67±0.49）D的主观拟调节力,（0.93±0.42）D的客观拟调节力;可调节IOL可以提供（3.00±0.78）D主观拟调节力,（0.91±0.58）D客观拟调节力;优于单焦点IOL的（1.78±0.26）D的主观拟调节力（F=18.51,P＜0.05）,和（0.37±0.22）D的客观拟调节力（F=7.39,P＜0.05）。结论 多焦点IOL与可调节性IOL均可提供较好的全程视力及拟调节力。     

IOL-Master测量硅油填充眼屈光结果分析

目的评价IOL—Master测量硅油填充眼屈光度数的准确性并分析不同因素与术后屈光误差的关系。方法29例（29眼）硅油填充眼行硅油取出联合人工晶状体（IOL）植入术,术前用IOL—Master进行IOL测量。根据不同病因、硅油放置时间、眼轴、术后并发症等因素进行分类,研究术后视力恢复情况及测量误差产生的原因。结果术后视力较术前均有不同程度的提高,屈光度数的平均预测误差为0．329±0．846（-1．5～-2．0D）,眼轴长度（P〉0．05）、病因[裂孔源性（t=0．478,P=0．637）、黄斑裂孔（t=0．135,P=0．895）]、是否近视（t=0．435,P=0．667）与术后产生的屈光误差均无相关性,硅油存留时间〈1年者术后矫正视力恢复好。结论硅油填充眼患者采用硅油取出联合IOL植入术对视力有一定提高,IOL—Master测量硅油填充眼IOL度数是相对准确、安全、方便的方式。     

景深对超声乳化术后假晶状体眼伪调节的影响

目的探讨白内障超声乳化术后假晶状体眼的景深对伪调节的影响。方法白内障患者30例（60眼），年龄（62.77±5.27）岁（50-70岁），其中44眼为假晶状体眼。测量屈光状态、调节幅度、瞳孔直径。睫状肌麻痹后，分别在不矫正散光和配戴人工瞳孔镜片（直径2.5mm）情况下测量单眼调节幅度。采用SPSS11.0统计软件行统计学分析。结果假晶状体眼的移近法单眼调节幅度为（2.35±1.14）D。散光和人工瞳孔对调节幅度的影响分别为0.21D和0.16D。调节前、后瞳孔直径分别为（4.52±0.66）mm和（2.72±0.64）mm。单眼调节幅度与调节前后瞳孔直径变化无相关性（r=0.164，P=0.305）。睫状肌麻痹时不矫正散光和配戴人工瞳孔镜片的单眼调节幅度分别为（0.61±0.18）D和（0.77±0.14）D。结论对于白内障超声乳化术后的假晶状体眼，瞳孔和单纯近视散光所致景深是伪调节的产生机制之一，但不是主要机制。增大景深不是改善伪调节的主要方法，今后还需要从人工晶状体本身的设计或在眼内的位置变化等方面来研究伪调节的机制和相应的改善方案。     

Accommodative ciliary body and lens function in rhesus monkeys, I: normal lens, zonule and ciliary process configuration in the iridectomized eye

PURPOSE: The underlying causes of presbyopia, and the functional relationship between the ciliary muscle and lens during aging are unclear. In the current study, these relationships were studied in rhesus monkeys, whose accommodative apparatus and age-related loss of accommodation are similar to those in humans. METHODS: Centripetal ciliary body and lens equator movements were measured during accommodation in 28 eyes of 21 rhesus monkeys (ages, 5.7-26 years) by goniovideography. Ultrasound biomicroscopy was performed in 21 eyes of 17 monkeys. Narrowing of the angle between the anterior aspect of the ciliary body and the inner aspect of the cornea was used as a surrogate indicator of forward ciliary body movement during accommodation. RESULTS: Average centripetal ciliary body movement in older eyes (age > or =17 years, n = 16) was approximately 20% (0.09 mm) less than in young eyes (age, 6-10 years, n = 6), but not enough to explain the 60% (0.21 mm) loss in centripetal lens movement nor the 76% (10.2 D) loss in accommodative amplitude. Average forward ciliary body movement was 67% (49 degrees ) less in older (n = 11) versus young (n = 6) eyes. Maximum accommodative amplitude correlated significantly with the amplitude of centripetal lens movement (0.02 +/- 0.003 mm/D; n = 28; P < 0.001) and with forward ciliary body movement (3.34 +/- 0.54 deg/D; n = 21; P = 0.01). CONCLUSIONS: Decreased lens movement with age could be in part secondary to extralenticular age-related changes, such as loss of ciliary body forward movement. Ciliary body centripetal movement may not be the limiting component in accommodation in the older eye.     

短时间平板电脑游戏对青少年近视患者调节反应和调节微波动的影响

背景 近距离使用电子平板设备是造成近视发生和进展的危险因素之一,研究此类设备对人眼调节系统的影响可能为近视防控提供新的思路. 目的 观察短时间进行平板电脑游戏前后青少年近视患者的调节反应值、调节微波动以及瞳孔直径的变化. 方法 采用前瞻性系列病例观察研究方法,纳入2014年8月至2015年4月于北京大学人民医院就诊的60例青少年近视患者,患者平均年龄(11.6±2.6)岁,平均等效球镜屈光度(SER)为(-2.38±1.08)D.采用随机数字表法将60例受试者随机分成不同游戏时间组,分别进行3、5和10 min iPAD电脑平板游戏,采用开放视野红外验光仪记录受试者游戏前后的瞳孔直径和调节数据,将采集的调节数据减去理论调节反应值计算为实际调节反应值,以实际调节反应值的均方根(RMS)作为调节微波动幅度,采用一维离散傅里叶变换法分析调节反应曲线的频谱特征.采用配对t检验对各组游戏前后的调节反应值、调节微波动幅度以及瞳孔直径进行比较.采用Wilcoxon符号秩检验对各组游戏前后调节反应曲线的高频信号占总信号功率百分比进行分析.结果 10 min组受试者游戏后的调节反应值为(0.74±0.27)D,明显低于游戏前的(0.81±0.29)D,差异有统计学意义(t=2.263,P=0.036),而3 min组和5 min组受试者游戏前后的调节反应值差异均无统计学意义(均P＞0.05).10 min组受试者游戏后调节微波动幅度(RMS)为(0.31±0.08)D,较游戏前的(0.27±0.09)D明显增加,差异有统计学意义(t=-2.259,P=0.036),而3 min组和5 min组受试者游戏前后的调节微波动幅度差异无统计学意义(均P＞0.05).3个组受试者游戏后调节微波动高频信号均高于游戏前,其中5 min组和10 min组受试者游戏前后高频信号比较差异均有统计学意义(Z=-2.213、-2.016,均P＜0.05).3个组受试者游戏后瞳孔直径较游戏前均缩小,其中5 min组和10 min组受试者游戏前后瞳孔直径的差异均有统计学意义(t=2.428,P=0.026;t=2.515,P=0.021). 结论 青少年近视患者进行短时间平板电脑游戏并不加重调节滞后,但是调节微波动幅度增加及调节反应曲线高频信号成分的增加均可能导致图像模糊,对控制近视进展不利.     

Magnetic resonance imaging of aging, accommodating, phakic, and pseudophakic ciliary muscle diameters

PURPOSE: To quantify in vivo accommodative changes in the aging human ciliary muscle diameter in phakic and pseudophakic eyes. SETTING: Department of Surgery/Bioengineering, UMDNJ-Robert Wood Johnson Medical School, Piscataway, and the Institute of Ophthalmology and Visual Science UMDNJ-New Jersey Medical School, Newark, New Jersey, USA. METHODS: Images were acquired from 48 eyes of 40 people between the ages of 22 and 91 years, 1 eye of 32 phakic volunteers and both eyes of 8 patients who had monocular implantation of a single-piece AcrySof intraocular lens (IOL) (Alcon Laboratories). Images were acquired during physiological accommodation and with accommodation at rest, and the diameter of the ciliary muscle ring was measured. RESULTS: Results show the ciliary muscle remains active throughout life. The accommodative change in its diameter (mean 0.64 mm) (P<.00001) was undiminished by age or IOL implantation. Preliminary data showed that the accommodative decrease in muscle diameter in phakic and pseudophakic eyes was statistically identical. The phakic eyes had a marked decrease in ciliary muscle diameter with advancing age for both accommodative states (P<.000001 and P<.000001), which did not appear to be altered by IOL implantation. The lens equator was constant with age in the unaccommodated human eye, resulting in decreased circumlental space with advancing age in the phakic eyes. CONCLUSION: Although the undiminished ability of the ciliary muscle to decrease its diameter with accommodation can be relied on in strategies for presbyopia correction, even in advanced presbyopia, the decreasing circumlental space and its potential effects on zonular tension must also be considered.     

Two years experience with the new accommodative 1 CU intraocular lens

After marked improvement of optical rehabilitation of cataract patients during the last decades due to small incision surgery and foldable intraocular lenses (IOL), presbyopia is now one of the great unsolved questions in ophthalmology. During recent years a new accommodative IOL, the 1CU lens, has been developed based on the concepts of K.D. Hanna and on finite element computer simulation models. The 1CU IOL is designed to transform contracting forces of the ciliary muscle into anterior movement of the IOL optic (optic-shift concept). After the first implantation of a 1CU IOL in Erlangen in June 2000, we have now successfully implanted the 1CU IOL in over 90 patients. Our experiences and the results of several clinical studies indicate good and safe implantability, good centration, no IOL-specific complications, and good distance visual acuity. In comparison to control groups with conventional IOL, patients with the 1CU enjoyed significantly better distance-corrected near visual acuity, a larger accommodative range, and increased anterior and posterior axial movement of the lens optic after medical stimulation or inhibition of the ciliary muscle. We interpret our results as confirmation of the optic-shift concept of the 1CU IOL. Overall, the concept of accommodative IOL appears attractive and may have a great potential in the future. Additional studies including randomized blind multicenter evaluation of the 1CU IOL are necessary to further evaluate long-term and accommodative results.     

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.     

全景超声活体显微镜对超声乳化白内障吸除术后前房结构改变的临床观察

目的 利用全景超声活体显微镜观察超声乳化白内障吸除术后前房结构的改变.方法 对年龄相关性白内障患者行超声乳化白内障吸除术前后的前房结构进行活体测量.81例(102只眼)年龄相关性白内障患者行超声乳化白内障吸除联合折叠型人工晶状体植入术,分别于术前、术后2个月利用全景超声活体显微镜测量前房水平、垂直直径及前房深度;并对其中32例患者(36只眼)测量颞侧前房角宽度.采用配对t检验及两个独立样本的t检验对相应数据进行统计学分析.结果 大部分患者术前术后前房垂直直径大于水平直径;全部患者术后2个月水平前房直径与术前相比明显增大(t=7.10,P<0.01),并与术前呈显著正相关(r=0.801,P<0.01).前房深度与术前相比明显加深(t=39.97,P<0.01),术后2个月前房深度与术前的比值与术前深度呈显著负相关(r=-0.864,P<0.01).32例患者(36只眼)术后2个月颞侧房角500μm处前房角开放距离(AOD500)和小梁虹膜夹角(TIA 500)较术前均显著增大,且比值(术后AOD 500/术前AOD500、术后TIA500/术前TIA 500)均分别与术前旱显著负相关(r=-0.763,-0.791;P<0.01).结论 大部分患者前房垂直直径大于水平直径;年龄相关性白内障患者行超声乳化白内障吸除联合人工晶状体植入术后前房直径增加,虹膜膈后移,前房深度、房角宽度增加.     

Drug-induced intraocular lens movement and near visual acuity after AcrySof intraocular lens implantation

PURPOSE: To evaluate the factors influencing AcrySof intraocular lens (IOL) (Alcon Laboratories) movement and near visual acuity after cyclopentolate 1% and pilocarpine 2%. SETTING: Department of Ophthalmology, University of Ankara, Ankara, Turkey. METHODS: Thirty eyes of 22 patients with AcrySof IOL implantation were included in this prospective study. Near visual acuity (Jaeger) at 35 cm through best distance correction without an add and pupil diameter were measured and correlated with anterior chamber depth (ACD) measured with ultrasound biomicroscopy (UBM) after application of cyclopentolate 1% and pilocarpine 2%, respectively. The magnitude of the change in the ACD was correlated with the accommodation amplitude, patient age, time interval between surgery and imaging, preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and presence of posterior capsule opacification (PCO). RESULTS: Near visual acuity significantly decreased after application of cyclopentolate 1% and increased after application of pilocarpine 2% (P < .001) in all eyes. The IOL moved anteriorly in 8 (26%) eyes and posteriorly in 22 (74%) eyes after pilocarpine 2%. There was no correlation between the ACD and near visual acuity under cyclopentolate 1% (r = 0.06, P > .05) or pilocarpine 2% (r = 0.04, P > .05). There was a moderate correlation between the anterior IOL movement and accommodation amplitude (P < .05, r = 0.42). There was no correlation between the magnitude of the IOL movement and patient age, time interval between surgery and imaging, the preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and the presence of PCO (P > .05). CONCLUSIONS: There was better near visual acuity in all eyes with the AcrySof MAIOL, although most IOLs move slightly backward after of pilocarpine 2%. This points out pseudoaccommodation rather than pseudophakic accommodation. Ultrasound biomicroscopy is useful in determining the ACD and the relation between the IOL and the surrounding tissues after cataract surgery.     

Refractive lensectomy and accommodating lens implantation in a case of hyperopia

We present a 39-year-old woman with high hyperopia who developed an intolerance to contact lenses due to dry-eye syndrome and Grave's disease. Refractive lensectomy with implantation of a custom-made +31.00 diopter (D) accommodating intraocular lens (IOL) (1CU, HumanOptics) was performed in both eyes. This foldable IOL has modified haptics with transmission elements that allow axial movement of the IOL optic and capsular bag secondary to contraction of the ciliary muscle. The calculated pseudophakic accommodation induced by the anterior shift of a +31.00 D IOL is 2.20 D per millimeter of axial displacement. After 6 months, the accommodative range determined by defocusing was 3.00 D. The subjective near point with best distance correction was 32.00 cm. Refractive lensectomy and implantation of an accommodating IOL based on focus shift may be a refractive solution in eyes with high hyperopia and a short axial length.