Clinical Research Of Accommodation And Visual Quality With A New Generation Accommodating Aspherical Intraocular Lens

ObjectiveTo compare the subjective and objective accommodation amplitude and visual quality of patients after phacoemulsification combined the accommodating aspherical intraocular lens（IOL） and two different haptic design monofocal aspherical IOL, providing a reference for cataract patients choosing appropriate intraocular lenses. Methods64 patients（85 eyes）underwent phacoemulsification and IOL implantation in Tianjin Eye Hospital from May to December 2014 were analyzed. 21 patients（27eyes） were implanted with Tetraflex HD accommodating aspherical IOL, 20 patients（28 eyes） were implanted with Akreos AO 4-plate monofocal aspherical IOL and 23 patients（30 eyes） were implanted with Softec HD C-loop monofocal aspherical IOL. Every visits, uncorrected distance visual acuity（UDVA）, corrected distance visual acuity（CDVA）, uncorrected near visual acuity（UNVA）, corrected near visual acuity（CNVA）, distance-corrected near visual acuity（DCNVA）, sphere, cylinder and subjective spherical equivalent（SE） refrection were evaluated; Ocular sphere aberration was measured by i-Trace aberrometer; Measured pupil diameter, objective scatter index（OSI）, objective accommodation amplitude and objective visual quality index including modulation transfer function（MTF） cut off, Strehl Ratio（SR） and contrast visual acuity（OV100%, OV20%, OV9%） were measured with OQASⅡ;subjective accommodation amplitude were measured by defocus method. Statistical analysis was performed using SPSS for Windows software（version 17.0）.Categorical parameters were compared by Pearson X2 test. Preoperatively continuous parameters were compared by the analysis of variance（ANOVA）. The difference between groups and between different time points were compared using the repeated measurement two-factor analysis of variance. A P value less than 0.05 was considered statistically significant.ResultsNo significant difference was found between groups or time points in measured pupil diameter(F_groups=2.058, P=0.134; F_time=0.405, P=0.805), in ocular sphere aberration(F_groups=0.096, P=0.909; F_time=1.448, P=0.218), and in cylinder(F_groups=0.007, P=0.993; F_time=0.557, P=0.694).Differences in sphere and SE were not significant between groups(F_groups=0.002, P=0.998; F_groups=0.000, P=1.000), but were significant between time points(F_time=3.237, P=0.042; F_time=3.837, P=0.025). Sphere and SE reduced from preoperation to 3 month and 6month postoperatively（P<0.05） and from 1 week to 6 month postoperatively（P<0.05）.Differences in UDVA, CDVA and CNVA were not significant between groups(F_groups=0.496, P=0.611; F_groups=0.353, P=0.703; F_groups=0.083,P=0.921), but were significant between time points(F_time=601.575, P=0.000; F_time=220.426,P=0.000; F_time=313.811, P=0.000). UDVA, CDVA and CNVA improved after surgery（P<0.01） and from 1 week to 1 month and 3 month postoperatively（P<0.05）, but reduced from 1 month and 3 month to 6 month postoperatively（P<0.05）. UDVA improved but CNVA decreased from 1 month to 3 month postoperatively（P<0.05）. CNVA decreased from 1 week to 6 month postoperatively（P<0.05）.Differences in UNVA and DCNVA were found between groups(F_groups=139.314, P=0.000; F_groups=151.275, P=0.000) and between time points(F_time=247.077, P=0.000; F_time=216.862,P=0.000). Tetraflex HD group had better UNVA and DCNVA than the other two groups（P<0.01）, and Akreos AO group had a tendency to be better than Softec HD group（P=0.098; P=0.149）. UNVA and DCNVA improved after surgery（P<0.01） and from 1 week to 1 month postoperatively（P<0.05）, but reduced from 1 month to 3 month postoperatively（P<0.05） and from 1 week, 1 month and 3 month to 6 month postoperatively（P<0.05）.Differences in OSI were not significant between groups(F_groups=0.301, P=0.741), but were significant between time points(F_time=361.706,P=0.000). OSI decreased after surgery（P<0.01） and from 1 week to 1 month and 3month postoperatively（P<0.01）, but increased from1 month and 3 month to 6 month postoperatively（P<0.01）.Differences in MTF cut off, SR, OV100%, OV20%, OV9% were not significant between groups(F_groups=0.465, P=0.630; F_groups=0.679, P=0.510;F_groups=0.494,P=0.612; F_groups=0.323, P=0.725; F_groups=0.074, P=0.929), but were significant between time points(F_time=291.318, P=0.000; F_time=200.535, P=0.000; F_time=250.104, P=0.000; F_time=266.539, P=0.000; F_time=183.043, P=0.000). The MTF cut off, SR, OV100%, OV20%, OV9% improved after surgery（P<0.01）, from 1 week to 1 month and 3 month postoperatively（P<0.01） and from 1 month to 3 month postoperatively（P<0.05）, but decreased from1 month and 3 month to 6 month postoperatively（P<0.01）.Differences in objective and subjective accommodation amplitude were found between groups(F_groups=47.624, P=0.000; F_groups=54.941, P=0.000) and between time points(F_time=19.732, P=0.000; F_time=15.888,P=0.000). Tetraflex HD group had better objective and subjective accommodation amplitude than the other two groups（P<0.01）, and Akreos AO group had a tendency to be better than Softec HD group（P=0.063; P=0.085）.The objective and subjective accommodation amplitude postoperatively improved from 1 week to 1 month（P<0.01）, but decreased from 1 month to 3 month and 6 month（P<0.01） and from 3 month to 6 month（P<0.01）. The objective accommodation amplitude improved from 1 week to 3 month postoperatively（P<0.05）. The subjective accommodation amplitude decreased from 1 week to 6 month postoperatively（P<0.05）. ConclusionNot only Tetraflex HD accommodating aspherical IOL provided patients similar distance visual acuity and objective visual quality, but also better near visual acuity, objective and subjective accommodation amplitude to monofocal aspherical IOL.The objective and subjective accommodation amplitude and near visual acuity of Tetraflex HD accommodating aspherical IOL decreased with time, but the long-term effect remains to be further researched.The objective and subjective accommodation amplitude and near visual acuity of Akreos AO 4-plate monofocal aspherical IOL had a tendency to be better than Softec HD C-loop monofocal aspherical IOL.