First Author: H.Kaymak GERMANY
Co Author(s): D. Breyer K. Klabe C. Pohl 0 0 0 0 0 0 0 0 0
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Previously the concomitant of cataract and macula pucker seduced surgeons to implant exclusively monofocal IOL in combination with a pars plana vitrectomy (ppV). The current MIOL spectrum requires a reconsideration, since characteristics like light transmission and photopsia show remarkable progress. The current study presents first clinical results after combined implantation apsheric, toric or multifocal IOL in combination with ppV.
Breyer Kaymak Eye Surgery, Duesseldorf/Germany; Eye Clinic Marienhospital, Duesseldorf/Germany; Internationale Innovative Ophthalmosurgery IIO, Duesseldorf/Germany
Results of patients of three different combination with vitrectomy were analyzed retrospectively: implantation of asperic IOL (group 1), toric (group 2) or multifocal IOL (group 3, case presentations). Analysis comprised macula morphology via OCT and autofluorescence, visual acuity (VA) with ETDRS chart and check for presence and intensity of metamorphopsies by Amsler-Test in all three groups. Group 1 was additionally checked for centration and tilt of IOL after 2 to 4 weeks postoperatively via a Purkinjemeter. Group 2 was additionally analyzed for rotational stability. Group 3 was analyzed for additional VA for near ind intermediate distance as well as asked for contentment concerning VA and photopsia. In group A and C only patients with diagnosed pucker on one eye but cataract in both eyes were included for this analysis, so that intraindivual analysis was possible (referred in the following to as „cat+ppv“ or „cat only“ eyes).
All patient underwent cataract surgery and vitrectomy successfully, no complication occurred. Postoperative OCT analysis revealed further successful removal of pucker and macular smoothing. Uncorrected monocular VA for far distance was 0.08 logMAR (group A), 0.1 logMAR (group B) and 0.0 logMAR (group C, case presentation). Metamorphopsies were in all cases reduced but remained to a detecable extent postoperatively. Horizontal and vertical decentration in group A showed an increased mean decentration in „cat+ppV“-eyes than in „cat only“-eyes but remained under the threshold of 0.50 mm for visible decrease of apshericity performance. Group B showed similar rotational stability compared to results after implantatoin of a toric IOL only. Results after simultaneous vitrecomy and implantation of a trifocal IOL (group C) showed a comparable VA to the „cat-only“ eye. Patients were able to read (0.52 logMAR near VA), to work at PCs (0.1 logMAR 70 cm) as well as to conduct vehicles without glasses (0.0 logMAR 4m). Due to low photopsia, nocturnal car trips were unproblematic as well.
The restriction of implantation of monofocal IOL into a pucker diagnosed eye has to be reevaluated. Although vitrectomy results in elevated levels of tilt and decentration measured in patients with apsheric IOLs, results point towards a less strong distressing of zonular fibers as previously assumed. The amount of IOL alignment still allows appropiate IOL positioning which allows apshericity to perform imaging in a standard quality. These results are promising, since toric or multifocal IOLs are even higher susceptible for tilt and decentration. Analyzing rotational stability, results encourage the combination of asymmetric IOLs, which include not only toric but also multifocal refractive IOLs. Results after implantation of a trifocal IOL suggest that todays IOL design enables the patient to achieve good optical performances also at near or intermediate distances, supposed that also a patient´s psychological constition conditiones him for the adaptation to premium IOLs. Results of all three analyzed categories support the idea, that a diagnosed pucker does not exclude the implantation of either aspheric, toric or multifocal IOLs per se which offers a new quality for patients and surgeons as well.