Laserinterferometric assessment of pilocarpine-induced movement of an accommodating intraocular lens: a randomized trial.
OBJECTIVE
To measure the axial movement of an accommodating intraocular lens (IOL) induced by ciliary muscle contraction after application of pilocarpine.


METHODS
Randomized, controlled, patient- and examiner-masked trial with intrapatient comparison.


METHODS
One hundred ten eyes of 55 patients with age-related bilateral cataract.


METHODS
This study was divided into 3 parts. In the first, the accommodating IOL (1CU) was compared with a 3-piece open-loop acrylic IOL that served as the control. In the second, to assess the effect of capsule fibrosis on the potential accommodating performance of the accommodating IOL, extensive polishing of the anterior capsule with a slit cannula was compared with standard surgery. In the third, the effect of a posterior capsulorhexis was compared with that of standard surgery. Anterior chamber depth (ACD) was assessed with partial coherence interferometry, measured before and after topical application of pilocarpine 2%, and near visual acuity (VA) was evaluated 3 months after surgery.


METHODS
Pilocarpine-induced change in ACD.


RESULTS
The accommodating IOL showed a forward movement under pilocarpine with a median amplitude of movement of -314 microm (95% confidence interval [CI]: -148 to -592), compared with the backward movement of 63 microm (95% CI: 161 to -41) for the open-loop control IOL (P = 0.001). Capsule polishing and a posterior capsulorhexis had no effect on IOL movement with the accommodating IOL. The median near VA with distance correction was 20/60.


CONCLUSIONS
Pilocarpine induced a small but significant forward movement of the accommodating IOL. However, the amount of movement was calculated to result in a refractive change of <0.5 diopters (D) in most patients, reaching 1 D or slightly more in only single cases, with a large variability of movement. Neither polishing of the capsule bag nor a posterior capsulorhexis could enhance the accommodative ability.
Findl
Oliver
O
Department of Ophthalmology, University of Vienna, Austria. oliver.findl@meduniwien.ac.at
Kriechbaum
Katharina
K
Menapace
Rupert
R
Koeppl
Christina
C
Sacu
Stefan
S
Wirtitsch
Matthias
M
Buehl
Wolf
W
Drexler
Wolfgang
W
D000065:Accommodation, Ocular / Q000502:physiology*; D000368:Aged; D000369:Aged, 80 and over; D002924:Ciliary Body / Q000187:drug effects; D005260:Female; D005355:Fibrosis; D006801:Humans; D007368:Interferometry / Q000379:methods; D007834:Lasers; D007903:Lens Capsule, Crystalline / Q000473:pathology; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D008916:Miotics / Q000494:pharmacology*; D009119:Muscle Contraction / Q000502:physiology*; D009130:Muscle, Smooth / Q000187:drug effects*; D010862:Pilocarpine / Q000494:pharmacology*; D011446:Prospective Studies; D014792:Visual Acuity
D008916:Miotics; D010862:Pilocarpine