Comparison of visual function following piggyback implantation of Acrysof ReSTOR intraocular lenses with Tecnis multifocal ZM900 intraocular lenses.

1
Comparison of visual function following piggyback
implantation of Acrysof ReSTOR intraocular lenses
with Tecnis multifocal ZM900 intraocular lenses.
Rodrigo Vaz, MD Leonardo Akaishi, MD Patrick F.
Tzelikis, MD
None of the authors has a financial or
proprietary interest in any material or method
mentioned.
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Purpose

• To compare the postoperative outcome of piggyback
  implantation using the AcrySof ReStor lens with
  Tecnis ZM900 multifocal intraocular lenses (IOL).

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Material / Methods

• This prospective comparative study included
  patients with age-related cataract, primary
  hyperopia or hyperopic astigmatism, a normal
  ophthalmologic examination besides senile
  cataract, and unsatisfactory correction with
  glasses.
• Information collected included uncorrected visual
  acuity (UCVA) for near and distance, best
  corrected visual acuity (BCVA), and spherical
  equivalent (SE) before and after the surgery.
• All patients were followed for 6 months

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Material / Methods

• The three lenses used in this study were TECNIS
  ZM900 multifocal IOL, AcrySof ReStor and
  CLARIFLEX.
• The multifocal IOL (Tecnis ZM900 or AcrySof
  ReStor) was first implanted in the capsular bag
  and the Clariflex lens was implanted second in
  the ciliary sulcus.

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Material / Methods

• The TECNIS multifocal IOL (Model ZM900, AMO,
  Santa Ana, CA) is a 3-piece diffractive
  multifocal lens with 6.00 mm polysiloxane optic.
• The AcrySof ReSTOR (Model SA60D3, Alcon
  Surgical Laboratories, Dallas, Texas) is an
  acrylic foldable single-piece IOL.
• The CLARIFLEX (Model AMO, Advanced Medical
  Optics, Santa Ana, California) is 3-piece
  monofocal lens with 6.00 mm biconvex square-edged
  silicone optic and 10-degree angulated C
  polymethyl-methacrylate (PMMA) haptics.

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Material / Methods

• The Holladay formula was used to calculate the
  IOL power when there was a short axial length (lt
  22.0 mm) and the SRK/T formula was used when
  there was an average axial length ( 22.0 mm).
  The A-constant used was 119.8 for the TECNIS
  multifocal IOL, 118.6 for the AcrySof ReStor and
  118.4 for the CLARIFLEX IOL. Axial length was
  measured with the IOL Master (Carl Zeiss Meditec
  AG), and the targeted postoperative refractive
  error was 0.0

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Results
Teste t Student (SPSS)
Preoperative Tecnis ZM900 (n20 eyes) ReStor (n21 eyes) P value
Axial length 20.80 mm (SD0.80) 21.68 mm (SD0.39) Plt0,001
Power IOL (D) 26.75 D (SD 1.95) 22.0 D (SD 1.75) Plt0.001
UCVA 0.08 (20/250) (SD 0.11) 0.25 (20/80) (SD 0.06) Plt0.001
BCVA 0.67 (20/30) (SD 0.08) 0.9 (20/22) (SD 0.17) P0.02
SE 6.25 D (SD 2.25) 4.25 D (SD 1.55) P0.002
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Results
Teste t Student (SPSS)
Postoperative (6 months) Tecnis ZM900 (n20 eyes) ReStor (n21 eyes) P value
UCVA for distance 0.67 (20/30) (SD 0.15) 0.86 (20/23) (SD 0.16) P0.002
UCVA for near 33 cm J1 J1 P0.14
BCVA for distance 0.90 (20/22) (SD 0.10) 1.00 (20/20) (SD 0.05) P0.002
BCVA at 60 cm J4.5 J5 P0.08
SE 0.00 D (SD 0.45) -0.25 D (SD 0.40) P0.06
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Results
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Results

• After a follow-up of 6 months, halos were
  reported as severe by 8.3 , moderate by 33.3
  and absent or mild by 58.4 of patients in the
  Tecnis group. In the ReStor group halos were
  reported as severe by 9.0, moderate by 27.3
  and absent or mild by 63.7.
• No interlenticular opacification (ILO) or another
  postoperative complication related to piggyback
  lenses was observed in our series.

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Conclusion

• Overall, the use of a multifocal IOL in a
  piggyback fashion appears to be a safe and
  efficient procedure and a good refractive
  solution.
• Implanting 2 piggyback IOLs was beneficial in
  eyes with short axial length. The AcrySof ReSTOR
  IOL gave better outcomes than the Tecnis
  multifocal IOL in UCVA and BCVA for distance,
  probably because in the Tecnis group the eyes had
  shorter axial length and required higher diopter
  lenses.