Unilateral Sulcus Implantation of the Crystalens HD
To evaluate the results after unilateral sulcus implantation of the Crystalens HD (Bausch & Lomb) accommodative intraocular lens (IOL).
This retrospective interventional case series comprised six eyes from three patients who underwent cataract surgery and bilateral Crystalens HD accommodative IOL implantation. The Crystalens HD was implanted in the bag in one eye (non-sulcus group) and, due to posterior capsule rupture, the lens was positioned in the ciliary sulcus in the fellow eye (sulcus group).
Mean patient age was 66.3 ± 4.9 years (range: 60 to 72 years). Mean follow-up was 14.3 ± 3.2 months (range: 12 to 18 months) for the non-sulcus group and 14 ± 2 months (range: 12 to 16 months) for the sulcus group. Uncorrected distance visual acuity improved from 20/100 to 20/33 in the non-sulcus group and from 20/63 to 20/32 in the sulcus group during last follow-up. Corrected distance visual acuity improved from 20/35 to 20/20 in the non-sulcus group and from 20/27 to 20/23 in the sulcus group. Regarding near vision, all eyes in the sulcus group and 66.7% of eyes in the non-sulcus group achieved J1-J2 (Birkhauser reading chart). None of the eyes had any intra- (except posterior capsule rupture in the sulcus cases) or postoperative complications.
Based on this small series, ciliary sulcus implantation of the Crystalens HD seems to be associated with no significant morbidity and provides satisfactory visual acuity outcomes.
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ABSTRACT: This study employs optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) imaging as well as optical aberrometry to examine correlations between the anterior chamber angle aperture and visual acuity for near vision as well as coma along the horizontal and vertical axes in eyes implanted with an accommodative intraocular lens (Crystalens). A retrospective comparative consecutive case series of 22 eyes of 11 patients (5 males) uneventfully implanted with a Crystalens. Eyes with signs of posterior capsular opacification were excluded. All eyes were examined with 40 MHz UBM (Ellex Eyecubed) and spectral-domain OCT (Zeiss Visante). The angle aperture along the horizontal and vertical meridians was recorded based on the software of the systems. The coma root mean square (RMS) scores for the horizontal and vertical meridians were also recorded with the iTrace aberrometer. The anterior chamber angle was significantly wider along the horizontal axis compared with the vertical axis by UBM (46.37° and 44.20°, respectively) and by OCT (46.79° and 43.58°, respectively) (p = 0.02 in both cases, paired-samples t test). The correlations between the logMAR-converted Jaeger near vision score and the horizontal or vertical angle apertures was not statistically significant. Horizontal coma RMS was significantly inversely correlated with the horizontal angle aperture (r = -0.45, p = 0.03 and r = -0.39, p = 0.04 by OCT and UBM, respectively). Measurement of the horizontal angle aperture by the modalities used may represent an anatomical and clinical predictor of the optical aberrations induced by the Crystalens.
Available from: David P Pinero
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ABSTRACT: Presbyopia is an age-related physiological condition that causes a gradual loss in the ability to focus on near objects, secondary to changes in zonular fibers, ciliary muscle and crystalline lens. Different surgical approaches are being pursued to surgically compensate presbyopia, such as corneal techniques or implantation of multifocal intraocular lenses (IOLs); however, their inability to restore accommodation has led to the development of single-optic positional accommodative IOLs. The axial shift, with the contraction of the ciliary muscle, of these IOLs increases the refractive power of the eye, improving the level of uncorrected near vision. Single-optic positional accommodative IOLs present few disturbances and larger ocular aberrations that improve near vision. However, reduced amplitudes of accommodation are obtained, little IOL shifts are measured and overall visual outcomes are limited.
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