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Aspheric Diffractive Versus Refractive Multifocal IOLs: Comparison of Visual Prognosis and Patient Satisfaction PowerPoint PPT Presentation


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Aspheric Diffractive Versus Refractive Multifocal IOLs: Comparison of Visual Prognosis and Patient Satisfaction. Eltutar , Kadir; Akcetin , Tulay A .; Ozcelik , N. Demet. Istanbul Education and Research Hospital Department of Ophthalmology.

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Aspheric Diffractive Versus Refractive Multifocal IOLs: Comparison of Visual Prognosis and Patient Satisfaction

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Aspheric Diffractive Versus Refractive Multifocal IOLs: Comparison of Visual Prognosis and Patient Satisfaction

Eltutar, Kadir; Akcetin, Tulay A.; Ozcelik, N. Demet

IstanbulEducationandResearchHospitalDepartment of Ophthalmology

Theauthorsstatethattheyhave no proprietaryinterestandtheyhave not receivedanygrantsorfunds in support of thestudy.


Purpose:

  • Toevaluate the optical and visual performance after bilateral implantation of refractive and aspheric diffractive multifocal intraocular lenses.


Methods:

  • Theprimaryobjective of thestudywastodeterminetheuncorrected distance, intermediate and near visual acuitiesafter uncomplicatedcataractsurgery, andbilateral MIOL implantation.

  • 10 patients who had bilateral implantation of the aspheric diffractive MIOL (n=20; + 4.00 D add), and 10 patients who had bilateral implantation of the refractive MIOL (n=20, + 3.50 add) wereenrolled.

  • Spectacleindependency, patientsatisfactionandphoticphenomenawereevaluated.

  • Thestudywascarriedoutprospectivelywith a follow-upperiodlastingforsixmonthspostoperatively.


Methods:

  • Patients had tofollowtheexaminationdates on postoperativedays 1, 30 and 180.

  • Immersion A-scanbiometrywasusedforaxiallengthmeasurementswithtargetedemmetropiausing SRK-T formula.

  • Distancevisualacuitieswereachievedby ETDRS chart at 4,0 meters, intermediate (60.0 cm) andnear (40.0 cm) visualacuitieswereevaluatedwithJaegercards.


Results:

  • Meanfollowup time was 25,30 ± 2,32 (24-30) weeks.

  • Meanage of thepatientswas 63,08 ± 4,20 (48-75 years).

  • Thesepatients had Grade 1-4 bilateralcataract (LOCS III) on baselineexamination.

  • No intraoperativecomplicationsoccurred in any of thecases.

  • PreoperativeandpostoperativeLogMAR UCVA findingsshowedstatisticallysignificantdifference in theasphericdiffractiveandtherefractivegroups (p < 0,05)

  • Consideringuncorrecteddistancevisualacuities , thedifferencebetweentherefractiveandtheasphericdiffractivegroupswas not statisticallysignificant (p>0.05) on postoperativefirstday, firstmonth, andsixthmonthexaminations.


UCVA fordistancevision in bothgroups at certainvisits


Uncorrectednearvisualacuities on postoperativefirstday, firstmonthandsixthmonth


Uncorrectedintermediatevisualacuities at postoperativefirstday, firstmonthandsixthmonth


SpectacleIndependency

  • Sixmonthspostoperatively, in asphericdiffractivegroupspectacleindependencyrateswere, 93,6 % fordistance, % 94,2 % fornear, and 88,4 % forintermediatevision.

  • Inrefractivegroupspectacleindependencyrateswere, 94,2 % fordistance, % 90,8 % fornear, and 92,8 % forintermediatevision.

  • Thedifferencewas not statisticallysignificant (p> 0,05).


Complications related to phacoemulsification and MIOL implantation

CME: Cystoid Macular Edema

PCO: Posterior Capsular Opacification


Conclusions:

  • Ourresultsshowthat; bilateralimplantation of MIOLswiththesameopticdesignsprovidesefficientdistancevision. There is no superioritybetweenthetwogroupsconsideringuncorrecteddistancevisualacuities.

  • The mean uncorrected near visual acuity was better in the aspheric diffractive group.

  • Themeanuncorrectedintermediatevisualacuitywasbetter in therefractivegroup.

  • Photicphenomenawastolerable in bothgroups. Though not statisticallysignificant, photicphenomenarelateddisturbanceswererelativelylessdetected in theasphericdiffractivegroup at allvisits.


Conclusions:

  • ForrefractiveMIOLs, ifpoorlytoleratedbythepatient, photicphenomenamayevenleadtotheextraction of MIOLs. Especially in dimlightconditionssomepatientsmayneedpresbyopiccorrectionbyspectacles, andpatientsmust be warnedabout not drivingforlonghours at night.

  • ForasphericdiffractiveMIOLswith + 4.00 D add, nearvisionwashighlysatisfactory in bothbrightanddimlightconditions. Somepatientsmayneedspectaclesforintermediatevision, whichmightalso be resolvedbypreoperativetargetedmyopiabybiometry, orpreferringdiffractivemiolswithlower presbyopicaddition.


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