New IOL accommodates cataract patients

By Roibeard O h'Éineacháin

NICE - The HumanOptics Accommodative® 1CU IOL can provide cataract patients with near and distance vision sufficient to drive and read without glasses, an Italian researcher told the XX ESCRS Congress.

In a prospective study of 18 eyes of 13 cataract patients who underwent phacoemulsification and implantation of the HumanOptics IOL, 15 eyes had uncorrected distance visual acuity of 20/25 or better and 16 had uncorrected near visual acuity of J3 or better after a mean follow-up of 5.8 months. Follow-up ranged from between three to nine months, Domenico D'Eliseo MD explained.

In addition, 16 eyes (89%) could read at least 0.33 Snellen equivalent characters at 35 cm without any correction, while 15 (83%) could read the same characters while wearing distance correction as well.

Five eyes achieved J1 vision with no correction. Of the remaining eyes, 12 achieved J1 with correction and one eye achieved J2 with correction. The mean correction was 0.75 D and the near point of accommodation of the patients was mean 33.5 cm within a range of between 18 cm and 50 cm.
"These data indicated that more than 80% of the eyes achieved good distance vision and were able to read newspaper prints without any correction and/or with their distance glasses.

"It should be noted that the addition of low refractive powers could greatly improve near vision performance," Dr D'Eliseo said.
All patients in the study, who ranged in age from 58 to 84 years, had preoperative pupil sizes of less than 6.0 mm in mesopic conditions and an endothelial cells density more than 1000 cell/mm2.

None of the patients had pseudoexfoliation syndrome, phacodonesis or damaged zonulae. Intraocular pressure (IOP) was normal in all cases. The cataract grading ranged from 2 + to 3 +.

The HumanOptics lens is composed of a new generation hydrophilic acrylic. It is a foldable single-piece IOL with four hinged haptics to allow the lens to achieve accommodation through the forward and backward movement of the optic along the visual axis of the eye in response to the contraction of the ciliary muscle.
Dr D'Eliseo reported that the implantation technique for the accommodative lens didn't differ from that used with conventional foldable IOLs. After creating a 3.2 mm temporal corneal tunnel incision and a 4.5 to 5.0 mm diameter capsulorhexis, he removed the lens with phacoemulsification.

With the capsular bag filled with viscoelastic material, he then placed the folded accommodative IOL in the cartridge and injected it into the capsular bag. He unfolded the haptics using a special hook and concluded the procedure by closing the incision with a hydro-suture.

The postoperative course was uneventful in all patients during the follow-up. None of the patients developed inflammatory reactions or synechiae. All lenses implanted were well positioned and centred, with no dislocation or vaulting.
Glare was absent in 16 eyes (89%), transient in one eye and persistent in one (5.5%). The mean endothelial cell density decreased from 2,299 cell/mm2 to 1,980 cell/mm2.

Most patients were happy with both their near and distance vision. With regard to distance vision, satisfaction was high in nine, good in three and poor in one.
With near vision, satisfaction was high in five patients, good in six and poor in two. Moreover, four out of five patients who underwent bilateral surgery were highly enthusiastic about the lens.

Dr D'Eliseo noted that the accommodative effect of the lens is not immediate. Generally patients have to wait at least one month so that capsular shrinkage will bring the capsule into close contact with the IOL's haptics.

Among the unresolved problems with the lens is the inability of surgeons to measure the dimensions of the capsular bag prior to surgery for accurate sizing of the haptics. In addition, how YAG capsulotomy affects the accommodative outcome has yet to be clearly established.

"Even if more studies, with more patients and with longer follow-up, are necessary to confirm its accommodative power and safety, our clinical findings seem to indicate the existence of pseudophakic accommodation with this lens.

"The 1CU IOL seems to provide a good uncorrected distance and near vision acuity and should be considered as a modality to allow the pseudophakic patient to see at all distance without glasses," Dr D'Eliseo said.

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