Purpose To measure the axial movement of an accommodating intraocular lens (IO L) induced by ciliary muscle contraction after application of pilocarpine. Desig n Randomized, controlled, patient and examiner masked tri...Purpose To measure the axial movement of an accommodating intraocular lens (IO L) induced by ciliary muscle contraction after application of pilocarpine. Desig n Randomized, controlled, patient and examiner masked trial with intrapatient co mparison. Participants and controls One hundred ten eyes of 55 patients with age -related bilateral cataract. Methods This study was divided into 3 parts. In th e first, the accommodating IOL (1CU) was compared with a 3-piece open-loop acr ylic IOL that served as the control. In the second, to assess the effect of caps ule fibrosis on the potential accommodating performance of the accommodating IOL , extensive polishing of the anterior capsule with a slit cannula was compared w ith standard surgery. In the third, the effect of a posterior capsulorhexis was compared with that of standard surgery. Anterior chamber depth (ACD) was assesse d with partial coherence interferometry, measured before and after topical appli cation of pilocarpine 2%, and near visual acuity (VA) was evaluated 3 months af ter surgery. Main outcome measure Pilocarpine-induced change in ACD. Results Th e accommodating IOL showed a forward movement under pilocarpine with a median am plitude of movement of -314 μm (95%confidence interval CI: -148 to -592), compared with the backward movement of 63 μm (95%CI: 161 to -41) for the ope n-loop control IOL (P=0.001). Capsule polishing and a posterior capsulorhexis h ad no effect on IOL movement with the accommodating IOL. The median near VA with distance correction was 20/60. Conclusion Pilocarpine induced a small but signi ficant forward movement of the accommodating IOL. However, the amount of movemen t was calculated to result in a refractive change of < 0.5 diopters (D) in most patients, reaching 1 D or slightly more in only single cases, with a large varia bility of movement. Neither polishing of the capsule bag nor a posterior capsulo rhexis could enhance the accommodative ability.展开更多
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 To measure the axial movement of an accommodating intraocular lens (IO L) induced by ciliary muscle contraction after application of pilocarpine. Desig n Randomized, controlled, patient and examiner masked trial with intrapatient co mparison. Participants and controls One hundred ten eyes of 55 patients with age -related bilateral cataract. Methods This study was divided into 3 parts. In th e first, the accommodating IOL (1CU) was compared with a 3-piece open-loop acr ylic IOL that served as the control. In the second, to assess the effect of caps ule fibrosis on the potential accommodating performance of the accommodating IOL , extensive polishing of the anterior capsule with a slit cannula was compared w ith standard surgery. In the third, the effect of a posterior capsulorhexis was compared with that of standard surgery. Anterior chamber depth (ACD) was assesse d with partial coherence interferometry, measured before and after topical appli cation of pilocarpine 2%, and near visual acuity (VA) was evaluated 3 months af ter surgery. Main outcome measure Pilocarpine-induced change in ACD. Results Th e accommodating IOL showed a forward movement under pilocarpine with a median am plitude of movement of -314 μm (95%confidence interval CI: -148 to -592), compared with the backward movement of 63 μm (95%CI: 161 to -41) for the ope n-loop control IOL (P=0.001). Capsule polishing and a posterior capsulorhexis h ad no effect on IOL movement with the accommodating IOL. The median near VA with distance correction was 20/60. Conclusion Pilocarpine induced a small but signi ficant forward movement of the accommodating IOL. However, the amount of movemen t was calculated to result in a refractive change of < 0.5 diopters (D) in most patients, reaching 1 D or slightly more in only single cases, with a large varia bility of movement. Neither polishing of the capsule bag nor a posterior capsulo rhexis could enhance the accommodative ability.
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.
