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.

International Center for Ophthalmology Moscow, Russia

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

Main Complication: Spherical Aberration

Cataract surgery is a refractive surgery procedure

Main Complication: ASTIGMATISM Main Complication: APHAKIA Main Complication: Presbyopia Main Complication: Glasses for far and near distance

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 ≤ 22.5mm 19 eyes 2 group 22.6 - 26.0mm 64 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.

3 group ≥ 26.1mm 19 eyes

• 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

Material and Methods

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?

Valid N Mean Median Minimum Maximum Std.Dev. 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 readings (D) 19 44,16 44,38 41,80 46,05 1,22 Pre op Mean corneal astigmatism (D) 19 1,01 0,89 0,36 1,84 0,39 Intraocular lens power (D) 19 25,84 26,00 22,50 30,00 1,86 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 1

Valid N Mean Media n Minimum Maximum Std.Dev. 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 (D) 64 43,17 43,11 40,62 46,06 1,22 Pre op Mean corneal astigmatism (D) 64 0,75 0,70 0,04 1,75 0,39 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

Group 2

группа 2 Median; Box: 25%-75%; Whisker: Min-Max uncorrected vision best-corrected vision

• 0,3
• 0,2
• 0,1

0,0 0,1 0,2 0,3 0,4 0,5 VA (logMAR) IVA (logMAR) NVA (logMAR)

Valid N Mean Median Minimum Maximum Std.Dev. 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 readings (D) 17 42,14 42,46 39,34 43,40 1,18 Pre op Mean corneal astigmatism (D) 17 0,72 0,67 0,24 1,20 0,31 Intraocular lens power (D) 17 11,97 11,50 8,00 18,00 2,84 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) fotopic 17

• 0,03

0,00

• 0,10

0,00 0,05 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

Group 3

группа 3 Median; Box: 25%-75%; Whisker: Min-Max uncorrected vision best-corrected vision

• 0,15
• 0,10
• 0,05

0,00 0,05 0,10 0,15 0,20 0,25 0,30 0,35 VA (logMAR) IVA (logMAR) NVA (logMAR)

bin.UCVA log Mar Median1 Median2 Median3 0,0

• 0,5
• 1,0
• 1,5
• 2,0
• 2,5
• 3,0
• 3,5
• 4,0
• 4,5
• 5,0
• 0,2
• 0,1

0,0 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8

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.

Pelli-Robson Contrast Sensitivity test

0,5 1 1,5 2 2,5

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 The population reporting decrease of contrast sensitivity was in the 3rd group predominantly

Quality of vision

0% 2% 4% 6% 8% 10% 12% 14% Halos Glare Night vision disturbances

• ften

severe bothersome

Patient satisfaction was high. 18 percent of the patients reported seeing halos first 6 months after operation.

Complication

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

• 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

RESULTS

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

Thank you

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