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Hon Shing Ong, Bruce D S Allan, ; Accommodative versus monofocal intraocular lens implantation in cataract surgery: a systematic review of randomized controlled trials. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1290.
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Following cataract surgery and intraocular lens(IOL) implantation, loss of accommodation occurs. This remains a challenge. This review aimed to define the extent to which accommodative IOLs improve near visual function, in comparison with monofocal IOLs.
We searched the Cochrane Central Register of Controlled Trials, containing the Cochrane Eyes and Vision Group Trials Register, The Cochrane Library, MEDLINE, EMBASE, Latin American and Caribbean Health Sciences Literature Database, the metaRegister of Controlled Trials and ClinicalTrials.gov. Only randomised controlled trials(RCT) were included. Risks of bias of included trials were assessed. Primary outcome measure was the amplitude of accommodation at 6 months. Amplitude of accommodation after 12 months was used to assess the stability of intervention effect.
Search revealed 55 reports. 4 RCT were included, with a total of 256 eyes(148 in the accommodative and 108 in the monofocal group). Compared to the monofocal group, the accommodative IOL group had significantly higher amplitude of accommodation at 6 months post treatment measured by near point of accommodation(mean difference(MD) 1.43 Dioptres; 95% CI 0.79 to 2.07) and defocus curves(MD 0.47 Dioptres; 95% CI 0.36 to 0.59). These were not maintained after 12 months. Patients who received accommodative IOLs achieved better distance corrected near visual acuity at 6 months(standardised mean difference(SMD) -2.86; 95% CI -3.37 to -2.34). This was maintained after 12 months(SMD -1.67; 95% CI -2.08 to -1.26). A small but statistically higher change in anterior chamber depth on accommodation was detected in patients who received accommodative IOLs at 6 months(MD 0.42 mm;95% CI 0.28 to 0.56) and 12 months(MD 0.21 mm; 95% CI 0.14 to 0.28). There was no significant difference between the 2 groups in corrected distance visual acuity(CDVA) at 6 months post treatment. At 12 months, patients who received accommodative IOLs achieved worse CDVA. There was a reported higher rate of posterior capsular opacification in the accommodative group.
Risk of bias, heterogeneity of outcome measures, and dominance of one accommodative IOL in current trials suggest that the results should be interpreted with caution. There is no evidence to recommend the use of accommodative IOLs. Further trials are required for a definitive evaluation of these IOLs.
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