Transcript The Red Eye That Doesn’t Go Away

Comparison of visual function following piggyback
implantation of Acrysof ReSTOR intraocular lenses
with Tecnis multifocal ZM900 intraocular lenses.
Rodrigo Vaz, MD
Leonardo Akaishi, MD
Patrick F. Tzelikis, MD
None of the authors has a financial or proprietary interest in
any material or method mentioned.
Purpose
• To compare the postoperative outcome of
piggyback implantation using the AcrySof
ReStor lens with Tecnis ZM900 multifocal
intraocular lenses (IOL).
Material / Methods
• This prospective comparative study included
patients with age-related cataract, primary
hyperopia or hyperopic astigmatism, a normal
ophthalmologic
examination
besides
senile
cataract, and unsatisfactory correction with
glasses.
• Information collected included uncorrected visual
acuity (UCVA) for near and distance, best
corrected visual acuity (BCVA), and spherical
equivalent (SE) before and after the surgery.
• All patients were followed for 6 months
Material / Methods
• The three lenses used in this study were
TECNIS® ZM900 multifocal IOL, AcrySof
ReStor® and CLARIFLEX®.
• The
multifocal
IOL
(Tecnis
ZM900
or
AcrySof ReStor) was first implanted in the
capsular bag and the Clariflex® lens was
implanted second in the ciliary sulcus.
Material / Methods
• The TECNIS® multifocal IOL (Model ZM900, AMO,
Santa Ana, CA) is a 3-piece diffractive multifocal lens with
6.00 mm polysiloxane optic.
• The AcrySof® ReSTOR® (Model SA60D3, Alcon Surgical
Laboratories, Dallas, Texas) is an acrylic foldable singlepiece IOL.
• The CLARIFLEX® (Model AMO, Advanced Medical Optics,
Santa Ana, California) is 3-piece monofocal lens with 6.00
mm biconvex square-edged silicone optic and 10-degree
angulated C polymethyl-methacrylate (PMMA) haptics.
Material / Methods
• The Holladay formula was used to calculate the IOL
power when there was a short axial length (< 22.0
mm) and the SRK/T formula was used when there
was an average axial length (≥ 22.0 mm). The Aconstant used was 119.8 for the TECNIS multifocal
IOL, 118.6 for the AcrySof ReStor and 118.4 for
the CLARIFLEX IOL. Axial length was measured
with the IOL Master (Carl Zeiss Meditec AG), and
the targeted postoperative refractive error was 0.0
Results
Preoperative
Tecnis ZM900
(n=20 eyes)
Teste t Student (SPSS)
ReStor
(n=21 eyes)
P value
Axial length 20.80 mm (SD:±0.80) 21.68 mm (SD:±0.39) P<0,001
Power IOL
(D)
26.75 D (SD: ±1.95)
22.0 D (SD: ±1.75)
P<0.001
UCVA
0.08 (20/250)
(SD: ±0.11)
0.25 (20/80)
(SD: ±0.06)
P<0.001
BCVA
0.67 (20/30)
(SD: ±0.08)
0.9 (20/22)
(SD: ±0.17)
P=0.02
SE
+ 6.25 D
(SD: ± 2.25)
+ 4.25 D
(SD: ±1.55)
P=0.002
Results
Teste t Student (SPSS)
Postoperative
(6 months)
Tecnis ZM900
(n=20 eyes)
ReStor
(n=21 eyes)
P value
UCVA for
distance
0.67 (20/30)
(SD: ± 0.15)
0.86 (20/23)
(SD: ± 0.16)
P=0.002
UCVA for
near 33 cm
J1
J1
P=0.14
BCVA for
distance
0.90 (20/22)
(SD: ± 0.10)
1.00 (20/20)
(SD: ± 0.05)
P=0.002
BCVA
at 60 cm
J4.5
J5
P=0.08
SE
0.00 D
(SD: ± 0.45)
-0.25 D
(SD: ± 0.40)
P=0.06
Results
3
1,00
2
0,90
UCVA for near at 6 months
UCVA for distance at 6 months
1,8
0,80
0,70
0,60
0,50
0,40
1,6
1,4
1,2
1
ReSTOR
Tecnis
ReSTOR
Intraocular lens
1,00
Spherical equivalent at 6 months
7,00
UCIVA at 60 cm (intermediate)
Tecnis
Intraocular lens
6,00
5,00
4,00
5
0,50
0,00
-0,50
-1,00
3,00
ReSTOR
Tecnis
Intraocular lens
ReSTOR
Tecnis
Intraocular lens
Results
• After a follow-up of 6 months, halos were
reported as severe by 8.3% , moderate by
33.3% and absent or mild by 58.4% of
patients in the Tecnis group. In the ReStor
group halos were reported as severe by 9.0%,
moderate by 27.3% and absent or mild by
63.7%.
• No interlenticular opacification (ILO) or
another postoperative complication related to
piggyback lenses was observed in our series.
Conclusion
• Overall, the use of a multifocal IOL in a
piggyback fashion appears to be a safe and
efficient procedure and a good refractive
solution.
• Implanting 2 piggyback IOLs was beneficial in
eyes with short axial length. The AcrySof
ReSTOR IOL gave better outcomes than the
Tecnis multifocal IOL in UCVA and BCVA for
distance, probably because in the Tecnis group
the eyes had shorter axial length and required
higher diopter lenses.