Comparison of two multifocal IOL types short and medium-term visual outcomes
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1 Comparison of two multifocal IOL types short and medium-term visual outcomes AF Dunai, K Kranitz, E Juhasz, G Sandor, T Filkorn, ZZs Nagy Semmelweis University, Department of Ophthalmology Budapest, Hungary Head: Prof. Zoltan Zsolt Nagy
2 Authors traveland certainaspectsof studywerefinanced by Medicontur, Geneva, Switzerland.
3 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).
4 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
5 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
6 Pre-and postoperativeexaminations 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
7 Opticalbiometry IOL planning Lenstar LS900; Haag-Streit AG, Koeniz, Switzerland Multi formula Postoperative follow-up of the biometric parameters
8 Surgicaltechnique 3 experienced surgeons (ZZsN, AD, TF) Same instruments and surgical technique Superior incisions ( ) No intraoperative complications In-the-bag implantations
9 Postoperativeexaminations 1 day, 1 week, 4 weeks 3, 6, 12, 24 months Digital slitlamp photos in retroillumination, dilated pupil (IOL position) BQ 900 Haag-StreitAG, Koeniz, Switzerland
10 Epidemiologicaland biometricdata Group A(MC 677MY) Group B (Restor) P* Number of cases(patients) 50 (25) 50 (25) Age(years) 65.0 ± ± Gender(male/female) 15/10 8/17 Preoperative far visual acuity Non-corrected(UDVA, LogMAR) 0.51 ± ± Best corrected(cdva, LogMAR) 0.14 ± ± Absolute value of preop. SE (diopters) 2.37 ± ± Preop. manifested astigmatism (diopters) 0.34 ± ± Spherical power of IOLs(diopters) ± ± *: Mann-Whitney U test
11 Non-corrected, monocularfar visual acuity(udva) 0,6 ETDRS LogMARVA 4 m 0,5 0,4 0,3 0,2 0,1 0 * * -0,1 Preop. 1st day 1st week 4th week 3rd month 6th 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 *: Mann-Whitney U test
12 Non-corrected, monocularintermediate visualacuity(uiva) 0,7 ETDRS LogMARVA 80 cm 0,6 0,5 0,4 0,3 0,2 0,1 * * 0 Preop. 1st day 1st week 4th week 3rd month 6th 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 *: Mann-Whitney U test
13 Non-corrected, monocularnearvisual acuity(unva) 0,9 ETDRS LogMARVA 40 cm 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 Preop. 1st day 1st week 4th week 3rd month 6th 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
14 Non-corrected, binocularvisualacuity (UVA, LogMAR) Group A (BiFlex 677MY) Group B (Restor SA6AT1) UDVA (3 months) ± ± UDVA (6 months) ± ± UIVA (3 months) 0.10 ± ± UIVA (6 months) 0.12 ± ± UNVA (3 months) 0.07 ± ± UNVA (6 months) 0.02 ± ± P* *: Mann-Whitney U test
15 Absolutevalueof themanifested sphericalequivalent(preopvs6 months) 4 Abs. valueof manifestedse (diopters) 3,5 3 2,5 2 1,5 1 0,5 * 0 Preop far 6 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 Wilcoxon test: significant change in every distances; *: Mann-Whitney U test; p= 0.008
16 Defocus curve(bilateral, 3 months) 1,4 DISTANCE ETDRS decimal VA 4m 1,2 1 0,8 0,6 0,4 0,2 NEAR INTERMEDIATE (65 cm) D +3.0D +2.0D +1.0D 0.00D -1.0D -2.0D -3.0D BiFlex 677MY Restor SN6AD1
17 Defocus curve(bilateral, 6 months) 1,40 1,20 DISTANCE NEAR ETDRS decimal VA 4m 1,00 0,80 0,60 0,40 0,20 INTERMEDIATE (65 cm) 0, D +3.0D +2.0D +1.0D 0.00D -1.0D -2.0D -3.0D BiFlex 677MY Restor SN6AD1
18 Areaunderthedefocuscurve (bilateral, 6 months) AutC (+4.0D; -3.5D) (whole area) AutC (+1.0D; -1.0D) (far vision) AutC (-1.0D; -2.0D) (intermediate vision) AutC (-2.0D; -3.0D) (near vision) Group A (BiFlex 677MY) Group B (Restor SA6AT1) Difference (%) 5.51 ± 0.52 D 4.75 ± 0.54 D 16.0% ± 0.19 D 1.83 ± 0.16 D 8.7% ± 0.20 D 0.70 ± 0.08 D 28.6% < ± 0.11 D 0.88 ± 0.11 D 9.1% P* *: Mann-Whitney U test
19 Visual FunctioningQuestionnaires(VFQ) Visual complaints Bi-Flex 677MY Restor SN6AD1 Blurred far vision Blurred near vision Double vision Glare/Flare 2,5 2 1,5 1 0,5 0 Night vision Colour perception Halos Distorted far vision Distorted near vision Depth perception Mann-Whitney U test: no significant difference between the two groups
20 Visual FunctioningQuestionnaires(VFQ) Cooking Shaving/make up Using mobile phone Shopping Visual functions Bi-Flex 677MY TV, movies 2,50 2,00 1,50 1,00 0,50 0,00 Restor SN6AD1 Working outside Caring for children Reading an alarm clock Seeing clearly when Using a computer Reading a wall clock Driving in rain Work/hobbies Driving at night Reading/near work Sport Social events Mann-Whitney U test: no significant difference between the two groups
21 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 the follow-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.
22 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
23 Thanksforyourkind attention!
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