Kriechbaum K, Findl O, Koeppl C, Menapace R, Drexler W
Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Ophthalmology. 2005 Mar;112(3):453-9. doi: 10.1016/j.ophtha.2004.09.021.
Most trials that study the lens movement of accommodative intraocular lens (IOLs) use pilocarpine to stimulate ciliary muscle contraction. The aim of this study is to assess in vivo whether a more physiologic, stimulus-driven accommodation is comparable to pilocarpine-induced IOL movement.
Controlled patient- and examiner-masked clinical trial.
The study population included 38 eyes with accommodative IOL implants (1CU) and a control group of 28 eyes with conventional open-loop IOLs.
A high-precision biometry technique, partial coherence interferometry, was used to measure IOL position. Anterior chamber depth was measured during physiologic (near point) and pharmacological (pilocarpine 2%) stimulation. In a subgroup of 14 1CU eyes, IOL position was determined repeatedly within 90 minutes after pilocarpine administration. A different subgroup was investigated as to the effect of cyclopentolate on IOL position. Best-corrected distance visual acuity (VA), best-corrected near VA, and distance-corrected near VA (DCNVA) were assessed using logarithm of the minimum angle of resolution charts.
Anterior chamber depth change under pilocarpine and near-point-driven accommodation.
Near-point accommodation did not induce movement of either the accommodating 1CU or the control IOLs. Pilocarpine induced a 201+/-0.137-mm anterior movement of the 1CU IOL (P<0.001), compared with no movement within the control IOL groups (P>0.05). There was no significant (P>0.05) difference in DCNVA between the accommodative and open-loop IOLs. No correlation between near point- or pilocarpine-stimulated IOL movement and DCNVA was found. Concerning the time course of movement after pilocarpine administration, most of the 1CU IOLs showed some movement 30 minutes after application. Cyclopentolate-induced ciliary muscle relaxation caused a posterior IOL movement, as compared with the relaxed state, when focusing on a distant target.
Pilocarpine-induced ciliary muscle contraction seems to overestimate IOL movement relative to a monocular near-driven stimulus. Therefore, concerning IOL movement, pilocarpine may act as a superstimulus and may not adequately simulate daily life performance of accommodative IOLs. However, it may be helpful to evaluate the maximum potential of an accommodating IOL.
大多数研究调节性人工晶状体（IOL）晶状体运动的试验使用毛果芸香碱来刺激睫状肌收缩。本研究的目的是在体内评估更生理性的、由刺激驱动的调节是否与毛果芸香碱诱导的IOL运动相当。
患者和检查者双盲的对照临床试验。
研究人群包括38只植入调节性IOL（1CU）的眼睛和28只植入传统开环IOL的眼睛作为对照组。
采用高精度生物测量技术，即部分相干干涉测量法来测量IOL位置。在生理性（近点）和药物性（2%毛果芸香碱）刺激期间测量前房深度。在14只1CU眼睛的亚组中，在给予毛果芸香碱后90分钟内重复测定IOL位置。对另一个亚组研究了环喷托酯对IOL位置的影响。使用最小分辨角对数视力表评估最佳矫正远视力（VA）、最佳矫正近视力和距离矫正近视力（DCNVA）。
毛果芸香碱和近点驱动调节下的前房深度变化。
近点调节未引起调节性1CU IOL或对照IOL的移动。与对照IOL组无移动（P>0.05）相比，毛果芸香碱使1CU IOL向前移动了201±0.137mm（P<0.001）。调节性IOL和开环IOL之间的DCNVA无显著差异（P>0.05）。未发现近点或毛果芸香碱刺激的IOL移动与DCNVA之间存在相关性。关于给予毛果芸香碱后运动的时间进程，大多数1CU IOL在给药后30分钟出现一些移动。与聚焦于远处目标时的松弛状态相比，环喷托酯诱导的睫状肌松弛导致IOL向后移动。
相对于单眼近驱动刺激，毛果芸香碱诱导的睫状肌收缩似乎高估了IOL的移动。因此，关于IOL移动，毛果芸香碱可能起超刺激作用，可能无法充分模拟调节性IOL的日常生活表现。然而，它可能有助于评估调节性IOL的最大潜力。
