["Refractive" cataract surgery. PMMA IOLs versus foldable IOLs].

OBJECTIVE

Modern cataract surgery claims to achieve the desired refractive result immediately after surgery.

METHODS

In 104 consecutive patients who were operated on with phacoemulsification and scleral incision and received a 6 mm PMMA IOL and in 70 consecutive patients operated on with temporal clear cornea incision and implantation of a foldable 6 mm IOL (Acrysof) visual acuity, refraction and astigmatism were determined preoperatively, between days 1 and 3 postoperatively and controlled again at least 5 months after surgery. The results were compared with the desired preoperative refraction.

RESULTS

At days 1-3 postoperatively,a deviation of not more than +/-1.0 D (spherical equivalent) from the desired refraction occurred in 73.1% of the PMMA IOL patients and in 77.2% of the foldable IOL patients. At control 76.0% of the PMMA and 85.7% of the foldable lens patients showed a deviation of not more than +/-1.5 D,88.5% of the PMMA and 98.6% of the foldable lens patients showed a deviation of not more than +/-1.5 D and 96.2% of the PMMA and 100% of the foldable lens patients showed a deviation of not more than +/-2.0 D from the desired refraction. The individual changes of the refraction (spherical equivalent) between the first and the third postoperative day and the time of control, however,were considerable and reached more than +/-1.0 D in 20.0% of the foldable lens patients and 16.3% in the PMMA lens patients. Only 6.7% of the patients in the PMMA lens group and not more than 12.8% patients of the foldable lens group showed no change of refraction (spherical equivalent).

CONCLUSION

The goal of modern cataract surgery, which is to achieve a stable refraction corresponding to the desired preoperative refraction immediately after surgery, has not yet been achieved. At present the refractive changes in scleral incision techniques as well as in clear cornea techniques make an immediate postoperative prescription of glasses impossible.