Stimulus-driven versus pilocarpine-induced biometric changes in pseudophakic eyes
Stimulus-driven versus pilocarpine-induced biometric changes in pseudophakic eyes
复制标题
DOI：
10.1016/j.ophtha.2004.09.021
复制
发表时间：
2005-03-01
期刊：
影响因子：
13.7
通讯作者：
Drexler, W
中科院分区：
文献类型：
--
作者：
Kriechbaum, K;Findl, O;Drexler, W
目的：大多数研究可调节人工晶状体 (IOL) 晶状体运动的试验都使用毛果芸香碱来刺激睫状肌收缩。本研究的目的是在体内评估更生理性的、刺激驱动的调节是否与毛果芸香碱引起的 IOL 移动相当。设计：受控的患者和检查者掩蔽临床试验。参与者：研究人群包括 38 只装有调节性 IOL 植入物 (1CU) 的眼睛和 28 只装有传统开环 IOL 的对照组。方法：采用高精度生物测量技术、部分相干干涉测量法来测量人工晶状体位置。在生理（近点）和药理（毛果芸香碱 2%）刺激期间测量前房深度。在 14 只 1CU 眼睛的亚组中，在毛果芸香碱给药后 90 分钟内重复确定 IOL 位置。针对环喷妥酯对 IOL 位置的影响，研究了不同的亚组。使用最小分辨角度图的对数评估最佳矫正远视力 (VA)、最佳矫正近视力 VA 和远视力矫正近视力 (DCNVA)。 主要结果指标：毛果芸香碱和近点驱动调节下前房深度的变化。 结果：近点调节不会引起调节 1CU 或对照 IOL 的移动。毛果芸香碱诱导 1CU IOL 向前移动 201+/-0.137 毫米 (P0.05)。调节性人工晶状体与开环人工晶状体之间的 DCNVA 差异无显着性（P>0.05）。未发现近点或毛果芸香碱刺激的 IOL 运动与 DCNVA 之间存在相关性。关于毛果芸香碱给药后的运动时间过程，大多数 1CU IOL 在使用后 30 分钟显示出一些运动。当聚焦于远处目标时，与放松状态相比，环喷托酯诱导的睫状肌松弛引起了 IOL 的后部运动。结论：相对于单眼近处驱动的刺激，毛果芸香碱诱导的睫状肌收缩似乎高估了 IOL 的运动。因此，对于 IOL 运动，毛果芸香碱可能充当超级刺激物，并且可能无法充分模拟可调节 IOL 的日常生活表现。然而，评估可调节人工晶状体的最大潜力可能会有所帮助。 (C) 2005 年由美国眼科学会颁发。
Purpose: Most trials that study the lens movement of accommodative intraocular lens (IOLs) use pilocarpine to stimulate ciliary muscle contraction. The aim of this study is to assess in vivo whether a more physiologic, stimulus-driven accommodation is comparable to pilocarpine-induced IOL movement.Design: Controlled patient- and examiner-masked clinical trial.Participants: The study population included 38 eyes with accommodative IOL implants (1CU) and a control group of 28 eyes with conventional open-loop IOLs.Methods: A high-precision biometry technique, partial coherence interferometry, was used to measure IOL position. Anterior chamber depth was measured during physiologic (near point) and pharmacological (pilocarpine 2%) stimulation. In a subgroup of 14 1CU eyes, IOL position was determined repeatedly within 90 minutes after pilocarpine administration. A different subgroup was investigated as to the effect of cyclopentolate on IOL position. Best-corrected distance visual acuity (VA), best-corrected near VA, and distance-corrected near VA (DCNVA) were assessed using logarithm of the minimum angle of resolution charts.Main Outcome Measures: Anterior chamber depth change under pilocarpine and near-point-driven accommodation.Results: Near-point accommodation did not induce movement of either the accommodating 1CU or the control IOLs. Pilocarpine induced a 201+/-0.137-mm anterior movement of the 1CU IOL (P0.05). There was no significant (P>0.05) difference in DCNVA between the accommodative and open-loop IOLs. No correlation between near point- or pilocarpine-stimulated IOL movement and DCNVA was found. Concerning the time course of movement after pilocarpine administration, most of the 1CU IOLs showed some movement 30 minutes after application. Cyclopentolate-induced ciliary muscle relaxation caused a posterior IOL movement, as compared with the relaxed state, when focusing on a distant target.Conclusion: Pilocarpine-induced ciliary muscle contraction seems to overestimate IOL movement relative to a monocular near-driven stimulus. Therefore, concerning IOL movement, pilocarpine may act as a superstimulus and may not adequately simulate daily life performance of accommodative IOLs. However, it may be helpful to evaluate the maximum potential of an accommodating IOL. (C) 2005 by the American Academy of Ophthalmology.