Transcript Time course of accommodation after Visian ICL implantation TM

Time course of accommodation
after Visian ICLTM implantation
Kazutaka Kamiya MD, PhD, Kimiya Shimizu MD, PhD
Daisuke Aizawa MD, PhD, Hitoshi Ishikawa MD, PhD
Akihito Igarashi MD, and Mari Komatsu MD, PhD
Department of Ophthalmology, Kitasato University, JAPAN
Authors have no financial interest.
Background
 Accommodation has hitherto been considered to be preserved
after ICL implantation by the presence of the crystalline lens.
 Considering that the haptics of an ICL
need to be secured in the ciliary sulcus,
it is possible that the ciliary muscles
may be functionally affected by the ICL.
 The purpose of the study is to longitudinally assess the
amplitude of accommodation in ICL-implanted eyes, and to
investigate its relationship with patient age in such eyes.
Kitasato University, School of Medicine
IL
Patients
 Sixty-nine eyes of the 40 consecutive patients who
underwent Visian ICLTM V4(STAAR Sugical) implantation.
 26 of men and 43 of women
 Patient age;
36.0 ± 10.2 yo (21 to 59 yo)
 Preoperative refraction;
-10.07 ± 3.49 D(-3.25 to -22.75 D)
Kitasato University, School of Medicine
Methods
 Before and 1, 3, 6, 12 months after surgery
 We assessed the amplitude of accommodation with
an accommodometer (D’ACOMO, WOC, Japan).
 The amount of accommodation was
calculated from the far and near points.
 We carried out this measurement
5 times.
D’ACOMO
Kitasato University, School of Medicine
Repeatability of the accommodometer
+ 95% LoA： 0.61D
- 95% LoA： -0.64D
Bland-Altman plots
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Accommodation was transiently impaired in the early postoperative
periods, and then recovered gradually over time.
6.36 D
*
4.89 D
*
4.98 D
*
5.16 D
5.72 D
The variance of data was statistically significant (p=0.02, ANOVA). *:Significant differences between
measurements made before surgery and at 1 month after (p =0.004, Fisher’s LSD Test), before and
at 3 months after (p=0.007), and before and at 6 months after (p=0.01).
Before ICL implantation
Pearson correlation coefficient, r=-0.665, p<0.01
Kitasato University, School of Medicine
After ICL implantation
Accommodation (D)
15
Pearson correlation coefficient, r=-0.802, p<0.001
10
5
0
20
30
40
Age (yo)
50
60
Accommodation with vs. without cataract
67 eyes (97%)
5.82 D
2 eyes (3%)
2.15 D
Discussion
 Accommodation in patients over 50 yo after ICL implantation:
2.07± 0.72 D, which was nearly identical to apparent
accommodation after IOL implantation (2.01± 0.92 D).
 The risk of developing cataracts has been significantly
Gonvers M et al, J Cataract Refract Surg, 2003
increased in older patients.
Lackner B et al, J Cataract Refract Surg, 2004
 A decrease in accommodation with aging may affect the
continuous flow of the aqueous humor, resulting in a higher
incidence of cataract.
Petternel V et al, Ophthalmology, 2004
Fujisawa T et al, Graefes Arch Clin Oph, 2007
 In light of the loss of accommodation and the higher risk for
cataract development, ICL implantation may be not suitable
for patients over 50.
Kamiya K et al, Am J Ophthalmol, 2008
Kitasato University, School of Medicine
 The accommodation of eyes with cataract was
considerably lower than that of eyes without cataract.
 The increase in the stiffness of the crystalline lens and
the decrease in contrast sensitivity due to opacification
may partially account for this transient dysfunction of
accommodation.
 The mean accommodation of catractous eyes was 2.18
D preoperatively, and 2.43, 2.08, 1.86, 2.15 D 1, 3, 6
and 12 months postoperatively, respectively.
 It is suggested that the stiffness of the anterior
subcapsular cataractous lenses may remain unchanged.
Kitasato University, School of Medicine
Conclusions
 ICL implantation may transiently impair
accommodative function in the early
postoperative period, but this function
appears to recover gradually over time.
 It may be caused by temporal dysfunction of
the ciliary muscle by ICL fixation.
 The amplitude of accommodation is
decreased with aging in ICL-fixated eyes as
well as normal eyes.
Kitasato University, School of Medicine
Thank you for your attention