comparison of two multifocal iol types –short and medium ... · comparison of two multifocal iol...

Comparison of two multifocal IOL

types – short and medium-term

visual outcomes

Semmelweis University, Department of Ophthalmology

Budapest, Hungary

Head: Prof. Zoltan Zsolt Nagy

AF Dunai, K Kranitz, E Juhasz, G Sandor, T Filkorn,

ZZs Nagy

SEMMELWEIS EGYETEM

SZEMÉSZETI KLINIKA

Authors’ travel and certain aspects of

study were financed by

Medicontur, Geneva, Switzerland.

SEMMELWEIS EGYETEM

SZEMÉSZETI KLINIKA

Aim

• To compare the refractive and visual outcomes collected

during the first six postoperative months after the

implantation of two types of different one-piece acrylic

diffractive multifocal intraocular lenses (IOL).

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SZEMÉSZETI KLINIKA

Patients

• Prospective randomised study• Crystalline lens extraction, 100 eyes of 50 patients• Indication: partly age-related cataracts, partly refractive lens

exchanges (RLE)

• Motivated patients, informed consent• Exclusion criteria:

• Any, potencially vision-resctrictive eye diseases• Preoperative refraction: more than +/- 6.0D spherical or

1.0D torical• Any intraoperative complications

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Patients

• Group A: 50 eyes of 25 patients• Medicontur Bi-Flex 677MY• PAD (Progressive Apodized

Diffractive) technology

• Group B: 50 eyes of 25 patients• Alcon Acrysof Restor SN6AD1• Diffractive multifocal technology

• Randomised study groups

http://www.reviewofoptometry.com/

http://www.medicontur.com

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Pre- and postoperative examinations

• Uncorrected and corrected ETDRS LogMAR visual acuity (VA)

• Far (UDVA, CDVA)• Intermediate (UIVA, CIVA)• Near (UNVA, CNVA)

• Autorefractometry• MRK-3100P, Huvitz Co., Gunpo-si Gyeonggi-do, Rep. of Korea

• Manifested refraction

www.intechopen.com

http://www.medwow.com

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Optical biometry

• IOL planning• Lenstar LS900; Haag-Streit AG, Koeniz, Switzerland

• Multi formula

• Postoperative follow-up of thebiometric parameters

http://haag-streit-usa.com

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Surgical technique

• 3 experienced surgeons (ZZsN, AD, TF)• Same instruments and surgical technique• Superior incisions (90-100°)• No intraoperative complications• In-the-bag implantations

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Postoperative examinations

• 1 day, 1 week, 4 weeks• 3, 6, 12, 24 months• Digital slitlamp photos in

retroillumination, dilatedpupil (IOL position)

• BQ 900® Haag-Streit AG, Koeniz, Switzerland

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Epidemiological and biometric data

Group A (MC 677MY) Group B (Restor) P*

Number of cases (patients) 50 (25) 50 (25)

Age (years) 65.0 ± 11.6 67.5 ± 9.4 0.547

Gender (male/female) 15/10 8/17

Preoperative far visual acuity

Non-corrected (UDVA, LogMAR) 0.51 ± 0.36 0.57 ± 0.35 0.492

Best corrected (CDVA, LogMAR) 0.14 ± 0.10 0.15 ± 0.20 0.626

Absolute value of preop. SE (diopters) 2.37 ± 1.82 1.88 ± 1.32 0.526

Preop. manifested astigmatism (diopters) 0.34 ± 0.42 0.26 ± 0.39 0.475

Spherical power of IOLs (diopters) 21.19 ± 4.61 22.28 ± 2.02 0.554

*: Mann-Whitney U test

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Non-corrected, monocular far visual

acuity (UDVA)


Preop. 1st day 1st week 4th week3rd

month6th

month

BiFlex 677MY 0,51 0,16 0,09 0,03 -0,02 0,02

Restor SN6AD1 0,57 0,26 0,08 0,05 0,06 0,06

-0,1

0

0,1

0,2

0,3

0,4

0,5

0,6

ET

DR

S L

og

MA

RV

A 4

m

* *

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Non-corrected, monocular intermediate

visual acuity (UIVA)


*


month6th

month

BiFlex 677MY 0,66 0,29 0,26 0,24 0,23

Restor SN6AD1 0,59 0,33 0,26 0,3 0,29

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

ET

DR

S L

og

MA

RV

A 8

0 c

m

*

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Non-corrected, monocular near visual

acuity (UNVA)


month6th

month

BiFlex 677MY 0,7 0,32 0,21 0,19 0,14 0,11

Restor SN6AD1 0,84 0,36 0,24 0,19 0,18 0,16

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

ET

DR

S L

og

MA

RV

A 4

0 c

m

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Non-corrected, binocular visual acuity

(UVA, LogMAR)


Group A(BiFlex 677MY)

Group B(Restor SA6AT1)

P*

UDVA (3 months) -0.08 ± 0.10 0.01 ± 0.05 0.001

UDVA (6 months) -0.03 ± 0.04 -0.01 ± 0.04 0.217

UIVA (3 months) 0.10 ± 0.11 0.18 ± 0.07 0.026

UIVA (6 months) 0.12 ± 0.12 0.22 ± 0.08 0.011

UNVA (3 months) 0.07 ± 0.06 0.10 ± 0.07 0.305

UNVA (6 months) 0.02 ± 0.12 0.08 ± 0.09 0.217

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Absolute value of the manifested

spherical equivalent (preop vs 6 months)

Preop far6 months

far

Preop

intermed

6 months

intermed

Preop

near

6 months

near

BiFlex 677MY 2,37 0,09 2,8 1,28 3,3 0,14

Restor SN6AD1 1,88 0,17 2,82 1,55 3,61 0,15

0

0,5

1

1,5

2

2,5

3

3,5

4

Ab

s. v

alu

eo

f m

an

ife

ste

dS

E

(dio

pte

rs)

Wilcoxon test: significant change in every distances;*: Mann-Whitney U test; p= 0.008

*

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Defocus curve (bilateral, 3 months)

0

0,2

0,4

0,6

0,8

1

1,2

1,4

+4.0D +3.0D +2.0D +1.0D 0.00D -1.0D -2.0D -3.0D

ET

DR

S d

eci

ma

lV

A 4

m

BiFlex 677MY Restor SN6AD1

DISTANCE

NEAR

INTERMEDIATE (65 cm)

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Defocus curve (bilateral, 6 months)

0,00

0,20

0,40

0,60

0,80

1,00

1,20

1,40

+4.0D +3.0D +2.0D +1.0D 0.00D -1.0D -2.0D -3.0D

ET

DR

S d

eci

ma

lV

A 4

m

BiFlex 677MY Restor SN6AD1

DISTANCE

INTERMEDIATE (65 cm)

NEAR

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Area under the defocus curve

(bilateral, 6 months)


Group A(BiFlex 677MY)

Group B(Restor SA6AT1)

Difference(%)

P*

AutC (+4.0D; -3.5D)(whole area)

5.51 ± 0.52 D 4.75 ± 0.54 D 16.0% 0.002

AutC (+1.0D; -1.0D)(far vision)

1.99 ± 0.19 D 1.83 ± 0.16 D 8.7% 0.025

AutC (-1.0D; -2.0D)(intermediate vision)

0.90 ± 0.20 D 0.70 ± 0.08 D 28.6% <0.001

AutC (-2.0D; -3.0D)(near vision)

0.96 ± 0.11 D 0.88 ± 0.11 D 9.1% 0.943

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Visual Functioning Questionnaires (VFQ)

Mann-Whitney U test: no significant difference between the two groups

0

0,5

1

1,5

2

2,5Glare/Flare

Night vision

Colour perception

Halos

Depth perception

Distorted near vision

Distorted far vision

Blurred near vision

Blurred far vision

Double vision

Visual complaints

Bi-Flex 677MY Restor SN6AD1

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Visual Functioning Questionnaires (VFQ)

Mann-Whitney U test: no significant difference between the two groups

0,00

0,50

1,00

1,50

2,00

2,50TV, movies

Working outside

Caring for children

Reading an alarm clock

Seeing clearly when…

Reading a wall clock

Work/hobbies

SportSocial eventsReading/near work

Driving at night

Driving in rain

Using a computer

Cooking

Shopping

Using mobile phone

Shaving/make up

Visual functions

Bi-Flex 677MY Restor SN6AD1

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Conclusion

• Multifocal IOL implantation is a well-calculable and efficient method for the cataract surgery of patients who wish to achieve spectacle independence.

• Similarly good near VA was found during thefollow-up of both IOL types.

• In Group A, superior uncorrected far and intermediate vision and better depth of focus was found three and six months after the surgery, compared to the patients in Group B.

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Conclusion

• For this reason, the Medicontur 677MY may be recommended for the patients for whom it is important to achieve:

– Fast visual rehabilitation after the surgery

– Excellent far and near visual acuity

– Good intermediate vision for different work distances

Thanks for your kind

attention!

comparison of two multifocal iol types –short and medium ... · comparison of two multifocal iol...

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