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Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens

Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens. Yoshihiko Iida , MD. Kimiya Shimizu , MD. Misae Ito , CO. Kitasato University. The authors have no Financial Interest. Background. Multifocal intraocular lenses(IOL) are increasingly

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Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens

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  1. Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens Yoshihiko Iida, MD Kimiya Shimizu, MD Misae Ito, CO Kitasato University The authors have no Financial Interest.

  2. Kitasato University School of Medicine Background • Multifocal intraocular lenses(IOL) are increasingly • used tocorrect presbyopia. • We experienced unsatisfactory results in a patient • who underwent bilateral implantation of refractive • multifocal IOLs, and considered that ocular deviation • may influence pupil size. We report a patient with unsatisfactory results, and evaluatethe effect of ocular deviation on pupil size using implanted IOLs.

  3. Kitasato University School of Medicine 1. Case report 54-year old female Preoperative data : Vd = 0.04 ( 0.3 x -5.00 Cyl-1.00 Ax 80 ) ( ) Vs = 0.04 ( 0.4 x -6.00 ) Hirschberg : orthophoria Alternate prism cover test : 14⊿X’(Near), 4⊿X (Far) (APCT) Pupil size (monocular vision) : R) 4.0 mm, L) 4.4 mm Selected the use of refractive multifocal IOL

  4. 2.1mm Near Far Kitasato University School of Medicine Implanted refractive multifocal IOL Bil) PEA + IOLwas performed R) 11.5 D IOL : Array SA40N (AMO) L) 12.0 D 3.4mm IOL design

  5. Kitasato University School of Medicine At 3 months postop. Course Far : Vd = 1.2xIOL BV = 1.2xIOL Vs = 1.2xIOL Near : Vd = 1.0xIOL BV = 0.4xIOL Vs = 0.9xIOL Binocular uncorrected visual acuity(UCVA) was worse thanmonocular UCVA. APCT:16⊿X’(Near) Withspectacle lenses of 3Δ base-intoeacheye BV = 1.0xIOL Binocular near UCVA wasimproved.

  6. 1) Far vision / Binocular 2) Near vision / Monocular Kitasato University School of Medicine FarBV = 1.2xIOL 2.8mm Vd=1.0xIOL Vs=0.9xIOL 3.1mm Evaluation of the Pupil size (1)

  7. 3) Near vision / Binocular 2) Near vision / Monocular Kitasato University School of Medicine Vd=1.0xIOL Vs=0.9xIOL NearBV = 0.4xIOL 2.4mm 3.1mm Evaluation of the Pupil size (2)

  8. 3) Near vision / Binocular Kitasato University School of Medicine NearBV = 0.4xIOL 2.4mm Evaluation of the Pupil size (3) 4) Near vision / Binocular + 3⊿base in 2.7mm NearBV = 1.0xIOL

  9. Kitasato University School of Medicine 2. Effect of ocular deviation on pupil size in near vision 17 exphoric patients implanted with IOL n=17 5 Dominant eye 4 Near vison 3 Pupil diameter (mm) 2 1 p=0.0017, R2 = 0.4679 0 Exophoria angle(⊿) 14 4 0 8 12 Pupil diameter was negatively correlated with exphoria angle.

  10. Far : 2.1mm Far : 2.1mm Near : 3.4mm Near : 3.4mm Kitasato University School of Medicine Discussion Binocular Binocular +3⊿ base in NearBV =1.0 NearBV =0.4 pupil diameter 2.4mm pupil diameter 2.7mm With spectacle prism lenses for the decrease of exophoria angle, the pupil diameter was increased and the binocular near UCVA was raised.

  11. Kitasato University School of Medicine Discussion Orthophoria Exophoria convergence miosis excess miosis When large exophoria angle, excess miosis might be caused by fusional convergence. Poor near visual acuity with refractive multifocal IOL.

  12. Kitasato University School of Medicine Conclusions • Ocular deviation affects pupil size. • Ocular deviation is an important factor in the • selection of patients with refractive multifocal • IOLs.

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