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Effect of Aspherical Intraocular Lens on
Blue-on-Yellow Perimetry
1
MD ;
1,2
MD ;
Rodrigo França de Espíndola,
Marcony Rodrigues Santhiago,
Paula de Camargo Abou Mourad,
Marco Aurélio Costa Marcondes, MD1; Flávio Gaieta Holzchuh, MD1;
1
1
Mário Luiz Ribeiro Monteiro MD, PhD ; Newton Kara-Junior, MD,PhD
1
MD ;
1Ophthalmology
Department, University of São Paulo, São Paulo, Brazil
2Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
PURPOSE
To determine whether implantation of an aspherical intraocular lens (IOL) interference
the blue-on-yellow perimetry.
METHODS
This study was conducted according to ethical standards for clinical research and was
approved by the University Hospital’s research ethics board. The observers who
conducted the postoperative visual evaluations did not have access to the
randomization code or information about the surgical procedures. Informed consent
was obtained, and the study was conducted in adherence with the tenets of the
Declaration of Helsinki. The approval of the study was obtained from the institutional
review board of Clinical Hospital, São Paulo, Brazil
Twenty-five patients (50 eyes) had bilateral sequential cataract surgery under similar
preoperative conditions using the same phacoemulsification technique in both eyes.
The same experienced surgeon performed all surgeries. The patients were randomized
to receive the IOLs. Approximately 30 days after the first surgery, the second eye had
cataract surgery with implantation of another IOL model. Each patient received a
spherical foldable, 1-piece, hydrophobic acrylic IOL (Akreos Fit, Bausch & Lomb, Inc.)
in 1 eye and a 1-piece foldable, hydrophobic acrylic IOL (Akreos AO, Bausch & Lomb,
Inc.) with aspherical anterior and posterior surface (aberration free) in the fellow eye.
All patients and observers were mask about the IOL type implanted.
The individuals met the following inclusion criteria at 12 moths postoperatively: visual
acuity better than 0.3 LogMAR in both eyes, normal intraocular pressures, no evidence
of posterior capsule opacity, and no signs of glaucoma. Patients with any ocular
disease (infectious, inflammatory, and degenerative) were excluded.
Patients were examined before surgery and at 1, 7, 30 days, 3, 6 and 12 months after
surgery. At 12 months postoperatively, best-corrected visual acuity (BCVA) and distance
uncorrected visual acuity (UCVA) were measured as well as B/Y values. The visual
acuity were measured at 100% contrast using Early Treatment of Diabetic Retinopathy
Study (ETDRS) charts (Precision Vision) under photopic conditions (target luminance
85 candelas [cd]/m2) at 4.0 m.
During visual field testing, optimal refractive correction was placed before the tested
eye, and the fellow eye was occluded with an opaque eye patch. SWAP was performed
using the Humphrey Visual Field Analyzer (Carl Zeiss Meditec, USA). A full-threshold
24-2 FASTPAC algorithm was used with a blue (440 nm) size V (1.72°) stimulus on a
yellow background (530 nm), with maximum brightness of 100 candela (cd/m2). The
measured levels were expressed in decibels (dB) for all points.
The SWAP provides two global indices; mean deviation (MD), that represents the
average sensitivity deviation from a normal healthy person of the same age; and
pattern standard deviation (PSD), which gives an indication of how each test location,
on average, deviates from the age adjusted normative database after it has been
adjusted for any general depression or sensitivity. Both indices were analyzed in this
study
Because the participants did not have previous experience with any visual field
testing, they underwent an initial SWAP test to learn how the examination was
performed. This initial test was not included in the analysis.
Only visual field tests with reliable results were analyzed. A reliable test was defined
as one with fixation losses of less than 25% and both false-positive and false-negative
responses of less than 33%.
No eye had intraoperative complications. At 12 months after surgery, all the lenses
were well centered and there was no evidence of posterior capsule opacity or
glaucoma.
At twelve months postoperatively, all eyes showed satisfactory UCVA. The spherical
equivalent was 0.03 ± 0.29 in the Akreos AO group and 0.06 ± 0.43 in the Akreos Fit
group (p= 0.296). The mean distance uncorrected visual acuity (UCVA) was 0.08 ±
0.05 in the Akreos AO group and 0.09 ± 0.06 in the Akreos Fit group. There was no
significant difference between the IOL groups for distance UCVA (p=0.379). The mean
distance best corrected visual acuity (BCVA) was 0.01 ± 0.10 in the Akreos AO group
and 0.02 ± 0.09 in the Akreos FIT group. There was no significant difference between
the IOL groups for distance BCVA (p=0.331).
The Figure 1 and 2 shows MD and PSD distribuition values. The MD mean value in
aspheric IOL was -2,40 dB and -4,70 dB in the other IOL (P = 0,071). The PSD mean
value was 3,30 dB in the Akreos AO group and 3,80 dB in the Akreos Fit group (P
=0,136).
FIGURE 1 - Distribution of mean deviation in
the aspherical and spherical groups at 12
moths postoperatively.
FIGURE 1 - Distribution of pattern standard
deviation in the aspherical and spherical
groups at 12 moths postoperatively.
There was no significant difference for either MD or PSD (Table 1,2).
The mean test duration was similar in both groups, 230,5 seconds (213,5 – 266,0
seconds) in the Akreos AO group and 227,00 seconds (204,0 – 324,2 seconds) in the
Akreos Fit group (P = 0,213.).
STATISTICAL ANALYSIS
Statistical analysis was conducted using the software SPSS version 15.0 (SPSS Inc.,
Chicago, IL, USA). The differences between PSD, MD, and MACS were performed
using an unpaired “t” test. The normality of the quantitative variables was verified using
the Kolmogorov-Smirnov test. The level of statistical significance for such comparison
was set a P <. 05.
CONCLUSION
RESULTS
Fifty eyes of 25 patients (12 men [48.0%] and 13 women [52.0%]) were enrolled in
this study. Mean age of the patients was 57.80 ± 6.48 years. All subjects showed good
reliability indices in B/Y perimetry, thus, no test was excluded from the study.
It seems to be no interference by the Akreos AO IOL in B/Y perimetry. Further studies
will be needed to evaluate this relationship because the sample size used in this study
is small.