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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.