Transcript 슬라이드 1 - ASCRS/ASOA 2008

Clinical Comparsion
After Implantation of
Three Different Aspheric IOLs
Shin Hae Park, Kyoung Min Lee, Choun Ki Joo
Department of Ophthalmology and Visual Science
Korean Eye Tissue and Gene Bank Related to Blindness
The Catholic University of Korea
Neither author has a financial or proprietary interest
in any material or method mentioned.
Introduction
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Advances in IOL technology using wavefront analysis
induce the modifications of IOL surface to improve visual
outcomes.
Aspheric IOLs has been reported to compensate the
spherical aberration(SA) of the cornea and improve
contrast sensitivity, which provides patients with better
quality of vision compared with conventional IOLs.
The Tecnis 9003 ® IOL was designed to reduce to 0.27 ㎛
to correct corneal aberrations completely.
The Acrysof IQ ® SN60WF IOL was designed to produce
negative SA of 0.20 ㎛.
The Adapt-AO ® IOL was designed to be aberration free to
maintain only the positive SA of cornea to be unchanged.
To compare the clinical results of implantation of 3 different types of aspheric IOLs
– Tecnis Z9000®, Acrysof IQ®, ADAPT-AO®
Tecnis Z9003®
Acrysof IQ®
Adapt AO®
Structure
pieces
Single piece
Single piece
with 4 square edge
Material
Hydrophobic acrylic
Hydrophobic acrylic
Hydrophilic acrylic
Aspherical
feature
Biconvex modified
prolate ant. Surface
Posterior aspherical
surface
-0.27
-0.17
Asymmetrical biconvex
design with aspherical
ant. & post. Surface
zero
A-constant
119.1
118.7
118.0
Characteristic
Sharp image to retina
Optimize vision quality
Filtering of
UV & blue light
Uniform power across
its entire surface
feature
Materials and Methods
Prospective and randomized study
90 eyes of 90 patients
All cases were uncomplicated.
4
3
2
1
Topical
anesthesia
3.00mm
temporal
clear
corneal
incision
About
5mm
CCC
diameter
Phacoemul
sification
6
5
In the bag
IOL
implantation
Sutureless
technique
Group A : 30 eyes implanted with Tecnis Z9003® (AMO, USA)
Group B : 30 eyes implanted with AcrySof IQ® SN60WF (Alcon, USA)
Group C : 30 eyes implanted with Adapt-AO® (Bausch & Lomb, USA)
Materials and Methods
6 Parameters to Evaluate the clinical Outcome of 3 IOLs
Postoperative 2 and 6 months
1
Uncorrected visual acuity (UCVA)
2
Best corrected visual acuity (BCVA)
3
Refractive error
4
Sensitivity to glare achieved by ACV
Parameters
5
6
Higher-order aberration
Contrast sensitivity
Statistical analysis was done by Kruskall-Wallis test
Materials and Methods
Preoperative characteristics
Tecnis Z9003®
(N=30 eyes)
Acrysof IQ®
(N=30 eyes)
Adapt AO
(N=30 eyes)
p-value
IOL Power
(Diopter)
20.62±1.51
20.25±2.06
20.34±1.47
0.526
UCVA
0.42±0.17
0.40±0.18
0.38±0.18
0.187
BCVA
0.51±0.17
0.49±0.17
0.42±0.22
0.174
Age
64.96±7.37
65.13±6.98
65.22±7.37
0.927
Sex (M:F)
12:18
14:16
12:18
0.825
*UCVA: uncorrected visual acuity
*BCVA: best corrected visual acuity
Results – visual acuity
UCVA
BCVA
VA change
Tecnis Z9003®
Acrysof IQ®
Adapt AO®
P-value
POD 2mo
0.83±0.18
0.83±0.18
0.84±0.19
0.927
POD 6mo
0.81±0.20
0.87±0.10
0.80±0.23
0.142
POD 2mo
0.95±0.01
0.96±0.02
0.95±0.05
0.635
POD 6mo
0.95±0.03
0.93±0.06
0.94±0.02
0.156
POD 2mo
0.38±0.09
0.35±0.39
0.38±0.46
0.906
POD 6mo
0.35±0.13
0.30±0.41
0.37±0.33
0.291
* VA change : Postoperative BCVA – Preoperative BCVA
Results - refractive error
Spherical
equivalent
(D)
Refractive
error
(D)
Tecnis Z9003®
Acrysof IQ®
Adapt AO®
P-value
POD 2mo
-0.39± 0.53
-0.23± 0.56
-0.18± 0.52
0.12
POD 6mo
-0.13± 0.37
-0.014± 0.43
0.08± 0.27
0.18
POD 2mo
-0.17± 0.55
0.21± 0.56
0.31± 0.41
0.063
POD 6mo
-0.02± 0.38
0.32± 0.43
0.37± 0.35
0.052
*Refractive error (RE)= postoperative spherical equivalent – target refraction
*SE : Spherical equivalent
Results – higher order aberrations
Tecnis Z9003®
Acrysof IQ®
Adapt AO®
P-value
Coma
(㎛)
POD 2mo
0.038 ± 0.093
0.031 ±0.072
0.038 ± 0.11
0.957
POD 6mo
0.011 ± 0.086
0.053±0.084
0.062 ± 0.064
0.786
Trefoil
(㎛)
POD 2mo
0.037 ± 0.076
0.0043 ±0.075
0.026 ±0.048
0.476
POD 6mo
0.022 ± 0.170
0.024 ± 0.099
0.098 ± 0.089
0.340
Spherical
aberration
(㎛)
POD 2mo
0.0068 ± 0.049
0.032 ±0.042
0.067 ±0.051
0.064
POD 6mo
0.0021± 0.096
0.048 ± 0.071
0.11 ± 0.089
0.012
High order
aberration
(㎛)
POD 2mo
0.16 ± 0.066
0.17 ±0.059
0.19 ± 0.074
0.319
POD 6mo
0.29± 0.17
0.30 ± 0.93
0.30 ± 0.08
0.417
Results – Contrast Sensitivity & Glare
cpd
★
Low
photopic
condition
(5cd)
4/1
3
High
photopic
condition
(100cd)
★
8/1
3
6/1
3
Under low and high photopic conditions, there was a statistically significant
improvement in Tecnis Z9003® group at POD 6 months.
Subjective glare sensation
in POD 6mon
Sensitivity to
glare
POD 2mon
POD 6mon
Tecnis Z9003®
Acrysof IQ®
Adapt AO®
P-value
7% (2/30)
26% (8/30)
10% (3/30)
0.368
6.17 ± 2.86
5.13 ±3.22
6.39 ±2.90
0.422
6.12± 1.73
6.00±1.24
6.25 ±1.23
0.843
* Sensitivity to glare : decreased VA at photopic condition measured by ACV
Discussion
1. Negative SA of IOL affected the postoperative spherical aberrations.
Postoperative spherical aberration was lowest in the eyes implanted
with Tecnis Z9003 ® IOL.
2. But, there were no significant differences in postoperative
BCVA, refractive error, glare among 3 different aspheric IOL groups.
There was a statistically significant improvement in Tecnis Z9003®
group at POD 6 months, under low and high photopic conditions.
3. Three IOLs were different in IOL design and material of optic and haptic.
In addition to the spherical aberrations, these are factors to affect the
visual quality in each group.
4. We cannot confirm that what level of SA can maximize the quality of
vision from this study.
5. Further studies are needed to analyze the effect of preoperative value
of corneal SA to the quality of vision after implantation of different
aspheric IOLs.
Thank You for Your Attention !
[email protected]
http://cmc.cuk.ac.kr/lovis