Theoretical Considerations

Transcription

1 Bedeutung der Linsenposition für die optische Abbildugsqualität- Ein neues Messverfahren mittels Purkinje Reflexbildern SA(-) Acri.Tec 35A Hoya FY60AD Tecnis ZCB00 AcrySof IQ U. Mester, T. Sauer, H.Kaymak (Sulzbach/Saar) Cornea: +0.27µm SA SA = ~ 0 µm D 16 D 26 D SA (µm) *** *** *** AcrySof IQ AcrySof SA 60 AT Theoretical Considerations mm Pupil ***= p<0.01 Contrast sensitivity AcrySof IQ) (AUC) AcrySof SA60AT (AUC) p-value photopic 26.5± ±4.1 < % mesopic 25.4± ±3.7 < % Emmetropia SA corrected Emmetropia + SA 1/8 D mesopic with glare 24.3± ±3.3 < % 1 D Myopia SA corrected 1 D Myopia + SA 1/8 D Thibos, 2002

2 Average Radial MTF vs Decentration (symmetric eye models - monochromatic) Average Radial MTF vs Decentration (asymmetric eye models - polychromatic) control Tecnis 0.12 Modulation (mm) Holladay, J., et al (2002). J Refract Surg, 18, Piers P, 2007 Jan Evangelista Purkyně ( ) Assesment of IOL and tilt Purkinje images 1, 3 and 4 set up Infrared-D to generate the Purkinje images and D P1 - Cornea P3 - anterior lens P4 - posterior lens

3 Movement of the Purkinje images with eye movements weak P3 in phakic eyes but bright P3 in pseudophakic eyes Own Results Strehl Ratio with IOL decentered (5 mm size, 20 D IOL power) Strehl Ratio with IOL tilted (5 mm size, 20 D IOL power) IOL SA(-) IOL SA(-) SA(0) SA(+) SA(0) SA(+) Decentration (mm) Tilt (degrees) Tecnis 1-piece mean Tecnis 1-piece Mean Tilt Pieh, 2007

4 Decentration Tilt temporal n.s. nasal -0,25 0,25 0,50 (mm) 0,50 0,25 ** -0,25-0,50 (mm) temporal Fixation axes -5,00-2,50 2,50 (degree) 5,00 2,50-2,50-5,00 (degree) Fixation axes mm nasall of of the Tecnis mm nasal of Right: mm Left: mm up of mm temporal of mm temporal of in phakic young eyes Right: mm Left: mm down of tilt deg of tilt deg of tilt Right: deg Left: deg up from tilt deg of tilt deg of tilt Right: deg Left: up from Tecnis ZCB and tilt vs. young phakic eyes Young phakic eye Tecnis ZCB eye of the HOYA FY 60AD Right: mm Left: mm down of Horizontal (mm) Vertical (mm) Horizontal tilt (deg) Vertical tilt (deg) ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± mm tilt deg of tilt deg of mm nasal of tilt Right: deg Left: deg up from

5 5 tilt = 0.12 coma for aspheric IOL 0.2 mm = 0.09 coma for aspheric IOL Tabernero et al 2006 Horizontal Coma Young individuals! 0,40 0,30 0,20 0,10-0,10-0,20-0,30-0,40 INTc08 OPDc08 Horizontal Coma phakic eyes corneal internal total (µm) 0,40 0,30 0,20 (+) (+) (µm) ,10-0,10-0,20-0,30-0,40 (-) (-) Z 7 Z 8 Z 12 Vertical Coma Horizontal Coma SA

6 (µm) Tecnis-1 corneal internal total Z 7 Z 8 Z12 Vertical Coma Horizontal Coma SA Summary The use of the new Purkinjemeter allows a fast and easy assessment of the lens/iol position. Our results confirm that, the natural crystalline lens is neither perfectly centered nor free of tilt. Aspheric IOLs show similar amounts of and tilt as the crystalline lens in young individuals. Concerns about deterioration of image quality with asperic IOls due to malposition of the IOL can therefore not be confirmed. The slight malposition of the crystalline lens as well as of the aspheric IOL contribute to a compensation of coma, the second most important high order aberration for optical performance. Universitätsaugenklinik Tübingen K. Petermeier, C. Frank, P. Szurman Bundesknappschaftskrankenhaus Sulzbach/Saar H. Kaymak, B. Junker, U. Mester Studiendesign: Hochmyope Patienten (20 Augen; 10 Patienten) nach Implantation der Alcon MA60 AT (3 stückig) Dioptrienstärke: 0,6 ± 3,6 Dioptrien Pupillendurchmesser: 6mm

7 Spherical aberration -0, mm temporal of mm nasal of Right: mm Left: mm up of : 0.22 ± 0.06 µm 0.23 ± 0.11 µm : 0.19 ± 0.1 µm 0.24 ± 0.12 µm tilt deg of tilt 4, deg of tilt Right: deg Left: up from Horizontal Coma : ± 0.12 µm ± 0.16 µm : 0.03 ± 0.18 µm 0.17 ± 0.16 µm