Langenbucher Achim, Huber Stefan, Nguyen Nhung X, Seitz Berthold, Gusek-Schneider Gabriele C, Küchle Michael
Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Germany.
J Cataract Refract Surg. 2003 Apr;29(4):677-85. doi: 10.1016/s0886-3350(02)01893-x.
To analyze techniques of measuring accommodation after implantation of an accommodating posterior chamber intraocular lens (PC IOL).
Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany.
This prospective study analyzed 23 eyes of 23 patients (aged 41 to 87 years) after cataract surgery and PC IOL implantation (1 CU, HumanOptics) 4 weeks and 3 and 6 months after surgery. The results were compared to those in an age-matched control group (n = 20) 6 months after surgery. The following methods were used to measure accommodation: dynamic with objective techniques (PlusOptix PowerRefractor videorefractometry, streak retinoscopy) and subjective techniques (subjective near point [push-up test, accommodometer], defocusing); static with pharmacologic stimulation after pilocarpine 2% eyedrops directly (conventional refractometry); indirectly (change in the anterior chamber depth [ACD] with Zeiss IOLMaster).
Results at 6 months, given as mean +/- SD (range), in the study and control groups, respectively, were as follows: near visual acuity (Birkhäuser reading charts at 35 cm) with distance correction, 0.32 +/- 0.11 (0.20 to 0.60) and 0.14 +/- 0.10 (0.05 to 0.30); accommodation amplitude (diopters) by PowerRefractor, 1.00 +/- 0.44 (0.75 to 2.13) and 0.35 +/- 0.26 (0.10 to 0.65), by retinoscopy, 0.99 +/- 0.48 (0.13 to 2.00) and 0.24 +/- 0.21 (-0.13 to +0.75), by subjective near point, 1.60 +/- 0.55 (0.50 to 2.56) and 0.42 +/- 0.25 (0.00 to 0.75), and by defocusing, 1.46 +/- 0.53 (1.00 to -2.50) and 0.55 +/- 0.33 (0.25 to 0.87). The mean ACD decrease (mm) was 0.78 +/- 0.12 (0.49 to 1.91) and 0.16 +/- 0.09 (0.00 to 0.34) after pilocarpine 2% eyedrops, indicating a mean accommodation of 1.40 D and 0.29 D, respectively, based on Gullstrand's model eye (P =.001). The lowest fluctuation between follow-ups was with the subjective near point and the defocusing techniques followed by ACD decrease with the IOLMaster.
Accommodation after implantation of an accommodating PC IOL should be assessed with several techniques, including subjective and objective, to differentiate true pseudophakic accommodation from pseudoaccommodation. Researchers should be aware of the different variability and consistency of measurements with each technique over time.
分析植入可调节后房型人工晶状体（PC IOL）后测量调节功能的技术。
德国埃尔朗根 - 纽伦堡大学眼科与大学眼科医院。
本前瞻性研究分析了23例患者（年龄41至87岁）的23只眼，这些患者在白内障手术后植入了PC IOL（1 CU，HumanOptics），并在术后4周、3个月和6个月进行观察。将结果与年龄匹配的对照组（n = 20）术后6个月的结果进行比较。采用以下方法测量调节功能：动态测量采用客观技术（PlusOptix PowerRefractor视频验光仪、带状检影法）和主观技术（主观近点[上推试验、调节计]、散焦）；静态测量采用直接滴入2%毛果芸香碱眼药水后的药物刺激（传统验光法）；间接测量采用蔡司IOLMaster测量前房深度（ACD）的变化。
研究组和对照组术后6个月的结果（以平均值±标准差[范围]表示）如下：矫正远视力后的近视力（35 cm处的Birkhäuser阅读图表），分别为0.32±0.11（0.20至0.60）和0.14±0.10（0.05至0.30）；PowerRefractor测量的调节幅度（屈光度），分别为1.00±0.44（0.75至2.13）和0.35±0.26（0.10至0.65），检影法测量的结果分别为0.99±0.48（0.13至2.00）和0.24±0.21（ - 0.13至 + 0.75），主观近点测量的结果分别为1.60±0.55（0.50至2.56）和0.42±0.25（0.00至0.75），散焦测量的结果分别为1.46±0.53（1.00至 - 2.50）和0.55±0.33（0.25至0.87）。滴入2%毛果芸香碱眼药水后，平均ACD下降（mm）分别为0.78±0.12（0.49至1.91）和0.16±0.09（0.00至0.34），根据Gullstrand模型眼，分别表明平均调节力为1.40 D和0.29 D（P = 0.001）。随访期间波动最小的是主观近点和散焦技术，其次是IOLMaster测量的ACD下降。
植入可调节PC IOL后的调节功能应采用多种技术进行评估，包括主观和客观技术，以区分真正的人工晶状体调节与假性调节。研究人员应了解每种技术随时间测量的不同变异性和一致性。
