Time–wise Alterations of Apparent Accomodation After Phacoemulsification with Implantation of the Akkomodative – 1CU IOL

Abstract

Abstract: : Purpose:To evaluate the visual function and accommodation in cataract patients having phaco surgery with implantation of the akkomodative 1 CU IOL. Methods:Twenty–one eyes of 15 patients (9 females, 6 males;mean age:64 years) underwent small–incision clear corneal cataract surgery and had in the bag implantation of the Akkomodative 1–CU intraocular lens (Human Optics IOL, Germany) . Fourteen eyes of 7 age and sex matched cataract patients had intracapsular foldable acrylic intraocular lens implantation(AcrySof^R MA60BM, Alcon, Texas, U.S.A).Subjects had refraction tests, anterior segment photography, uncorrected distance visual acuity (UCDVA), best corrected distance visual acuities (BCDVA) and chart contrast visual acuity (CVA) measurements before as well as 1 week, 1 month, 3 and 6 months after surgery. Uncorrected near visual acuity (UCNVA), and near visual acuity under best corrected distance visual acuities(BCNVA) were also measured before and 6 months after surgery. Apparent accommodation was measured by the AA 2000 Nidek accomodometer instrument. Results:The final best corrected distance visual acuity (BCDVA) was above 20/25 in all eyes with Akkomodative 1–CU IOL and the AcrySof IOLs. None of the eyes with the AcrySof IOL had apparent accommodation at any of the examination points whereas 66% of the eyes had apparent accommodation between 0.5D and 1.0D six months after surgery which declined to 15% at one year. While none of the eyes with AcrySof IOL had posterior capsular opacity at one year, 57% of the eyes with the Akkomodative 1–CU IOL had posterior capsular opacity and anterior capsular fibrosis at the same follow up visit. All eyes with apparent accommodation as assessed by the accomodometer had significantly better near vision under distance correction than the uncorrected near visual acuity at 6 months. There were no significant differences in relation to mean contrast acuities measured with charts 2 and 3 between the two IOLs at all examination points Conclusions:The Akkomodative 1 CU IOL implantation provided satisfactory best corrected near and distance visual acuities comparable to the AcrySof IOLs. Patients with the 1CU implant displayed accommodation response at all time points but the accommodative range seemed to decline with time which was thought to be due to loss of capsular elasticity with posterior capsular opacification and anterior capsular fibrosis.

Keywords: treatment outcomes of cataract surgery • refraction • small incision cataract surgery