Refractiveoutcomeafter phacoemulsificationwithfoldableintraocularlensesmain2

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04/14/20231

Sudhalkar Eye Hospital, Mahajan Lane, Raopura, Baroda

Refractive outcome after Phacoemulsification with Foldable intraocular lenses.

Dr. Anand Sudhalkar

Baroda

04/14/20232


Aim :

To predict the refractive outcome after cataract surgery after

Phaco-emulsification and implantation of various foldable intraocular lenses

having different designs and materials.

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Study Design:

• Prospective, single surgeon clinical trial

• 236 consecutive cataract cases.

• Routine, standardized clear corneal phacoemulsification

• Implantation of foldable intraocular lenses (IOL).

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Pre-operative work up

• Slit-Lamp, Applanation, Indirect ophth.

• Keratometry: Autokeratometer (Nidek)

• A-Scan (Storz Omega Compuscan)

• SRK II formula.

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Exclusion: Pre Operative

• Traumatic, Secondary Cataract

• Corneal curvature defects, Surgery forrefractive procedures, Pterigium & post ulceration opacities.

• Zonular weakness, exfoliations

• Previous Glaucoma procedures

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IOL power selection

• A-scan printout

• Designated IOL A-Constant

• Targeted refraction and corresponding power for the selected IOL

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Surgical procedure

• 3mm clear corneal, single plane, self sealing incision at 12 o’clock.

• 5 to 5.5mm continuous capsulorrhexis, followed by multiport cortico cleaving hydrodissection, nuclear rotation was done prior to starting phacoemulsification with B&L millenium.

• After deep central sculpting, first vertical crack was obtained and further procedure completed by stop and chop technique.

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Surgical procedure

• IOL injected with the injector system specific to the respective IOls

• The anterior and posterior surfaces identified and to achieve complete in the bag placement having a thin rim of anterior capsule covering the IOl all along the circumference.

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Late Exclusions

• Complications like posterior or anterior capsular tears, vitreous loss or zonular dehiscence

• the clear corneal incision requiring suturing and

• when complete in the bag placement was not possible.

• Post op. capsular phimosis

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236 foldable IOLs:Design: Spherical(160) or Aspherical(76)

Material: Hydrophilic(106) or Hydrophobic(130)

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Age distribution

Range 9 to 89 years

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Power distribution of IOls

Range 6 to 29 Dioptres

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Results

• Retinoscopy after 6 weeks and spherical equivalent Dioptre to obtain BCVA noted.

• Compared with targeted spherical equivalent from A-Scan

• The difference between targeted and observed refraction calculated for each case and crosstabulated within +/- 0.5D group using SPSS software.

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Predictions with all IOls

DIFF

2.25

- 2

.75

1.75

- 2

.25

1.25

- 1

.75

.75

- 1.

25

.25

- .7

5

-.25

- .2

5

-.75

- -

.25

-1.2

5 -

-.75

-1.7

5 -

-1.2

5

-2.2

5 -

-1.7

5

-2.7

5 -

-2.2

5

-3.2

5 -

-2.7

5

60

50

40

30

20

10

0

Std. Dev = .97

Mean = -.09

N = 236.00

16

26

47

53

35

26

16

10

•WITHIN +/- 0.5 D

04/14/2023Sudhalkar Eye Hospital, Mahajan Lane, Raopura, Baroda 15

Crosstab Between Aspheric and Spherical Design

12 40 14 66

18.2% 61% 21.2% 100.0%

47 90 33 170

27.6% 53% 19.4% 100.0%

59 130 47 236

25.0% 55% 19.9% 100.0%

Count

% within IOL

Count

% within IOL

Count

% within IOL

ASPHERICAL

SPHERICAL

IOL

Total

-3.0 to -.51 -.5 to .5 >.5

RANGE.5

Total


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Crosstab Between Hydrophilic and Hydrophobic groups

32 53 21 106

30.2% 50.0% 19.8% 100.0%

27 77 26 130

20.8% 59.2% 20.0% 100.0%

59 130 47 236

25.0% 55.1% 19.9% 100.0%

Count

% within IOL

Count

% within IOL

Count

% within IOL

Hydrophilic

Hydrophobic

IOL

Total

-3.0 to -.51 -.5 to .5 >.5

RANGE.5

Total

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IOL * RANGE.5 Crosstabulation

18 54 19 91

19.8% 59% 20.9% 100.0%

29 36 14 79

36.7% 46% 17.7% 100.0%

3 17 7 27

11.1% 63% 25.9% 100.0%

3 8 5 16

18.8% 50% 31.3% 100.0%

6 15 2 23

26.1% 65% 8.7% 100.0%

59 130 47 236

25.0% 55% 19.9% 100.0%

Count

% within IOL

Count

% within IOL

Count

% within IOL

Count

% within IOL

Count

% within IOL

Count

% within IOL

ACRYSOF

AKREOS

AKREOS A0

Acry-SN60WF

TECNIS

IOL

Total

-3.0 to -.51 -.5 to .5 >.5

RANGE.5

Total


Cumulative percentagesIOL +/-0.5 +/-0.75 +/-1.0

AKREOSADAPT 45.6% 49.4% 70.9%

ACRYSOF 59.3% 61.5% 72.5%

ACRYSNWF 50% 62.5% 81.3%

AKREOSAO 63% 66.7% 88.9%

TECNIS 65.2% 73.9% 87%

ALL IOLs 55.1 59.3 75.8


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• Reference 1.Effect of intraocular lens implantation on visual acuity, contrast sensitivity, and depth of focus. Nio YK; Jansonius NM; Geraghty E; Norrby S; Kooijman AC

•J Cataract Refract Surg. 2003; 29(11):2073-81 (ISSN: 0886-3350)

•CONCLUSIONS: There was a higher amount of spherical aberration in the IOL group, related to a larger depth of focus, without loss of contrast sensitivity at optimum focus or loss of visual acuity. This might contribute to better quality of vision in pseudophakic subjects than in presbyopic phakic subjects.

http://www.medscape.com/medline/publicationbrowser/123?pmid=14670415

Reference 2

Spherical aberration influence in visual function after cataract surgery: prospective randomized trial

• Martínez Palmer A; Palacín Miranda B; Castilla Céspedes M; Comas Serrano M; Puntí Memorial Garrigosa, Universidad Autónoma de Barcelona, Barcelona, España. Arch Soc Esp Oftalmol. 2005; 80(2):71-7 (ISSN: 0365-6691)

• PURPOSE: We compare the contrast sensitivity and visual acuity obtained with an anterior surface modified prolate intraocular lens (Tecnis Z9000) with the contrast sensitivity and visual acuity obtained with a standard acrylic foldable intraocular lens (Acrysof SA60 AT).

•CONCLUSION: Visual acuity and contrast sensitivity after cataract surgery improved in both groups. But monocular and binocular visual acuity was statistically significantly better only in Tecnis group. The contrast sensitivity mean values were greater in Tecnis group but without statistically significant differences.



Reference 3. Visual acuity and contrast sensitivity comparison between Tecnis and Acrysof SA60AT intraocular lenses. A multicentre randomized study. Bellucci R.,Scialdone A. from Verona Italy

• Purpose: To evaluate BCVA and photopic and mesopic contrast sensitivity in pseudphakic patients implanted either with the aspheric IOL or a conventional IOL.

• Conclusion: The aspheric Tecnis Iol yielded better BCVA and distance contrast sensitivity than conventional Acrysof SA60AT.

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Reference 4. Predicting the refractive outcome after cataract surgery: the comparison of different IOLs and SRK-II v SRK-T M J Elder British Journal of Ophthalmology 2002;86:620-622

•Aim: To determine any differences between the predictive abilities of the IOL calculation formulas of SRK-II and SRK-T and to compare these using two different IOL types.

•If it is assumed that an eye retains similar axial lengths and keratometry before and after surgery, and if IOL powers are accurately stated by the manufacturer then the only explanation for a more consistent refractive outcome is that the ACD is more predictable

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04/14/2023Sudhalkar Eye Hospital, Mahajan Lane, Raopura, Baroda

CONCLUSIONS• Predictability of refractive outcome

significantly better with aspheric design and Hydrophobic IOL

• The difference in final refraction within +/-0.5Dioptre range, statistically significant.

• Predictions in target refraction possible if the A-constant mentioned on IOL is reliable.

Refractiveoutcomeafter phacoemulsificationwithfoldableintraocularlensesmain2

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