Time course of accommodation after Visian ICLTM implantation

1
Time course of accommodation after Visian ICLTM
implantation
Kazutaka Kamiya MD, PhD, Kimiya Shimizu MD,
PhD Daisuke Aizawa MD, PhD, Hitoshi Ishikawa MD,
PhD Akihito Igarashi MD, and Mari Komatsu MD,
PhD Department of Ophthalmology, Kitasato
University, JAPAN Authors have no financial
interest.
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Background

• Accommodation has hitherto been considered to be
  preserved after ICL implantation by the presence
  of the crystalline lens.
• Considering that the haptics of an ICL
• need to be secured in the ciliary sulcus,
• it is possible that the ciliary muscles
• may be functionally affected by the ICL.
• The purpose of the study is to longitudinally
  assess the amplitude of accommodation in
  ICL-implanted eyes, and to investigate its
  relationship with patient age in such eyes.

IL
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Patients

• Sixty-nine eyes of the 40 consecutive patients
  who underwent Visian ICLTM V4(STAAR Sugical)
  implantation.
• 26 of men and 43 of women
• Patient age
• 36.0 10.2 yo (21 to 59 yo)
• Preoperative refraction
• -10.07 3.49 D(-3.25 to -22.75 D)

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Methods

• Before and 1, 3, 6, 12 months after surgery
• We assessed the amplitude of accommodation with
  an accommodometer (DACOMO, WOC, Japan).
• The amount of accommodation was
• calculated from the far and near points.
• We carried out this measurement
• 5 times.

DACOMO
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Repeatability of the accommodometer
95 LoA 0.61D
- 95 LoA -0.64D
Bland-Altman plots
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Accommodation was transiently impaired in the
early postoperative periods, and then recovered
gradually over time.



6.36 D
5.72 D
5.16 D
4.89 D
4.98 D
The variance of data was statistically
significant (p0.02, ANOVA). Significant
differences between measurements made before
surgery and at 1 month after (p 0.004, Fishers
LSD Test), before and at 3 months after
(p0.007), and before and at 6 months after
(p0.01).
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Before ICL implantation
Pearson correlation coefficient, r-0.665, plt0.01
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After ICL implantation
15
Pearson correlation coefficient, r-0.802, plt0.001
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Accommodation (D)
5
0
20
30
40
50
60
Age (yo)
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Accommodation with vs. without cataract
67 eyes (97)
5.82 D
2 eyes (3)
2.15 D
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Discussion

• Accommodation in patients over 50 yo after ICL
  implantation 2.07 0.72 D, which was nearly
  identical to apparent accommodation after IOL
  implantation (2.01 0.92 D).
• The risk of developing cataracts has been
  significantly increased in older patients.
• A decrease in accommodation with aging may affect
  the continuous flow of the aqueous humor,
  resulting in a higher incidence of cataract.
• In light of the loss of accommodation and the
  higher risk for cataract development, ICL
  implantation may be not suitable for patients
  over 50.

Gonvers M et al, J Cataract Refract Surg,
2003 Lackner B et al, J Cataract Refract Surg,
2004
Petternel V et al, Ophthalmology, 2004 Fujisawa T
et al, Graefes Arch Clin Oph, 2007
Kamiya K et al, Am J Ophthalmol, 2008
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• The accommodation of eyes with cataract was
  considerably lower than that of eyes without
  cataract.
• The increase in the stiffness of the crystalline
  lens and the decrease in contrast sensitivity due
  to opacification may partially account for this
  transient dysfunction of accommodation.
• The mean accommodation of catractous eyes was
  2.18 D preoperatively, and 2.43, 2.08, 1.86, 2.15
  D 1, 3, 6 and 12 months postoperatively,
  respectively.
• It is suggested that the stiffness of the
  anterior subcapsular cataractous lenses may
  remain unchanged.

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Conclusions

• ICL implantation may transiently impair
  accommodative function in the early postoperative
  period, but this function appears to recover
  gradually over time.
• It may be caused by temporal dysfunction of the
  ciliary muscle by ICL fixation.
• The amplitude of accommodation is decreased with
  aging in ICL-fixated eyes as well as normal eyes.

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