1. KHOZAM I, TANGUY C, COCHENER B
Multifocal implantation 4 years later : stability of results according to the IOL model
KHOZAM I, TANGUY C, COCHENER B
(CHU BREST)
The authors do not benefit of any financial interest concerning this study.

2. INTRODUCTION:
Independence of spectacles use has become a postoperative target after cataract surgery, and can greatly enhance patients’ quality of life. The global experience around the world concerning the latest generation of multifocal IOLs is very promising. This technology offers surgeons a feaseble way of meeting patients’expectations of an improved lifestyle as the result of reduced spectacles dependence.
STUDY:
-Purpose: To compare visual results and quality of vision of five types of multifocal intraocular lenses and evaluate these results during 4 years of follow up.
-Patients: 148 patients (278 eyes)
-Mean age: years +/-7.85 (from 41 to 80 years)
-Surgery (Phacoemulsification): June 2006 to November 2009

3. POPULATION: Groupe I: 77 ReStor (Alcon) AD3 (addition +4)
Groupe II: 21 ReStor (Alcon) AD1 (addition+3)
Groupe III: 69 Tecnis (AMO) ZM 900
Groupe IV: 20 ReZoom (AMO) NGX1
Groupe V: 92 AcriLisa (Zeiss)

4. EVALUATION:
1) Visual acuity (distance, near and intermediate VA, pre and postoperative)
2) refraction (pre et postoperative)
3) quality of vision (objective/subjective)
Symptoms (glare, halos, problems with night vision)
PC platform « EyeVis Pro » for the quality of vision study and visual performance score
Defocus curve
4) Slit lamp examination (IOLs centration/ posterior capsule opacification)
5) Nd:YAG capsulotomy for PCO
6) PRK for residual ametropia
7) Questionnaires (patient satisfaction/independence of spectacles use)

5. RESULTS: Preoperative refraction: Postoperative refraction: ReStor AD3
Tecnis
ZM 900
ReZoom NGX1
AcriLisa
Sphere
0.93(+/-3.3)
(-8.50 to 9.75)
0.94(+/-2.05)
(-2.75 to 4.50)
0.86(+/-3.72)
(-10 to 9)
0.71(+/-1.8)
(-3.75 to3.25)
-3.46(+/-5.4)
(-15 to 8.5)
Cylinder
1.66(+/-1.08)
(0 to 5)
0.29(+/-0.54)
(0 to 0.75)
0.03(+/-0.76)
(0 to 1.75)
0.28(+/-0.61)
(0 to 2)
0.25(+/-1.2)
(0 to 4)
Preoperative refraction:
ReStor
AD3
ReStor AD1
Tecnis
ZM 900
ReZoom NGX1
AcriLisa
Sphere
-0.03(+/-0.74)
(2.50 to1.75)
0.61(+/-0.62)
(0.50 to1.75)
0.15(+/-0.77)
(-2 to 2)
-0.54(+/-0.9)
(-2.50 to 1)
0.02(+/-0.53)
(-2 to 1.25)
Cylinder
0.12(+/-0.76)
(0 to 1.75)
0.29(+/-0.66)
(0 to 0.75)
0.35(+/-0.84)
0.44(+/-1.04)
(0 to1.50)
0.16(+/-0.61)
(0 to 2)
Postoperative refraction:

6. RESULTS: Uncorrected Visual Acuity (UCVA)
ReStor AD3
ReStor AD1
Tecnis ZM 900
ReZoom NGX1
AcriLisa
Distance VA
(4m)
0.7(+/-0.21)
(0.1to1)
0.69(+/-0.18)
(0.6 to 1)
0.64(+/-0.24)
(0.5 to 1)
0.69(+/-0.22)
(0.4 to 1)
0.65(+/-0.23)
% > 0.8
75%
74%
62%
67%
58%
Intermediate VA (50cm)
P4.7(+/-1.9)
(P2 to P8)
P4.9(+/-1.18)
(P2 to P6)
P3.9(+/-1.4)
(P2 to P10)
P4.5(+/-1.2)
(P2 to P12)
P4.69(+/2.13)
(P3 to P12)
Near VA (33cm)
P2.44(+/-0.92)
(P2 to P5)
P2.29(+/-0.46)
P2.29(+/-0.24)
P2.61(+/-1.5)
P2.51(+/-1.32)
(P2 to P14)
% P2
78%
73%
80%
82%
77%

7. Postoperative interval
RESULTS:
Treatment with complementary PRK (for residual ametropia):
% treatment with PRK
Postoperative interval
Mean VA
%>0.8
ReStor AD3
23%
5.5 months(+/-2.2)
0.83(+/-0.12)
(0.6 to 1)
80%
ReStor AD1
14%
5.8 months(+/1.8)
0.93(+/-0.05)
(0.9 to 1)
100%
Tecnis ZM900
39%
6 months(+/-2)
0.86(+/-0.15)
75%
ReZoom NGX1
11%
5.8 months(+/-1)
0.9
(0.8 to 1)
AcriLisa
20%
6 months(+/-1)
0.9(+/-0.05)
95%

8. RESULTS: Nd:YAG capsulotomy for PCO: % %
Intervention by Nd:Yag (between 6 to 36 months )
Early intervention by Nd:Yag (between 6 and 12 months)

9. RESULTS: ReStor AD3 ReStor AD1 Tecnis ZM900 ReZoom NGX1 AcriLisa
VA post Nd:YAG:
Mean VA
%>0.8
ReStor AD3
0.91(+/-0.07)
(0.8 to 1)
100%
ReStor AD1
0.93(+/-0.05)
Tecnis ZM900
0.93(+/-0.07)
(0.7 to 1)
97%
ReZoom NGX1
0.9(+/-0.08)
(0.6 to 1)
AcriLisa
0.89(+/-0.09)
95%

10. RESULTS: QUALITY OF VISION
Questionnaires: %
Reading test:
fluence and comprehension

11. DISCUSSION:
Patients satisfied with their IOL performance/ most would have multifocal IOLs implanted again.
15% of overall population: PRK for residual ametropia (esp.astigmatism) Not before 3 months posoperatively (neuroadaptation).
Excellent intermediate vision with Restor AD1++(then by order of performance come: AcriLisa, Restor AD3, ReZoom, Tecnis)
Mild PCO significantly influences visual performance/ Earlier intervention was noticed with AcriLisa group; but at 2 years comparable YAG rate in all groups
Safety issue: No retinal complications at the term of 4 years (even after early Nd:Yag laser treatment in Prelex )

12. CONCLUSION: Modern cataract surgery refractive cataract surgery.
(The new technologies in the design of multifocal IOLs has greatly improved the quality of life in active patients who wish to reduce their dependence on glasses)
Optimisation of results by:
- preoperative patient selection
- excellent IOL calculation management and surgical technique
- advent of toric multifocal IOLs shoud decrease the rate of secondary procedure
Surgical pearls: Good peroperative cleaning of anterior capsule/ large capsulorrhexis (6mm)/ perfect centralisation of the IOL + prevent early PCO
Larger series and longer follow up (one decade) must be needed to reinforce the proof of the safety issue of this procedure.