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Visual outcomes in asymmetric implantation of phakic intraocular lens (ICL) and apodized diffractive intraocular lens (ReSTOR)

Session Details

Session Title: Phakic IOL Implantation II

Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30

Paper Time: 10:10

Venue: E104-105 (First Floor)

First Author: : M.Garcķa-Fernįndez SPAIN

Co Author(s): :    M. Naveiras   B. Martķn-Escuer   J. Alfonso        

Abstract Details


To evaluate refractive and functional outcomes, stereopsis and patient satisfaction after asymmetric implantation of a myopic phakic intraocular lens (ICM) and an apodized diffractive lens (ReSTOR).


Instituto Oftalmológico Fernįndez-Vega, Oviedo, Spain.


This study comprised 12 eyes of six patients who had implantation of an ICM in one eye and an apodized diffractive intraocular lens lens (ReSTOR) in the fellow eye. In three patients: one eye had undergone phacoemulsification with implantation of ReSTOR due to the presence of a posttraumatic cataract, and the fellow eye underwent ICL implantation for correction of the remaining myopic anisometropia. In the other three patients, who had previous bilateral implantation of an ICM: one eye underwent phacoemulsification with implantation of ReSTOR due to the development of anterior subcapsular cataract (related to low vaulting). The main analyzed parameters were: Best Corrected Visual Acuity (BCVA)(logMAR), spherical equivalent (SE), refractive and keratometric astigmatism, endothelial cell count (EC) and intraocular pressure (IOP). A binocular vision study (including cover test, ocular motility, Worth test and stereopsis test- Titmus and Random Dot E) was performed at last visit. Mean follow-up period was 28.50±20.2 (range: 6-60) months.


In eyes with ICL implantation: mean BCVA (logMAR) improved from 0.06±0.10 (range:0.00-0.20) to 0.01±0.04 (range:0.00-0.10) postoperatively (p>0.05).Mean Security Index (SI) was1.12±0.19. Mean preoperative SE was -8.18±4.21 diopters (D) and at last follow-up it was -0.31±0.56 D (p<0.05). The mean refractive cylinder diminished from -2.58±1.71 to -0.12±0.58 D (p<0.05). The mean keratometric astigmatism diminished by 0.79±0.67 D (p>0.05). In eyes with ReSTOR implantation: mean BCVA (logMAR) improved from 0.10±0.13 (range:0.00- 0.30) to 0.01±0.40 (range:0.00-0.10) (p>0.05). Mean SI was 1.40±0.45. Mean postoperative SE (-0.03±.30) was significantly better (p<0.05) than preoperative SE (-6.72±3.69). The mean refractive astigmatism decreased from -2.70±2.45 to -0.54±0.64 D (p<0.05) after surgery. The mean keratometric astigmatism decreased by 0.81±0.34 D (p>0.05). EC and IOP did not experienced significant changes during follow-up period (p>0.05). Binocular vision studies showed presence of vertical phoria in 2 eyes, and microesotropia in 1 eye. Ocular motility and Worth test were normal in all patients. Mean stereoscopic visual acuity (SVA) in near vision was 68.66±52.80 seconds of arc and in far vision there was absence of stereopsis. The smaller the preoperative myopic anisometropia the better the postoperative SVA. High rates of patient satisfaction were found in all cases after surgeries.


Asymmetric implantation of an ICM and a diffractive lens ReSTOR is a safe procedure, that yields good refractive and functional outcomes. The SVA in near vision is acceptable, and high rates of patient satisfaction can be reached.

Financial Interest:


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