Lens exchange for multifocal IOL in cataract refractive surgery 3 - PowerPoint PPT Presentation

Lens exchange for multifocal IOL in cataract refractive surgery 3 years’ experience. Dimitrii Dementiev, MD. Anna Shipunova, MD, PhD., Irina Ivanchikova, MD., Vera Veshchikova “International Center for Ophthalmology” Moscow , Russia “Blue Eye, Centro di Microchirurgia ” Milan, Italy Financial Interest International Center for Ophthalmology Moscow, Russia

Cataract surgery is a refractive surgery procedure Main Complication: Glasses for far and near distance Main Complication: Main Complication: Main Complication: Main Complication: Presbyopia APHAKIA ASTIGMATISM Spherical Aberration 1960 1970 1985 2000 2005 2009 > 2013

What to do ?

Acri.LISA (Carl Zeiss) AT LISA tri 839MP – Combination of diffractive and refractive optic  Refractive zones, which are designed so that they also have a diffractive function  No topographical structure (e.g. steps) on the lens surface

Purpose To evaluate the subjective and objective visual results after the implantation of a trifocal diffractive intraocular lens AT Lisa tri 839MP (Carl Zeiss Meditec) in different refractive groups

Material and Methods 1 group 2 group 3 group ≤ 22.5mm ≥ 26.1mm 22.6 - 26.0mm 19 eyes 64 eyes 19 eyes The mean age of patients was 56,28 ± 9.93 y.o. The mean follow-up period was 29.7 ± 8.12 months. Refractive errors ranged from -14.00 to +5.0 D.

Material and Methods • Autorefractokeratometry (Tomey, Japan ) • Uncorrected distance visual acuity (UDVA) & Best-corrected distance visual acuity (BDVA) for far, short, intermediate distance • Slit-lamp examination • Optical biometry (IOL Master V.5.4.1, Carl Zeiss Meditec, Germany) • OCT Cirrus (Carl Zeiss Meditec, Germany) • IOP – Applanation Tonometer (Tono-Pen XL, Medtronic) • Corneal topography (Carl Zeiss Meditec, Germany) • Binocular defocus curve • Pelli-Robson Contrast Sensitivity test

Questionnaire • Would you undergo implantation with this lens type again? • How do you assess the quality of vision for watching TV, reading, and doing needlework? (excellent/good/poor/very bad) • Have to use spectacles for distance? • Have to use spectacles for near distance? When? • Do you experience halos? • Do you experience glare? • Do you see ghost images? • Do you see double images? Do you experience discoloration? • • Do you have difficulty in transitioning from dark to light or the contrary?

Group 1 Valid Mean Median Minimum Maximum Std.Dev. N Age 19 52,63 51,00 39,00 64,00 8,30 Pre op UCVA (logMAR) 19 0,54 0,60 0,15 1,00 0,25 Pre op BCVA (logMAR)1 19 0,08 0,05 0,00 0,70 0,16 Pre op SE 19 2,91 2,50 0,00 5,00 1,48 Axial length (mm) 19 21,90 21,82 21,28 22,45 0,38 Pre op Mean corneal K 19 44,16 44,38 41,80 46,05 1,22 readings (D) Pre op Mean corneal 19 1,01 0,89 0,36 1,84 0,39 astigmatism (D) Intraocular lens power 19 25,84 26,00 22,50 30,00 1,86 (D) Post op UCVA (logMAR) 19 -0,04 0,00 -0,25 0,05 0,09 Post op SE 19 0,08 0,00 -0,25 0,50 0,21 Post op BCVA (logMAR) 19 -0,05 0,00 -0,25 0,05 0,09 Post op UIVA (logMAR) 19 0,24 0,27 0,05 0,30 0,07 Post op BIVA (logMAR) 19 0,10 0,10 0,05 0,15 0,04 Post op UNVA (logMAR) 19 0,09 0,05 0,00 0,27 0,10 Post op BNVA logMAR 19 0,04 0,00 0,00 0,10 0,05

Group 1

Group 2 Media Valid N Mean Minimum Maximum Std.Dev. n Age 64 58,28 60,00 29,00 79,00 10,64 Pre op UCVA (logMAR) 64 0,63 0,55 0,02 2,00 0,45 Pre op BCVA (logMAR) 64 0,18 0,05 0,00 2,00 0,32 Pre op SE 64 -0,41 0,00 -8,25 4,00 2,82 Axial length (mm) 64 23,92 23,84 22,50 25,92 0,89 Pre op Mean corneal K readings 64 43,17 43,11 40,62 46,06 1,22 (D) Pre op Mean corneal astigmatism 64 0,75 0,70 0,04 1,75 0,39 (D) Intraocular lens power (D) 64 20,33 21,00 12,50 25,50 3,04 Post op UCVA (logMAR) 64 -0,01 0,00 -0,25 1,15 0,17 Post op SE 64 -0,08 0,00 -1,00 0,25 0,22 Post op BCVA (logMAR) 64 -0,04 0,00 -0,25 0,10 0,08 Post op UIVA (logMAR) 64 0,26 0,27 0,05 0,45 0,09 Post op BIVA (logMAR) 64 0,10 0,10 0,00 0,27 0,05 Post op UNVA (logMAR) 64 0,10 0,10 0,00 0,30 0,09 Post op BNVA logMAR 64 0,04 0,05 0,00 0,17 0,05

Group 2 группа 2 Median; Box: 25%-75%; Whisker: Min-Max -0,3 VA (logMAR) IVA (logMAR) -0,2 NVA (logMAR) -0,1 0,0 0,1 0,2 0,3 0,4 0,5 uncorrected vision best-corrected vision

Group 3 Valid Mean Median Minimum Maximum Std.Dev. N Age 17 52,82 54,00 41,00 62,00 6,48 Pre op UCVA (logMAR) 17 1,58 2,00 0,10 2,00 0,62 Pre op BCVA (logMAR) 17 0,14 0,10 0,00 0,40 0,14 Pre op SE 17 -7,84 -8,25 -14,00 -0,75 3,61 Axial length (mm) 17 26,86 26,47 26,03 28,58 0,80 Pre op Mean corneal K 17 42,14 42,46 39,34 43,40 1,18 readings (D) Pre op Mean corneal 17 0,72 0,67 0,24 1,20 0,31 astigmatism (D) Intraocular lens power 17 11,97 11,50 8,00 18,00 2,84 (D) Post op UCVA (logMAR) 17 0,03 0,02 -0,05 0,10 0,05 Post op SE 17 -0,24 -0,25 -0,75 0,25 0,29 Post op BCVA (logMAR) 17 -0,03 0,00 -0,10 0,00 0,05 fotopic Post op UIVA (logMAR) 17 0,26 0,27 0,15 0,30 0,05 Post op BIVA (logMAR) 17 0,09 0,10 0,05 0,15 0,04 Post op UNVA (logMAR) 17 0,08 0,10 0,00 0,27 0,07 Post op BNVA logMAR 17 0,14 0,05 0,00 1,00 0,32

Group 3 группа 3 Median; Box: 25%-75%; Whisker: Min-Max -0,15 VA (logMAR) IVA (logMAR) -0,10 NVA (logMAR) -0,05 0,00 0,05 0,10 0,15 0,20 0,25 0,30 0,35 uncorrected vision best-corrected vision

bin.UCVA log Mar -0,2 -0,1 0,0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 Median1 Median2 0,8 Median3 0,0 -0,5 -1,0 -1,5 -2,0 -2,5 -3,0 -3,5 -4,0 -4,5 -5,0 The binocular defocus curve confirms good VA even in the intermediate distance range, with a moderate decrease of less than LogMAR 0.15 at −2.0 D in the 1st and 2nd groups, and 0.15 at -1.5 in the 3rd group, with respect to the best distance VA at 0 D defocus.

The population reporting decrease of contrast sensitivity was in the 3rd group predominantly Pelli-Robson Contrast Sensitivity test 2,5 2 1,5 1 0,5 0 Pre op 1 week 1 month 12 months 24 months 36 months Score 2.0 =Normal Score< 1.5 = Visual impairment Score <1.0 = Visual disability

Patient satisfaction was high. 18 percent of the patients reported seeing halos first 6 months after operation. Quality of vision 14% 12% 10% 8% often 6% severe 4% bothersome 2% 0% Halos Glare Night vision disturbances

Complication • PCO - 15 % • Overtime neuroadaptation - 4 % (all patients - 3rd group)

RESULTS Spectacle independence was achieved for 100% of eyes for distance • vision and for 80% for near vision IOL induces minimal photic phenomena (halos, glare) and provides good • VA for distance, near, and intermediate vision Intermediate vision was good when tested with the near visual chart as • well as with a defocus addition of the defocus curve

Conclusion • The introduction of a third focus in diffractive multifocal intraocular lenses AT Lisa tri 839MP (Zeiss) improves the intermediate vision with minimal visual discomfort for the hyperopic, emmetropic and myopic patients This kind of IOL can be used not only in cataract surgery but also in • refractive surgey for correction of myopia, hyperopia and presbiopia by clear lens exchange in patients over 50 age Miopic patients have to be informed about at least 6 month of near • vision adoptation

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