Early Curative Effect Analysis Of Akreos Adapt And PMMA IOLs Implantations

Since the first intraocular lens (IOLs) were implanted by Harold Ridley in 1949, cataract surgery with IOLs implantations has been developed so much,and patients received more perfect visual acuity. Owing to the improvements of modern intraocular lens (IOLs) in terms of design and material,PMMA one-piece IOLs are not the only choice any longer,and more people choose various foldable IOLs ,which have small incision and perfcct curative effect. In our hospital ,we often choose Akreos Adapt IOLs made of hydrophilic acrylic material from Bausch&Lomb company,whose perfect results have been accepted abroad.In this paper,we retrospectively compare 65 pantients'(76eyes) early postoperative effect who received phacoemulsification cataract surgery with EZE-55 PMMA IOLs implantation and Akreos Adapt IOLs implantation between 2006.5 and 2007.11. The patients include 40 female(48 eyes) and 25 male(28 eyes),from 19 to 90 years old,and the mean age is 64.1. Eyes were not included if they had any ocular disease which can affect surgical outcomes.Relevant data were collected at a 3-day follow-up examination.36 patients(40 eyes) received phacoemulsification with Akreos Adapt foldable hydrophilic acrylic single-piece IOLs implantation (group A ). 5 of them are gradeⅣnucleus(12.5 %),the others are gradeⅠ-Ⅲ.Their preoperative visual acuity: hand movement/10cm to 0.3.The incision is 3.2mm, and the IOLs were implanted used Hydroport injector.29 patients(36 eyes) received phacoemulsification with EZE-55 poly(methyl methacrylate) (PMMA) IOLs (group P ). 4 of them are gradeⅣnucleus(11.1 %),the others are gradeⅠ-Ⅲ.Their preoperative visual acuity: light perception to 0.5.The incision is 5.5mm, and the IOLs were implanted used forceps. Results:1,postoperative reception:in group P ,1 patient with 1 eye said his vision had no improvement and 1 patient with 1 eye said dysphotopsia had appeared 2 times,and all the others were satisfied.2,postoperative visual acuity:best naked distance visual acuity≥0.3 was 52.5%(21/40)in group A,and 47.2%(17/36)in group P, and there was no statistically significant difference between the 2 groups (P>0.05). Best naked distance visual acuity≥0.5 was 52.5%(21/40)in group A,and 22.2%(8/36)in group P, and there was statistically significant difference between the 2 groups (P<0.05).3,main complications:(1)conjunctival congestion and subconjunctival hemorrhage: the incidence rate was 77.5%(31/40)in group A,and 88.9%(32/36)in group P, and there was no statistically significant difference between the 2 groups (P>0.05). They were given cidomycin and decaesadril sub-conjunctival injection.The conjunctival congestion disappeared in 3 days,and subconjunctival hemorrhage released.(2) corneal edema: the incidence rate was 57.5%(24/40)in group A,and 75%(27/36)in group P,and there was no statistically significant difference between the 2 groups (P>0.05).Although the incidence rate was high in both groups,all the reactions disappeared in 3 days.So we think the causes are hard press or pull to cornea , mannul injury during the surgery,high press or rapid speed of perfusate,and long phacoemulsification time.(3)KP:we obserbed dust KP in 2 eyes in group A ,and the incidence rate was 5.0%(2/40),while in group P we observed dust KP in 5 eyes and pigment KP in 3 eyes,and the total incidence rate was 13.9%(5/36).There was no statistically significant difference between the 2 groups (P>0.05).(4) aqueous flare intensity:in group A we observed aqueous flare(+) in 25 eyes,and (++)in 3 eyes,and the total incidence rate was 70%(28/40),while (+)27eyes and (++)3 eyes in group P and the rate was 94.4%(34/36).There was statistically significant difference between the 2 groups (P < 0.05).As one of the indexes of breakdown of blood-aqueous barrier and reaction of the biologic system, the aqueous flare intensity can reflect the biocompatibility of IOLs.Our results ,the same as literature abroad, demonstrate that foldable hydrophilic acrylic IOLs implantation leads to a mild alteration of blood-aqueous barrier, and this materials offer better uveal biocompatibility.(5) The incidence rate of anterior chamber exudative fibrin in group A was 2.5%(1/40),while 8.3%(3/36)in group P. There was no statistically significant difference between the 2 groups (P>0.05).We gave the patients with complications above cidomycin and decaesadril sub-conjunctival injection and antibiotics intravenous drip.Since the 3nd day,we began to give them ocular humor with glucocorticoids 4 times a day.Owing to all the treatments we done, all the complications above disappeared or released in 3 days.(6) anterior chamber hyphema: the incidence rate of anterior chamber hyphema in group A was 2.5%(1/40),while 5.6%(2/36)in group P. There was no statistically significant difference between the 2 groups (P>0.05). The patient in group A had a cough after the surgery,maybe it's the reason.The one in group P was too old to obey our advice,and he always touched his eyes with his hands,and that cause his anterior chamber hyphema.For the other patient who had anterior chamber hyphema in group P,we think burning the vessels around the incision too much may be one of the reasons.We gave them adrenobazone by mouth and Reptilase and endoiodin by muscle injection. The hyphema disappeared within 7-10 days.(7) heightened intraocular tension:the intraocular tension of 1 eye in group A rose to 26mmHg at the 1st day.There are many reasons to heightened intraocular tension,and viscoelastic agent residue may be the key to this case.We gave the patient Acetazolamide 250mg once a day by mouth.In all,We make conclusions that:1,Akreos Adapt IOLs make small incision, convenient and stable.No dysphotopsia or glare appeared,and the patients satisfied with the postoperative reception.2,Akreos Adapt foldable hydrophilic acrylic single-piece IOLs and EZE-55 poly(methyl methacrylate) (PMMA) IOLs implanted with phacoemulsification are both modus operandi for the cataract patients.3,Akreos Adapt IOLs lead to lower incidence rate of postoperative complications than EZE-55 PMMA IOLs.Especially significant between-group difference was observed at aqueous flare intensity.So Akreos Adapt IOLs offer better biocompatibility.