Clinical Outcomes After Microincision Cataract Surgery and In-the-bag Implantation of a New Intraocular Lens

Chul Jin Shin; Joo Eun Lee; Jae Hyung Lee; Jae Yong Kim; Hungwon Tchah

doi:10.3341/jkos.2010.51.5.677

Journal List > J Korean Ophthalmol Soc > v.51(5) > 1008808

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Shin, Lee, Lee, Kim, and Tchah: Clinical Outcomes After Microincision Cataract Surgery and In-the-bag Implantation of a New Intraocular Lens

Original Article

J Korean Ophthalmol Soc 2010;51(5):677-683.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.5.677

Clinical Outcomes After Microincision Cataract Surgery and In-the-bag Implantation of a New Intraocular Lens

Chul Jin Shin, MD, Joo Eun Lee, MD, Jae Hyung Lee, MD, Jae Yong Kim, MD, PhD, Hungwon Tchah, MD, PhD

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Hungwon Tchah MD, PhD Department of Ophthalmology, Asan Medical Center #388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea Tel: 82-2-3010-3680, Fax: 82-2-470-6440, E-mail: HungTchah@amc.seoul.kr

Received 5 August 2009 Accepted 9 February 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare visual performance after microincision cataract surgery (MICS) with the implantation of the Akreos MI-60 (MI-60) intraocular lens (IOL) through a 1.8-mm microincision with that after conventional cataract surgery with implantation of the Akreos Adapt-AO IOL (Adapt-AO).

Methods

All MICS procedures were performed by the same surgeon. The MI-60 was implanted into 25 eyes, and the Adapt-AO was place in 28 eyes. Best corrected visual acuity (BCVA), total high-order-aberration (HOA), contrast sensitivity, and surgi-cally-induced astigmatism (SIA) were recorded one-week, one-month, and four-months postoperatively.

Results

There were no statistically significant differences in BCVA between eyes implanted with the MI-60 or those with the Adapt-AO (MI-60 vs. Adapt-AO, 0.09±0.11 at baseline (logMAR), 0.11±0.08 at one-week, 0.06±0.07, 0.06±0.06 at one-month, 0.05±0.06, 0.06±0.05 at four-months according to the Mann-Whitney U test, p＞0.05). Refractive errors were significantly less with the Adapt-AO than with the MI-60 (MI-60 vs. Adapt-AO, −0.50±0.43 at baseline (diopter), −0.06±0.39 at one-week, −0.50±0.41, 0.01±0.57 at one-month, −0.46±0.36, 0.08±0.58 at four-months according to the Mann-Whitney U test, p＜0.05). There were no statistically significant differences in total HOA or contrast sensitivity between eyes implanted with the MI-60 and those implanted with the Adapt-AO. SIAs were significantly reduced in eyes implanted with the MI-60 than in those with the Adapt-AO at one-month and four-months postoperatively (Mann-Whitney U test, p＜0.05).

Conclusions

Implantation with either the MI-60 or the Adapt-AO produced clinically acceptable outcomes, including good spherical aberration and contrast sensitivity. Furthermore, implantation with the MI-60 caused less SIA at one- and four-months postoperation, as compared to that with the Adapt-AO.

Keywords: Contrast sensitivity, Microincision cataract surgery, Phacoemulsification, Spherical aberration, Surgically-induced astigmatism

References

1. Ginsberg AP, Evans DW, Sekuler R, et al. Contrast sensitivity predicts pilots' performance in aircraft simulation. Am J Optom Physiol Opt. 1982; 59:105–9.

2. Pesudovs K, Hazel CA, Doran RM, Elliot DB. The usefulness of Vistech and FACT contrast sensitivity charts for cataract and abdominal surgery outcomes research. Br J Ophthalmol. 2004; 88:11–6.

3. Applegate RA, Hilmantel G, Howland HC, et al. Corneal surface abdominal aberrations and visual performance. J Refract Surg. 2000; 16:507–14.

4. Mierdel P, Kaemmerer M, Mrochen M, et al. Ocular optical aberr-ometer for clinical use. J Biomed Opt. 2001; 6:200–4.

5. Bhattacharjee H, Bhattacharjee K, Medhi J. Visual performance: abdominal of foldable intraocular lenses. J Cataract Refract Surg. 2006; 32:451–5.

6. Agarwal A, Agarwal A, Agarwal S, et al. Phakonit: phacoemulsification through a 0.9 mm corneal incision. J Cataract Refract Surg. 2001; 27:1548–52.

7. Agarwal A, Agarwal S. Phakonit with an AcriTec IOL. J Cataract Refract Surg. 2003; 29:854–5.

8. Fine IH, Hoffman RS, Packer M. Optimizing refractive lens exchange with bimanual microincision phacoemulsification. J Cataract Refract Surg. 2004; 30:550–4.

9. Braga-Mele R, Liu E. Feasibility of sleeveless bimanual abdominal with the Millenium microsurgical system. J Cataract Refract Surg. 2003; 29:2199–203.

10. Mackool RJ. Temperature during bimanual phacoemulsification. J Cataract Refract Surg. 2004; 30:732.

11. Soscia W, Howard J, Olson R. Bimanual phacoemulsification through 2 stab incision a woundtemperature study. J Cataract Refract Surg. 2002; 28:1039–43.

12. Soscia W, Howard JG, Olson RJ. Microphacoemulsification with WhiteStar. A woundtemperature study. J Cataract Refract Surg. 2002; 28:1044–6.

13. Olson RJ. Clinical experience with 21-gauge manual microphacoemulsification using Sovereign Whitestar technology in eyes with dense cataract. J Cataract Refract Surg. 2004; 30:168–72.

14. Alio JL, Rodriguez Prats JL, Galal A. Advances in microincision abdominal surgery intraocular lenses. Curr Opin Ophthalmol. 2006; 17:80–93.

15. Hill W. Expected effects of surgically induced astigmatism on AcrySof toric intraocular lens results. J Cataract Refract Surg. 2008; 34:364–7.

16. Donnenfeld ED, Olson RJ, Solomon R, et al. Efficacy and woundtemperature gradient of whitestar phacoemulsification through a 1.2 mm incision. J Cataract Refract Surg. 2003; 29:1097–100.

17. Steinert RF, Brint SF, White SM, et al. Astigmatism after small incision cataract surgery. A prospective, randomized, multicenter comparison of 4- and 6.5 mm incisions. Ophthalmology. 1991; 98:417–23.

18. Alió JL, Piñero DP, Ortiz D, Montalbán R. Clinical outcomes and postoperative intraocular optical quality with a microincision aberration-free aspheric intraocular lens. J Cataract Refract Surg. 2009; 35:1548–54.

19. Tong N, He JC, Lu F, et al. Changes in corneal wavefront aberrations in microincision andsmall-incision cataract surgery. J Cataract Refract Surg. 2008; 34:2085–90.

20. Denoyer A, Denoyer L, Marotte D, et al. Intraindividual comparative study of corneal and ocular wavefront aberrations after biaxial abdominal versus coaxial small-incision cataract surgery. Br J Ophthalmol. 2008; 92:1679–84.

21. Wilczynski M, Supady E, Piotr L, et al. Comparison of surgically abdominal astigmatism after coaxial phacoemulsification through 1.8 mm microincision and bimanual phacoemulsification through 1.7 mm microincision. J Cataract Refract Surg. 2009; 35:1563–9.

22. Milla E, Verges C, Cipres M. Corneal endothelium evaluation after phaocoemulsification with continuous anterior chamber infusion. Cornea. 2005; 24:278–82.

23. Choi JA, Kim CY, Na KS, et al. Clinical results after implantation of a spherical aberration-free intraocular lens: Effect of contrast sensitivity and wavefront aberration-a clinical comparative study. Ophthalmologica. 2009; 223:320–5.

Figure 1.

(A) Contrast sensitivity test results of Akreos MI-60 and Akreos Adapt-AO IOL-implanted groups in photopic condition at postoperative 1 month (Mann-Whitney U test, P>0.05). (B) Contrast sensitivity test result of Akreos MI-60 and Akreos Adapt-AO IOL-implanted groups in mesopic condition at postoperative 1 month (Mann-Whitney U test, ^* P=0.03).

Figure 2.

(A) Contrast sensitivity test result of Akreos MI-60 and Akreos Adapt-AO IOL-implanted groups in photopic condition at postoperative 4 months (Mann-Whitney U test, P>0.05). (B) Contrast sensitivity test result of Akreos MI-60 and Akreos Adapt-AO IOL-implanted groups in mesopic condition at postoperative 4 months (Mann-Whitney U test, P>0.05).

Figure 3.

Comparison of preoperative and postoperative astigmatism between Akreos MI-60 IOL-implanted group and Akreos Adapt-AO IOL-implanted group. (^* Mann-Whitney U test, P<0.05)

Table 1.

Comparison of sex, age, preoperative BCVA, axial length, IOL power between akreos MI-60 IOL-im-planted group and akreos Adapt-AO IOL-implanted group (Mean± SD^†)

	Akreos MI-60	Akreos Adapt-AO	P value^*
Number of eyes	25	28
Age (years)	67.88±8.97	69.96±6.34	P>0.05
BCVA^‡ (logMAR)	0.39±0.15	0.38±0.21	P>0.05
Axial length (mm)	23.51±0.72	23.19±0.51	P>0.05
IOL Power^§ (diopter)	21.00±1.46	20.93±1.04	P>0.05
Sex (M:F)	1:1	3:4

^* Mann-Whitney U test

^† SD=standard deviation

^‡ BCVA=best corrected visual acuity

^§ IOL power=intraocular lens power.

Table 2.

Comparison of postoperative BCVA, spherical equivalent, refractive error between akreos MI-60 IOL-implanted group and akreos Adapt-AO IOL-implanted group (Mean± SD^†)

Results	Group	Post OP 1week	Post OP 1month	Post OP 4months
BCVA^‡ (logMAR)	MI-60	0.09±0.11	0.06±0.07	0.05±0.06
	ADAPT-AO	0.11±0.08	0.06±0.06	0.06±0.05
Spherical equivalent (diopter)	MI-60	–0.86±0.85^*	–0.83±0.78^*	–0.74±0.85^*
	ADAPT-AO	–0.36±0.70^*	–0.25±0.81^*	–0.21±0.90^*
Refractive error^§ (diopter)	MI-60	–0.50±0.43^*	–0.50±0.41^*	–0.46±0.36^*
	ADAPT-AO	–0.06±0.39^*	0.01±0.57^*	0.08±0.58^*

^* Mann-Whitney U test (P<0.05)

^† SD=standard deviation

^‡ BCVA=best corrected visual acuity

^§ Refractive error=postoperative spherical equivalent-target refraction.

Table 3.

Comparison of postoperative total high order aberration, spherical aberration, coma aberration between akreos MI-60 IOL-implanted group and akreos Adapt-AO IOL-implanted group (Mean± SD^†)

Results	Group	Post OP 1week	Post OP 1month	Post OP 4months
RMS HoA_‡	MI-60	0.657±0.153^**	0.649±0.188^**	0.753±0.251^**
	ADAPT-AO	0.755±0.102^*	0.826±0.262^*	0.643±0.163^*
Spherical aberration	MI-60	0.394±0.110^**	0.399±0.147^**	0.424±0.110^**
	ADAPT-AO	0.412±0.141^*	0.413±0.134^*	0.408±0.103^*
Coma aberration	MI-60	0.233±0.140^**	0.286±0.126^**	0.338±0.243^**
Coma aberration	ADAPT-AO	0.328±0.150^*	0.370±0.326^*	0.311±0.225^*

^* Mann-Whitney U test (P>0.05)

^† SD=standard deviation

^‡ RMS HoA=root mean square of total high order aberrations.

Table 4.

Comparison of postoperative surgically induced astigmatism between Akreos MI-60 IOL-implanted group and akreos Adapt-AO IOL-implanted group (Mean± SD^†)

Results	Group	Post OP 1week	Post OP 1month	Post OP 4months
SIA_‡	MI-60	0.662±0.685	0.417±0.503^**	0.394±0.235^**
SIA_‡	ADAPT-AO	0.936±0.863	1.040±0.857^*	0.594±0.299^*

^* Mann-Whitney U test (P<0.05)

^† SD=standard deviation

^‡ SIA=surgically induced astigmatism.

Table 5.

Comparison of preoperative and postoperative astigmatism between akreos MI-60 IOL-implanted group and akreos adapt-AO IOL-implanted group (Mean± SD^†)

Results	Group	Pre OP	Post OP 1week	Post OP 1month	Post OP 4months
Astigmatism	MI-60	0.656±0.659^**	0.800±0.655	0.530±0.565	0.676±0.524
Astigmatism	ADAPT-AO	1.090±0.767^*	0.790±0.612	0.670±0.681	0.691±0.524

^* Mann-Whitney U test (P<0.05)

^† SD=standard deviation.

Table 6.

Comparison of postoperative anterior chamber depth between akreos MI-60 IOL-implanted group and akreos adapt-AO IOL-implanted group (Mean± SD^†)

Results	Group	Post OP 1week	Post OP 1month	Post OP 4months
ACD_‡	MI-60	3.948±0.288^**	3.858±0.496	3.682±0.664
ACD	ADAPT-AO	3.721±0.376^*	3.762±0.459	3.784±0.488

^* Mann-Whitney U test (P<0.05)

^† SD=standard deviation

^‡ ACD=anterior chamber depth.

Table 7.

Comparison of postoperative refractive error and anterior chamber depth between akreos MI-60 IOL-implanted group A and B (Mean± SD^†)

	Akreos MI-60 A^‡	Akreos MI-60 B^§	P value^*
Number	17	8
RE^∏ post OP 1week	–0.399±0.369	–0.733±0.684	P=0.198
RE^∏ post OP 1month	–0.383±0.423	–0.719±0.404	P=0.076
RE^∏ post OP 4months	–0.383±0.406	–0.528±0.520	P=0.904
ACD^∏ post OP 1week	3.935±0.353	3.973±0.081	P=0.743
ACD^∏ post OP 1month	3.813±0.549	3.949±0.393	P=1.000
ACD^∏ post OP 4months	3.677±0.582	3.698±0.955	P=0.933

^* Mann-Whitney U test

^† SD=standard deviation

^‡ group A=IOL power ≤22.0 diopter

^§ group B=IOL power ≥22.5 diopter

^∏ RE=refractive error

^＃ ACD=anterior chamber depth.

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