Original article
Time Course of Accommodation After Implantable Collamer Lens Implantation

https://doi.org/10.1016/j.ajo.2008.05.049Get rights and content

Purpose

To assess the time course of accommodative function after Implantable Collamer Lens (ICL) implantation and to investigate the relationship between patient age and accommodation in ICL-implanted eyes.

Design

Prospective, nonrandomized clinical trial.

Methods

We prospectively examined 69 eyes of 40 consecutive patients with myopic refractive errors of −3.25 to −22.75 diopters (D) who were undergoing ICL implantation. We assessed the amplitude of accommodation using an accommodometer before and one, three, six, and 12 months after surgery. We also investigated its relationship with patient age.

Results

The accommodation was 6.36 ± 3.94 D (mean ± standard deviation) before surgery and 4.89 ± 2.72 D, 4.98 ± 2.67 D, 5.16 ± 2.72 D, and 5.72 ± 2.85 D at one, three, six, and 12 months after surgery, respectively. The variance of data was statistically significant (P = .02, repeated-measures analysis of variance). Multiple comparisons demonstrated significant differences between measurements made before surgery and at one month after (P = .004, Fisher least significant difference test), before surgery and at three months after (P = .007), and before surgery and at six months after (P = .01). There was a significant correlation between patient age and accommodation before (Pearson correlation coefficient, r = −0.665; P < .001) and one year after (r = −0.803; P < .001) ICL implantation.

Conclusions

Accommodation was impaired transiently in the early postoperative periods, and then recovered gradually over time, indicating that transient dysfunction of the ciliary muscles by ICL fixation may occur after ICL implantation even if the crystalline lens remained intact. As patients aged, the amplitude of accommodation became significantly smaller not only in normal eyes but also in ICL-implanted eyes.

Section snippets

Methods

Sixty-nine eyes (from 26 men and 43 women) of the 40 consecutive patients who underwent implantation of the posterior chamber phakic ICL for the correction of myopia were included in this study. The patient age at the time of surgery was 36.0 ± 10.2 years (mean age ± standard deviation [SD]; range, 21 to 59 years). The preoperative refraction ± spherical equivalent was −10.07 ± 3.49 diopters [D] (range, −3.25 to −22.75 D). The relationship between patient age and preoperative refraction is

Results

Bland-Altman plots indicate that the mean difference between the five consecutive measurements with this accommodometer (± 95% limits of agreement [LoA]) was −0.01 ± 0.32 D (range, −0.64 to 0.61 D; Figure 2).

The time course of accommodation is shown in Figure 3. Accommodation was 6.36 ± 3.94 D (mean ± SD) before surgery, and 4.89 ± 2.72 D, 4.98 ± 2.67 D, 5.16 ± 2.72 D, and 5.72 ± 2.85 D at one, three, six, and 12 months after surgery, respectively. The variance of the data was statistically

Discussion

Our results demonstrated that accommodation decreased transiently at one month after ICL implantation, which gradually returned almost back to baseline levels at one year after ICL implantation. This may be attributed to transient dysfunction of the ciliary muscles by ICL fixation to the sulcus even if the crystalline lens remained untouched. Myopic eyes wearing spectacle lenses have higher accommodation than emmetropic eyes. Moreover, retinal magnification of ICL implantation is less decreased

Kazutaka Kamiya, MD, PhD, graduated from Kobe University, Faculty of Medicine, Japan, and specialized in ophthalmology in the Faculty of Medicine, Tokyo University, Japan. Dr Kamiya is Chief of Corneal Research and Refractive Surgery in Kitasato University Hospital, and an Assistant Professor in the Faculty of Medicine, Kitasato University, Faculty of Medicine, Japan.

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Kazutaka Kamiya, MD, PhD, graduated from Kobe University, Faculty of Medicine, Japan, and specialized in ophthalmology in the Faculty of Medicine, Tokyo University, Japan. Dr Kamiya is Chief of Corneal Research and Refractive Surgery in Kitasato University Hospital, and an Assistant Professor in the Faculty of Medicine, Kitasato University, Faculty of Medicine, Japan.

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