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Clinical Improvement and Prevention • 201 16th Ave. E, CWB-3 • Seattle, WA 98112 • 206-326-3938
Study
Mesci et al. 2010
Population
Inclusion:
Age 40-70 years,
Study type:
unilateral cataract
Prospective nonneeding distance
randomized
correction, Snellen visual
controlled.
acuity <20/32, healthy
fellow eye with no cataract,
Aim:
corrected Snellen visual
To evaluate and
acuity 20/25 or better, and
compare the clinical precataract myopia or
safety and efficacy of hyperopia <1.5 diopters.
conventional
monofocal intraocular Exclusion:
History of amblyopia,
lenses (IOL),
accommodating IOL, astigmatism >1.5 D,
mesopic pupil size >6 mm,
and refractive, and
diffractive multifocal aniridia, uncontrolled
IOLs in patients with glaucoma, chronic uveitis,
corneal disease, previous
unilateral cataract.
ocular trauma or surgery
Outcomes:
that caused zonular
defects, microphthalmos,
Post-operative
iris and lens capsule
distance and near,
best corrected visual defects, previous retinal
acuity, stereoscopic surgery, or retinal
pathology. Intraoperative
function, spectacle
exclusion criteria included
independence, and
capsular defect and
patient satisfaction.
vitreous loss.
N of patients :
Patient characteristics:
87 patients with
Mean age 62 years, 53%
unilateral cataract.
males, mean distance
Blinding:
BCVA of eyes with cataract
0.4-0.46, distance UCVA of
No.
fellow eye 0.13-0.17,
Follow-up:
distance BCVA of felloweye 0.04-0.05, and
18 months.
refraction of fellow eye -0.1
to -0.3.
Treatment groups
Group 1: N= 24
patients received
monofocal IOLs (Alcon
Acrysof).
Group 2: N= 21 1CU
(Human Optics)
accommodative
implants.
Group 3: N=22 had
diffractive multifocal
implants (Tecnis
ZM900)
Group 4: N= 20
patients had refractive
multifocal IOLs (AMO
Rezoom).
Patient selection was
based on age, and all
surgeries were
performed by the
same surgeon, under
topical anesthesia.
Follow-up was
conducted at 1 and 2
weeks after surgery
and then at 1,
3,6,9,12,14, and 18
months after surgery.
During each visit a slit
lamp examination was
performed and
intraocular pressure
measures, At 18
months subjective
refraction, monocular
and binocular
distance, intermediate,
and near uncorrected
visual acuity were
measured.
Results
Mean postoperative refractive values and near additions of IOL groups
Astigmatism†
(D)
Mean (SD)
-0.45 (0.19)
Spherical
equivalent** (D)
Mean (SD)
-0.16 (0.29)
Near
addition†† (D)
Mean (SD)
2.46 (0.18)
1 CU Human Optics
(Group 2)
-0.51 (0.23)
-0.13 (0.32)
1.33 (0.25)
Tecnis ZM900
(Group 3)
-0.47 (0.19)
0.32 (0.14)
0.31 (0.27)
Alcon SA 60AT
(Group 1)
0.7 (0.19)
0.24 (0.15)
-0.48 (0.2)
Rezoom
(Group 4)
P value*
.765
0.0001
0.0001
* For between group differences
† Mean cylindrical error
** This was slightly hyperopic in the multifocal and slightly myopic in the
accommodative and monofocal
†† Add power to achieve the near best-corrected visual acuity. Monofocal IOL
[group 1] required the most add power, and the diffractive IOL required [group 3]
the least. The refractive multifocal [group 4] had a lower add value than the
accommodative IOL [group2].
Postoperative visual acuity at 18 months
Posterior capsular opacity was observed in 12.5% of the patients in
group 1, 38.1% in group 2,13.6% in group 3,10% in group 4 (P=.064)
Monocular distance best- corrected visual acuities
p=.442
Monocular distance-corrected intermediate visual acuity p=.0001
Monocular distance-corrected near visual acuity
p=.0001
Monocular distance-uncorrected visual acuity
p=.86
Monocular intermediate-uncorrected I visual acuity
p=.0001
Monocular near-uncorrected visual acuity
p.0001
Monocular near best-corrected visual acuity
p=.287
Binocular distance-uncorrected visual acuity
p=.979
Binocular intermediate uncorrected visual acuity
p=.0001
Binocular near uncorrected visual acuity
p=.0001
Group 3 & 4 had better near vision than groups 1&2 (P<.05)
More patients in groups 3 and 4 had better stereoscopic function, near
vision spectacle independence and more complaints of halo than groups
1 and 2 (P<.05).
Validity/conclusion
The study compared the
efficacy of 4 different
IOLs; however, it had
several limitations.
Patients were not
randomly assigned to
each IOL which is a
source of selection bias.
They were not blinded,
which is another source
of bias. In addition, the
population sizes in each
group were small and
may not provide
sufficient statistical
power to detect
significant differences
between the subgroups.
The authors concluded
that unilateral
implantation of a
multifocal IOL provides
the patient with a
broader range of
functional vision from
near to distance foci,
higher rates of spectacle
independence, and
better stereoscopic
vision. They however,
had higher rates of halo
complaints.