Centre Hospitalier Universitaire et Psychiatrique de Mons-Borinage. B-Flex Multifocal. Dr Emmanuel Van Acker Belgium

Transcription

1 Centre Hospitalier Universitaire et Psychiatrique de Mons-Borinage B-Flex Multifocal Dr Emmanuel Van Acker Belgium

2 Comparison of clinical outcomes and patient satisfaction after implantation of two different types of diffractive apodized IOLs: Bi-Flex M (based on PAD technology) FineVision (Micro F) trifocal diffractive IOL Prospective, randomized, observational study

3 Description * Value Bi Flex M () FineVision (MicroF) Optic & haptics material Hydrophilic acrylic (copolymer formed of 2-HEMA and OEMA) => 25% water content UV filter; Blue light filter ( nm) Refractive index 1.46 (when hydrated) Optic diameter 6 mm 6.15mm Overall diameter 13 mm mm IOL Single piece Single piece Technology Aspheric; Refractive/diffractive apodized; PAD technology Aspheric; trifocal; diffractive (2 diffractive arrays); apodized Type of haptics Double (Z-loop modified) Four loops haptics Haptic angulation 0 (posterior voltage) 5 Available power +10D to +35D +10 to + 35D Addition +1.75, , +3.5 Estimated Incision mm 1.8 A-Constant SRK II A-constant SRK-T *Data of FineVision IOL are taken from official scientific material (brochure; website) from company Physiol

4 Bi Flex M Technology Central 3.0 mm apodized diffractive structure Step heights decrease peripherally from microns +3.5D at lens plane equalling +2.7D at spectacle plane Outer refractive zone Aspheric (neutral approach)

5 Bi-Flex M () FineVision 7 rings Diffractive zone diameter: 3 mm 20 rings Diffractive zone diameter: full optic

6 STUDY DESIGN Prospective Randomly chosen IOL type for each patient Consent form Tenets of Declaration of Helsinki international Ethical committee (FEKI) Statistical analysis: Mann-Whitney-U test and independent t-test. Significance level was set up to 0,05. Analysis performed by IBM SPSS Statistics version 24.

7 MEASUREMENTS Metrovision Glare test Contrast sensitivity Pupillometry Standard tests Visual acuity (ETDRS) Biomicroscopy Defocus curves Visual Fct Questionnaire

8 Examination Test Protocol of the Study Randomly included patients Discussion, explanations Follow-up 12 months D1 D7 M1 M3 M6 M12 Medical history Pre-operative examination biometry UCDVA, UCIVA, UVNVA (monocular, binocular) ETDRS table (Decimal) Implantation of the IOL bilateral (interval min. 24 hours) Refraction, intraocular pressure Contrast sensitivity (Metrovision) Defocus curves Subjective satisfaction Spectacle independency Optic phenomena's (glare, halo..) Validated quality of vision questionnaire

9 Consecutive patients included 39 patients / 78 eyes 20 patients/ 40 eyes 19 patients / 38 eyes

10 64 Age of patients (49-71) 54 (47-65) 63 (49-71) 53 (47-65) Bi-Flex M FineVision 48 Mean Median There WERE STATISTICALLY SIGNIFICANT DIFFERENCES IN AGE of patients in between both groups

11 1,20 UCDVA, monocular 1,20 UCDVA, binocular 1,00 1,00 0,80 0,80 0,60 0,60 0,40 0,40 0,20 0,20 Preop D1 M1 M3 M6 Y1 Micro F M1 M3 M6 Y1 Micro F There were NOT STATISTICALLY SIGNIFICANT DIFFERENCES IN BINOCULAR VA

12 UCIVA, monocular UCIVA, binocular 1,20 1,20 1,00 1,00 0,80 0,80 0,60 * 0,60 0,40 0,40 0,20 0,20 Preop M1 M3 M6 Y1 M1 M3 M6 Y1 Micro F Micro F *UCIVA at M6 - statistically significant differences; All other UCIVA during other follow up periods NO STATISTIC DIFFERENCEs There were NOT STATISTICALLY SIGNIFICANT DIFFERENCES IN BINOCULAR VA

13 UCNVA, monocular UCNVA, binocular 1,20 1,20 1,00 1,00 0,80 * 0,80 0,60 0,60 0,40 0,40 0,20 0,20 Preop D1 M1 M3 M6 Y1 M1 M3 M6 Y1 Micro F Micro F *UCIVA at Y1 - statistically significant differences; All other UCIVA during other follow up periods NO STATISTIC DIFFERENCEs There were NOT STATISTICALLY SIGNIFICANT DIFFERENCES IN BINOCULAR VA

14 70 cm Defocus curve - 3M 1,50 1,00 0,50 +4,0 D +3,5 D +3,0 D +2,5 D +2,0 D +1,5 D +1,0 D +0,0 D -0,5 D -1,0 D -1,5 D -2,0 D -2,5 D -3,0 D -3,5 D Micro F Defocus curve - 6M 1,40 1,20 1,00 0,80 0,60 0,40 0,20 +4,0 D +3,5 D +3,0 D +2,5 D +2,0 D +1,5 D +1,0 D +0,0 D -0,5 D -1,0 D -1,5 D -2,0 D -2,5 D -3,0 D -3,5 D Micro F

15 70 cm 1,50 Defocus curve - 12M 1,00 0,50 +4,0 D +3,5 D +3,0 D +2,5 D +2,0 D +1,5 D +1,0 D +0,0 D -0,5 D -1,0 D -1,5 D -2,0 D -2,5 D -3,0 D -3,5 D Micro F There were NOT STATISTICALLY SIGNIFICANT DIFFERENCES in any points of the defocus curves during follow-up period In the area underneath the defocus curves during follow-up period

16 Emmétrope 1998

17 Emmétrope née 2000

18 B-Flex M

19 % of letters recognized % of letters recognized % pf letters recognized Glare [100 cd/m 2 luminance] Glare [5 cd/m 2 luminance] M 1..3M 3..6M 6..12M 12+M Postop time M 1..3M 3..6M 6..12M 12+M Postop time MicroF MicroF Glare [1 cd/m 2 luminance] M 1..3M 3..6M 6..12M 12+M Postop time MicroF

20

21 Contrast static, 1-3 M Postop 25, ,00 1 5,00 0,1 cpd 1,0 cpd 10,0 cpd 100,0 cpd MicroF Contrast static, 6-12 M Postop CONTRAST SENSITIVITY PHOTOPIC 25, ,00 1 5,00 0,1 cpd 1,0 cpd 10,0 cpd 100,0 cpd MicroF

22 Mesopic, 1-3 M Postop 25, ,00 1 5,00 0,1 cpd 1,0 cpd 10,0 cpd 100,0 cpd MicroF CONTRAST SENSITIVITY MESOPIC Mesopic, 6-12 M Postop 25, ,00 1 5,00 0,1 cpd 1,0 cpd 10,0 cpd 100,0 cpd MicroF

23 Overall satisfaction: 9.3/10 QUALITY OF VISION QUESTIONNAIRE

24 CONCLUSION The study showed similar clinical performance of trifocal Fine Vision IOL (Physiol) and PAD Bi-Flex M (Medicontur) IOLs. Contrast sensitivity, glare tests Refractive results & stability Visual acuities Satisfaction of the patients Defocus curves The study confirmed clinical trifocal performance of PAD Bi-Flex M Both IOLs were accepted by patients with high satisfaction All patients in both examined groups were glass independent