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Clinical research of accommodating intraocular lens

The other two studies only reported follow-up to 6 months.No eyes with the standard intraocular-lens implant achieved distance-corrected visual acuity of 20/40 or better at follow-up.Use of an accommodating intraocular lens is intended to allow focusing on near and distant objects, so that the patient may not require reading spectacles.The National Institute for Health and Clinical Excellence is examining implantation of accommodating intraocular lenses during cataract surgery and will publish guidance on its safety and efficacy to the NHS in England, Wales, Scotland and Northern Ireland.The process that the Institute will follow after the consultation period ends is as follows.For further details, see the Interventional Procedures Programme manual, which is available from the Institute's website (org.uk/ipprogrammemanual).The Specialist Advisers listed potential adverse events as including lens decentration, posterior capsule opacification, lens or haptics buckling, development of capsular contraction syndrome and loss of quality of vision.This guidance requires that clinicians undertaking the procedure make special arrangements for audit.

The Advisory Committee has made provisional recommendations about implantation of accommodating intraocular lenses during cataract surgery.A non-randomised controlled trial reported halos in 8% (2/24) and flare, flashes or glare each in 4% (1/24) of eyes with an accommodating lens.Higher rates of halos, flare and glare were reported by patients with either a multifocal or bifocal lens.A case series reported cystoid macular oedema in 4% (12/324) of eyes with an accommodating lens over a 12-month follow-up period.Persistent cystoid macular oedema was reported in 1% (3/304) of eyes.An ultrasound probe is used to break the opacified lens into tiny pieces, which are removed through a small incision in the cornea (phacoemulsification).An accommodating lens rather than a standard intraocular lens is then inserted through the incision.The aim of the procedure is to allow the eye to focus on near as well as distant objects, so that the patient may not need spectacles.Four randomised controlled trials reported significantly better distance-corrected near visual acuity for eyes with an accommodating lens than for eyes with a standard intraocular lens; follow-up ranged between 6 and 12 months.The mechanism of action of accommodating lenses is unclear.A non-randomised comparative study reported that, after 12 months' follow-up, 13% (3/24) of eyes with an accommodating lens required capsulotomy for posterior capsule opacification, compared with 25% (8/32) of eyes with a multifocal lens and 29% (7/24) of eyes with a bifocal lens (p value not reported).

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