Purpose: Most trials that study the lens movement of accommodative intraocular lens (IOLs) use pilocarpine to stimulate ciliary muscle contraction. The aim of this study is to assess in vivo whether a more physiologic...Purpose: Most trials that study the lens movement of accommodative intraocular lens (IOLs) use pilocarpine to stimulate ciliary muscle contraction. The aim of this study is to assess in vivo whether a more physiologic, stimulus- driven accommodation is comparable to pilocarpine- induced IOL movement. Design: Controlled patient- and examiner- masked clinical trial. Participants: The study population included 38 eyes with accommodative IOL implants (1CU) and a control group of 28 eyes with conventional open- loop IOLs. Methods: A highprecision biometry technique, partial coherence interferometry, was used tomeasure IOL position. Anterior chamber depthwas measured during physiologic (near point) and pharmacological (pilocarpine 2% ) stimulation. In a subgroup of 14 1CU eyes, IOL position was determined repeatedly within 90 minutes after pilocarpine administration. A different subgroup was investigated as to the effect of cyclopentolate on IOL position. Best- corrected distance visual acuity (VA), best- corrected near VA, and distance- corrected near VA (DCNVA) were assessed using logarithm of the minimum angle of resolution charts. Main Outcome Measures: Anterior chamber depth change under pilocarpine and near- point- driven accommodation. Results: Near- point accommodation did not induce movement of either the accommodating 1CU or the control IOLs. Pilocarpine induced a 201± 0.137 mm anterior movement of the 1CU IOL (P< 0.001), compared with no movement within the control IOL groups (P >0.05). There was no significant (P >0.05) difference in DCNVA between the accommodative and open- loop IOLs. No correlation between near point- or pilocarpine- stimulated IOL movement and DCNVA was found. Concerning the time course of movement after pilocarpine administration, most of the 1CU IOLs showed somemovement 30 minutes after application. Cyclopentolate- induced ciliary muscle relaxation caused a posterior IOL movement, as compared with the relaxed state, when focusing on a distant target. Conclusion: Pilocarpine- induced ciliary muscle contraction seems to overestimate IOL movement relative to a monocular near- driven stimulus. Therefore, concerning IOL movement, pilocarpine may act as a superstimulus and may not adequately simulate daily life performance of accommodative IOLs. However, it may be helpful to evaluate the maximum potential of an accommodating IOL.展开更多
文摘Purpose: Most trials that study the lens movement of accommodative intraocular lens (IOLs) use pilocarpine to stimulate ciliary muscle contraction. The aim of this study is to assess in vivo whether a more physiologic, stimulus- driven accommodation is comparable to pilocarpine- induced IOL movement. Design: Controlled patient- and examiner- masked clinical trial. Participants: The study population included 38 eyes with accommodative IOL implants (1CU) and a control group of 28 eyes with conventional open- loop IOLs. Methods: A highprecision biometry technique, partial coherence interferometry, was used tomeasure IOL position. Anterior chamber depthwas measured during physiologic (near point) and pharmacological (pilocarpine 2% ) stimulation. In a subgroup of 14 1CU eyes, IOL position was determined repeatedly within 90 minutes after pilocarpine administration. A different subgroup was investigated as to the effect of cyclopentolate on IOL position. Best- corrected distance visual acuity (VA), best- corrected near VA, and distance- corrected near VA (DCNVA) were assessed using logarithm of the minimum angle of resolution charts. Main Outcome Measures: Anterior chamber depth change under pilocarpine and near- point- driven accommodation. Results: Near- point accommodation did not induce movement of either the accommodating 1CU or the control IOLs. Pilocarpine induced a 201± 0.137 mm anterior movement of the 1CU IOL (P< 0.001), compared with no movement within the control IOL groups (P >0.05). There was no significant (P >0.05) difference in DCNVA between the accommodative and open- loop IOLs. No correlation between near point- or pilocarpine- stimulated IOL movement and DCNVA was found. Concerning the time course of movement after pilocarpine administration, most of the 1CU IOLs showed somemovement 30 minutes after application. Cyclopentolate- induced ciliary muscle relaxation caused a posterior IOL movement, as compared with the relaxed state, when focusing on a distant target. Conclusion: Pilocarpine- induced ciliary muscle contraction seems to overestimate IOL movement relative to a monocular near- driven stimulus. Therefore, concerning IOL movement, pilocarpine may act as a superstimulus and may not adequately simulate daily life performance of accommodative IOLs. However, it may be helpful to evaluate the maximum potential of an accommodating IOL.
