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Various Measurements of Accommodation after Implantation of an Accommodative Posterior Chamber Intraocular Lens (1 CU)

1Huber S., 2Langenbucher A., 2Seitz B., 2Nguyen N. X., 2Küchle M.,
1HumanOptics AG (Erlangen)
2Friedrich-Alexander-Universität, Augenklinik (Erlangen)

Purpose: To give an overview on and a comparison of different techniques of measuring pseudoaccommodation after cataract surgery for a new accommodative posterior chamber lens (PCIOL).
Methods and Patients: Accommodation can be measured in a dynamic fashion with objective (videorefractometry (PowerRefractor), streak retinoscopy) and subjective (subjective near point (NP), defocusing) as well as statically with pharmacologic stimulation in miosis after 2% pilocarpine directly (conventional refractometry) or indirectly (change of the anterior chamber depth (ACD) with IOL-Master or ultrasonography (US)). We analyzed the results of a prospective study on twenty-three eyes of twenty-one patients (age 41-87 years), who underwent cataract surgery and PCIOL implantation (1 CU, HumanOptics AG, Erlangen, Germany) with a follow up of at least 3 month.
Results: After six months our observations (mean, SD, range and median) included: Near visual acuity with distance correction 0.32±0.11, 0.2-0.6, 0.3; the accommodation amplitude was 1.00±0.44, 0.75-2.13, 1.0 D (PowerRefractor), 0.99±0.48, 0.13-2.0, 0.88 D (retinoscopy), 1.6±0.55, 0.5-2.56, 1.7 D (NP), 1.46±0.53, 1.0-2.5, 1.75 D (defocusing). ACD decreased 0.78±0.12, 0.59-0.26, 0.65 mm (Zeiss IOL-Master) and 0.63±0.15, 0.34-1.12, 0.66 mm (US) indicating a pseudoaccommodation of 1.40 and 1.13 D on average based on Gullstrand's model eye. The most stable indicators with the lowest fluctuation between follow-up examinations were the NP, the defocusing technique, followed by the ACD decrease as assessed with the IOL-Master.
Conclusions: Pseudoaccommodation should be measured with different techniques to validate the results. For a dynamic measure, the subjective near point assessed with the accommodometer revealed the most stable results over time on this new accommodative PCIOL.