Accommodation after Nd: YAG capsulotomy in patients with accommodative posterior chamber lens 1CU.

ABSTRACT

PURPOSE: After initial encouraging results with the accommodative 1CU posterior chamber lens (PCIOL), we investigated the rate, the postoperative time point of posterior capsular opacification (PCO) necessitating YAG capsulotomy and the accommodative range after Nd YAG capsulotomy in patients with 1CU-PCIOL. PATIENTS AND METHODS: This prospective clinical study included 65 patients who underwent phacoemulsification and implantation of the accommodative 1CU-PCIOL with postoperative follow-up from 3 to 24 months. Postoperative examination was performed 3, 6 and 12 months after surgery, then before and 6 weeks after Nd YAG capsulotomy. Measurements included the best corrected distance visual acuity, distance refraction, near visual acuity (Birkhauser charts in 35 cm) obtained with best distance correction, accommodative range measured by subjective near point with an accodommometer and defocusing with a visual acuity fall to 0.4. RESULTS: Both best corrected distance visual acuity (1.1+/-0.1) and near visual acuity with best distance correction (0.4+/-0.1) remained stable over the follow-up period until 12 months postoperatively. The accommodative range determined by near point was stable (mean 2.0+/-0.5 D). Also, the defocusing range remained stable over 12 months (1.8+/-0.4 D). A clinically relevant posterior capsule opacification with a significant decrease of visual acuity (0.4+/-0.2) and a need for Nd YAG capsulotomy was diagnosed in 12 patients between 15 and 22 (mean 20+/-4, median 20) months postoperatively. All capsulotomies were performed without complication. Six weeks after capsulotomy, best corrected distance visual acuity was improved (1.1+/-0.1), near visual acuity with best distance correction was 0.4+/-0.1 and the accommodative range determined by near point was 1.95+/-0.6 D and by defocusing was 1.88+/-0.47 D. Six weeks after capsulotomy, measurements of the accommodative range did not show any statistical difference to the 12-month results before the occurrence of PCO (P>0.5). CONCLUSIONS: A clinically relevant PCO with a significant decrease of visual acuity necessitating Nd YAG capsulotomy occurred mainly after 15 postoperative months in patients with 1CU. Our results indicate that Nd YAG capsulotomy may not affect the accommodation ability of the 1CU. Nevertheless, long-term studies are needed to further analyze the accommodative properties.