Positional accommodative intraocular lens power error induced by the estimation of the corneal power and the effective lens position.

Purpose: To evaluate the predictability of the refractive correction achieved with a positional accommodating intraocular lenses (IOL) and to develop a potential optimization of it by minimizing the error associated with the keratometric estimation of the corneal power and by developing a predictive formula for the effective lens position (ELP). Materials and Methods: Clinical data from 25 eyes of 14 patients (age range, 52–77 years) and undergoing cataract surgery with implantation of the accommodating IOL Crystalens HD (Bausch and Lomb) were retrospectively reviewed. In all cases, the calculation of an adjusted IOL power (PIOLadj) based on Gaussian optics considering the residual refractive error was done using a variable keratometric index value (nkadj) for corneal power estimation with and without using an estimation algorithm for ELP obtained by multiple regression analysis (ELPadj). PIOLadj was compared to the real IOL power implanted (PIOLReal, calculated with the SRK‑T formula) and also to the values estimated by the Haigis, HofferQ, and Holladay I formulas. Results: No statistically significant differences were found between PIOLReal and PIOLadj when ELPadj was used (P = 0.10), with a range of agreement between calculations of 1.23 D. In contrast, PIOLReal was significantly higher when compared to PIOLadj without using ELPadj and also compared to the values estimated by the other formulas. Conclusions: Predictable refractive outcomes can be obtained with the accommodating IOL Crystalens HD using a variable keratometric index for corneal power estimation and by estimating ELP with an algorithm dependent on anatomical factors and age.

Incidence, indications, and outcomes of Yag Capsulotomy in eyes Implanted with an accommodating intraocular lens

Objectives@#To do report the incidence of capsular changes in Crystalens-implanted eyes and analyze the indications and outcomes of yag capsulotomy. @*Methods@#We reviewed the records of 411 eyes of 258 patients implanted with the Crystalens IOL. Capsular change indications for yag capsulotomy were posterior capsular opacification (PCO), lens tilt, and capsular striae. Eyes in each indication were further subdivided into therapeutic yag (TY) and prophylactic yag (PY) groups. Outcomes before and after yag capsulotomy were analyzed. @*Results@#Ninety of 411 crystalens-implanted eyes (22%) had undergone yag capsulotomy. Sixty-one eyes had PCO, 12 had lens tilt, and 17 had striae. Twenty-seven eyes belonged to the therapeutic (TY) and 63 eyes to the prophylactic (PY) yag subgroups. The mean interval between phacoemulsification and yag capsulotomy was 10 months. In the TY PCO subgroup, uncorrected distance visual acuity (UDVA) changed from 20/40 pre-yag to 20/25 post-yag, uncorrected near visual acuity (UNVA) from J3 to J2, manifest refraction spherical equivalent (MRSE) from -0.43D to -0.2D. In the TY tilt subgroup, UDVA changed from 20/50 to 20/30, UNVA was unchanged at J2, and MRSE from -1.21D to -0.89D. In the TY striae group, UDVA changed from 20/50 to 20/30, UNVA from J3 to J2, and MRSE from 0.62D to -0.4D. In the PY PCO subgroup, UDVA was unchanged at 20/25, UNVA unchanged at J2, and MRSE changed from -0.52D to -0.47D. In the PY tilt subgroup, UDVA changed from 20/25 to 20/20, UNVA unchanged at J2, and MRSE changed from -0.87D to -0.45D. In the PY striae subgroup, UDVA was unchanged at 20/30, UNVA changed from J3 to J2, and MRSE changed from -0.62D to -0.7D. @*Conclusion@#Capsular changes occurred after Crystalens implantation that necessitated yag capsulotomy. Once vision has deteriorated, a therapeutic yag treatment can help improve vision. If capsular changes have occurred but vision has not deteriorated, a prophylactic yag capsulotomy can stabilize visual and refractive outcomes.

Clinical comparison of visual and refractive outcomes of two models of accommodative intraocular lenses

Objective@#To evaluate the visual and refractive outcomes of eyes implanted with the Crystalens HD and the Crystalens AO intraocular lens.@*Methods@#We retrospectively reviewed the records of 159 eyes of 100 patients implanted with the Crystalens HD IOL and 108 eyes of 66 patients implanted with the Crystalens AO IOL. Visual and refractive outcomes preoperatively and postoperatively were assessed and compared between the lenses. @*Results@#At 1 year, uncorrected distance VA was 20/30 in 78% of eyes in the HD and 76% of eyes in the AO groups. Uncorrected intermediate VA was 20/30 in 90% of eyes in both groups. Uncorrected near VA was J3 in 92% in the HD and 90% in the AO groups. Comparing the two groups, the difference in uncorrected distance (p=0.60), intermediate (p=0.77), and near (p=0.64) vision was not statistically significant. Spherical equivalent was -0.42D +/-0.51D in the HD and -0.6 +/-0.48D in the AO groups (p=0.10). @*Conclusion@#Refractive outcomes were similar between the Crystalens HD and AO groups. Mild myopic refractive outcomes were targeted and achieved in both lens groups. These refractive outcomes provided good uncorrected distance, intermediate, and near vision postoperatively.

Clinical Results of Crystalens(R) (AT-45) Accommodating Intraocular Lens

PURPOSE: To evaluate one-year clinical results of Crystalens(R) (AT-45, Eyeonics, CA, USA) accommodating IOL implantation. METHODS: In this retrospective study, 25 eyes of 18 patients had phacoemulsification and Crystalens(R) accommodating IOL implantation. Distance and near visual acuity (VA) during the 12-months were measured. RESULTS: At two months, uncorrected distance visual acuity (VA) of 13 eyes (52.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At six months, 11 eyes (44.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At 12 months, 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At two months, the uncorrected near VAs of 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At six months, 9 eyes (36.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. After 12 months, 6 eyes (24.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. CONCLUSIONS: The uncorrected near VAs gradually decreased with the passage of time until 12 months after Crystalens(R) accommodating IOL implantation.

Clinical Results of Crystalens(R) (AT-45) Accommodating Intraocular Lens

PURPOSE: To evaluate one-year clinical results of Crystalens(R) (AT-45, Eyeonics, CA, USA) accommodating IOL implantation. METHODS: In this retrospective study, 25 eyes of 18 patients had phacoemulsification and Crystalens(R) accommodating IOL implantation. Distance and near visual acuity (VA) during the 12-months were measured. RESULTS: At two months, uncorrected distance visual acuity (VA) of 13 eyes (52.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At six months, 11 eyes (44.0%) and 21 eyes (84.0%) were 20/25 and 20/40 or better, respectively. At 12 months, 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At two months, the uncorrected near VAs of 11 eyes (44.0%) and 17 eyes (68.0%) were 20/25 and 20/40 or better, respectively. At six months, 9 eyes (36.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. After 12 months, 6 eyes (24.0%) and 16 eyes (64.0%) were 20/25 and 20/40 or better, respectively. CONCLUSIONS: The uncorrected near VAs gradually decreased with the passage of time until 12 months after Crystalens(R) accommodating IOL implantation.

Clinical Evaluation of Accommodative Intraocular Lens Implantation in High Myopic Eyes

PURPOSE: To compare the clinical outcome of AT-45 implantation between high myopic eyes and non-high myopic eyes. METHODS: Retrospective, non-randomized, comparative trial. The medical charts of 28 patients with 35 eyes who had phacoemulsification and AT-45 implantation were retrospectively reviewed. 13 eyes of 10 patients were included in the high myopic group (axial length > or = 26.0 mm) and 22 eyes of 18 patients were included in the non-high myopic group. The clinical data included unilateral best-corrected visual acuity (BCVA) and distance-corrected near visual acuity (DCNVA) at 6 months follow-up after the surgery. The results were compared between the two groups. RESULTS: In the non-high myopic group, 22 eyes (100%) and 19 eyes (86.4%) achieved a BCVA of 20/25 and 20/20 or better respectively. For the high myopic group, the results were 13 eyes (100%) and 12 eyes (92.3%) respectively, at 6 months after the surgery. In the non-high myopic group, 21 (95.4%) and 7 eyes (31.8%) achieved a DCNVA of 20/40 and 20/25 or better. For the high myopic group, the results were 13 (100%) and 4 eyes (30.8%) respectively, at 6 months after the surgery, the differences between the two groups for a BCVA of 20/25 or better and 20/20 or better and a DCNVA 20/40 or better and 20/25 or better were not statistically significant. CONCLUSIONS: Six months clinical outcome of cataract surgery with an AT-45 for the high myopic eyes was satisfactory; it was not significantly different from that of the non-high myopic eyes.

Clinical Evaluation of AT-45 Implantation

PURPOSE: To evaluate clinical results of AT-45. METHODS: In a prospective study, 24 eyes of 21 patients had phacoemulsification and AT-45 implantation. Clinical data included distance visual acuity, near visual acuity, complication, during the 6-months follow-up period. RESULTS: Result analysis was performed with 22 eyes of 19 patients, except 2 complicated eyes. 6-months after operation, 22 eyes (100%) and 19 eyes (86.4%) were achieved best corrected visual acuity 20/25 and 20/20 or better respectively. 21 eyes (95.4%) and 7 eyes (31.8%) were achieved best distance corrected near visual acuity 20/40 and 20/25 or better respectively. Posterior capsular opacity was developed in 5 eyes (22.7%) and posterior synechia was developed in 1 eye (4.5%). CONCLUSIONS: Clinical result of cataract surgery with AT-45 was relatively satisfactory. Long term follow-up is recommended.

Changes in Anterior Chamber Depth and Refraction after Accommodative Intraocular Lens Implantation

PURPOSE: To evaluate the change in anterior chamber depth and refraction after AT-45 implantation METHODS: Twenty-two eyes from 22 patients were enrolled in this prospective study. After phacoemulsification, AT-45 (11 eyes) and SA60AT (11 eyes) were implanted. Clinical data included anterior chamber depth and refractive error at 1 week, 1 month, 2 months and 6 months postoperatively. The correlation between anterior chamber depth change and spherical equivalent change was also evaluated. RESULTS: In the AT-45 implanted group, the mean anterior chamber depth was 4.56+/-0.59 mm at 1 week postoperative, 4.70+/-0.69 mm at 1 month postoperative, 4.78+/-0.71 mm at 2 months postoperative and 4.76+/-0.69 mm at 6 months postoperative. The mean spherical equivalent was -0.53+/-0.48D, -0.37+/-0.42D, -0.27+/-0.47D, and -0.33+/-0.44D respectively. When analyzed using the Mann-Whitney U test, p-values of anterior chamber depth differences between the 2 groups were P=0.52 at 1 week to 1 month, P=0.32 at 1 month to 2 months, P=0.89 at 2 months to 6 months, and P=0.02 at 1 week to 6 months, showing a deeper anterior chamber in the AT-45 implanted group. P-values (Mann-Whitney U test) of spherical equivalent differences between the 2 groups were P=0.33, P=0.56, P=0.94, and P=0.19, respectively, showing more hyperopic change in the AT-45 implanted group. The correlation between anterior chamber depth change and spherical equivalent change in the AT-45 implanted group at 1 week to 6 months was not statistically significant (Spearman correlation analysis, P=0.223). CONCLUSIONS: Anterior chamber depth deepening and associated hyperopic refractive change were observed after AT-45 implantation, especially at 1 month after the surgery.