Accommodating IOL has high rates of spectacle independence

At the annual meeting of the American Academy of Ophthalmology, he presented data from a study including 83 eyes of 44 patients that were followed for 1 to 36 months. Thirty-nine (89%) of the subjects had undergone bilateral implantation, and nine eyes underwent LASIK after accommodating IOL implantation because of >1 D of residual myopia. The patients were operated on at the Vlemma Eye Institute, Athens, Greece, by Dr. Papastergiou and his colleague Dimitrios S. Siganos, MD, PhD.

At 2 weeks after the primary surgery, the IOL showed excellent centration in all eyes, and there were no eyes with flare or cells in the anterior chamber, IOP≥19 mm Hg, or corneal edema.

Accommodation, which was measured by defocusing, ranged from 0.75 to 2 D and did not change significantly throughout the follow-up period. Mean accommodation was 1.65 ± 0.21 D at 1 month and 1.48 ± 0.46 D at last visit, Dr. Papastergiou reported.

"Our patient satisfaction has remained high, even in those patients who have had this accommodative IOL for up to 3 years, but careful patient selection is important because this implant should not be used in eyes with a scotopic pupil larger than 6 mm," Dr. Papastergiou said.

The subjects in his study ranged in age from 42 to 74 years and included 29 females (66%). All patients had pupil sizes measured preoperatively with infrared pupillometry (Procyon) and biometry was performed with immersion A-scan (Axis II). IOL power calculation was performed using the Holladay Consultant formula.

Postoperatively, the mean refractive error for the series was -0.23 ± 0.47 D. With distance correction, all patients could read J4 or better, 69 (83%) could read J3 or better, and nearly half (38 eyes, 45.8%) could read J1 or better.

At the time of Dr. Papastergiou's report, 23 (23.7%) eyes had undergone Nd:YAG capsulotomy for posterior capsule opacification.

"These eyes presented with regression of the accommodative effect, but it improved after capsulotomy. However, further follow-up is needed to determine the long-term incidence of fibrosis," Dr. Papastergiou noted.

The change in the accommodative effect after Nd:YAG capsulotomy ranged up to 0.75 D and averaged 0.22 ± 0.19 D.

Other postoperative complications included a case of endophthalmitis that developed at 6 weeks after surgery. The patient underwent pars plana vitrectomy with intravitreal injection of antibiotics and did not lose visual acuity compared with the pre-infection level.

After 2 years, one eye developed a macular hole and was awaiting posterior segment surgery.

I. Howard Fine, MD, discussed the paper and compared the outcomes with his own series of cataract patients who had the accommodating IOL implanted in the FDA-monitored, premarketing study.

Similar to Dr. Papastergiou's report, 100% of eyes in Dr. Fine's study group had distance UCVA of 20/30 or better while 71% saw 20/20 or better at near, intermediate, and distance.

"However, we have also been implanting this lens in patients undergoing refractive lens exchange and have been achieving similar results," Dr. Fine said.

Data from 124 patients undergoing refractive lens exchange have been analyzed, and those results show 100% achieved 20/40 or better UCVA at all distance ranges while 73% saw 20/25 or better at near, intermediate, and distance.