Title Presbyopia treatment by lens surgery versus Laser in situ keratomileusis Title (croatian) Tretman prezbiopije: kirurgija leće u odnosu na Laser in situ keratomileuza Author Adis Pašalić Mentor Iva Dekaris (mentor)Committee member Smiljka Popović-Suić (predsjednik povjerenstva)Committee member Jakov Šikić (član povjerenstva)Committee member Rajko Pokupec (član povjerenstva)Granter University of Zagreb Defense date and country 2021-02-25, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 617 - Surgery. Orthopaedics. Ophthalmology Abstract PURPOSE: To evaluate the effectiveness in presbyopia treatment of two surgical methods: lens surgery versus Laser in situ keratomileusis. -----
METHODS: Patients were separated into two groups according to the surgical procedure which they were treated — lens surgery with multifocal intraocular lens implantation (MFIOL group) and Lasik in situ keratomileusis procedure on the cornea (LASIK group). Within each group, the treated eyes were further subdivided according to the type of diopter: myopic or hypermetropic patients. A total of 200 eyes (100 patients) were included in the MFIOL group. There were 110 eyes (54 patients) with hypermetropia and 90 eyes (45 patients) with myopia who underwent lens surgery. A total of 198 eyes (99 patients) were included in the Lasik in situ keratomileusis group. There were 98 eyes (49 patients) with hypermetropia and 100 eyes (50 patients) with myopia. Patients were followed up for 6 months on time points 1st day, 1st week, 1st month, 3rd month and finally 6th month, when manifested refraction in spherical equivalent (SE), uncorrected near visual acuity and uncorrected distant visual acuity (UCNVA, UCDVA), best corrected near visual acuity and best corrected distant visual acuity (BCNVA, BCDVA), were analyzed and statistically compared. Satisfaction questionnaire was given preoperatively and on 1st month, 3rd month and 6th month postoperatively. -----
RESULTS: Both groups of patients were presbyopes with average age in MFIOL group of 52 years, and in LASIK 48,8 years old, respectively. Thus, when comparing hyperopes in MFIOL group versus LASIK group we observed:
1. Manifest refraction in MFIOL was 0.38±0.79D (0.75-1.25) as compared to 0.51±0.53D (-0.88-1.75) in LASIK 6 months postoperatively, which was not statistically significant (p=0.08). 2. Six months postoperative UCNVA in MFIOL was 1.16±0.37J (1-2) versus 1.45±0.62J (1-3) in LASIK group, which was statistically significant (p=0.0002). MFIOL group had statistically better UCNVA than LASIK group. 3. Six months postoperative UCDVA was greater in MFIOL with 0.95±0.07 (0.65-1) versus 0.87±0.15 (0.40-1) in LASIK group, which was statistically significant (p=0.000004). 4. Patients satisfaction score in MFIOL group was 4.48+/-0.69 (3-5) versus 3.58±0.59 (2-4) in LASIK group, which was statistically significant (p=0.01).
When comparing myopes in MFIOL group versus LASIK group we observed:
1. Manifest refraction in MFIOL was 0.32±0.65D (1.25-2.00) as compared
to -0.61±0.37D (-1.75-0) in LASIK 6 months postoperatively, which was statistically significant (p=3.72E-23). LASIK myopes were in slightly more minus diopter than MFIOL group. 2. Six months postoperative UCNVA in MFIOL was 1.43±0.47 (1-3) versus 1.06±0.23 (1-2) in LASIK group, which was statistically significant (p=5.59E-10). LASIK group had statistically better UCNVA than MFIOL group.
3. Six months postoperative UCDVA was greater in MFIOL with 0.94±0.08 (0.65-1) versus 0.87±0.17 (0.30-1) in LASIK group, which was statistically significant (p=0.000003). 4. Patient satisfaction score in MFIOL group was 3.54±0.79 (2-4) versus 4.54±0.89 (3-5) in LASIK group, which was statistically significant (p=0.009). Myopes in LASIK group were more satisfied than myopes in MFIOL group. -----
CONCLUSION: Both surgical procedures: MFIOL implantation and LASIK surgical procedures had proven to be effective and safe with a low rate of complications. Overall manifest refraction as well as manifest refraction in subgroups of hyperopes and myopes in both procedures were significantly decreased 6 months postoperatively. Uncorrected near visual acuity was statistically different between subgroups of hyperopes and myopes in MFIOL group and in LASIK group. uncorrected near visual acuity in hyperopic group was statistically better than uncorrected near visual acuity in myopic group in the MFIOL procedure. However, in LASIK group it was vice versa in favor of myopes.
Additionally, there was statistical difference between uncorrected near visual acuity of hyperopes in MFIOL versus hyperopes in LASIK group, and myopes in MFIOL versus myopes in LASIK group. The hyperopes in MFIOL group had better uncorrected near visual acuity than in LASIK group. Similarly, myopes in LASIK group had better uncorrected near visual acuity than myopes in MFIOL group.
Abstract (croatian) CILJ: Evaluirati učinkovitost dviju kirurških metoda u tretmanu prezbiopije: kirurgija leće u odnosu na Laser in situ keratomileuzu. -----
METODE: Pacijenti su podijeljeni u dvije grupe prema kirurškoj metodi kojoj su podvrgnuti - kirurgija leće s ugradnjom multifokalnih intraokularnih leća (MFIOL grupa) i kirurška procedura na rožnici Laser in situ keratomileuza (LASIK grupa). U svakoj grupi tretirane oči su dalje podijeljene prema vrsti dioptrije na kratkovidne i dalekovidne pacijente. Ukupno 200 očiju (100 pacijenata) je uključeno u MFIOL grupu. Od toga je bilo 110 očiju (55 pacijenta) sa dalekovidnošću i 90 očiju (45 pacijenata) sa kratkovidnošću koji su podvrgnuti kirurgiji leće. Ukupno 198 očiju (99 pacijenata) je uključeno u LASIK grupu. Od toga je bilo 98 očiju (49 pacijenata) sa dalekovidnošću i 100 očiju (50 pacijenata) sa kratkovidnošću. Pacijenti su praćeni 6 mjeseci; prvi dan, prvi tjedan, zatim 1, 3 i 6 mjesec poslijeoperacijski, pri čemu je analizirana i statistički uspoređena manifestna refrakcija u sfernom ekvivalentu, nekorigirana vidna oštrina na blizinu i na daljinu (UCNVA, UNDVA), najbolja korigirana vidna oštrina na blizinu i daljinu (BCNVA, BCDVA). Upitnik o zadovoljstvu pacijenta popunjen je prijeoperacijski te 1, 3 i 6 mjesec poslijeoperacijski. -----
REZULTATI: Obje grupe pacijenata dalekovidne su na blizinu s prosječnom dobi u MFIOL grupi od 52 godine, a u LASIK grupi od 48,8 godina. Pri usporedbi dalekovidnih pacijenata u MFIOL grupi u odnosu na LASIK grupu analizirali smo i pronašli:
1). Manifestna refrakcija u MFIOL grupi je bila 0.38±0.79D (0.75-1.25) u odnosu na 0.51±0.53D (-0.88-1.75) u LASIK grupi 6 mjeseci poslijeoperacijski, što nema statističkog značaja, (p=0.08). 2). Šest mjeseci poslijeoperacijski UCNVA u MFIOL grupi je bila 1.16±0.37J (1-2) u usporedbi sa 1.45±0.62J (1-3) u LASIK grupi, što je statistički značajno (p=0.0002). MFIOL grupa je imala statistički bolju UCNVA nego LASIK grupa. 3). Šest mjeseci poslijeoperacijski UCDVA je bila bolja u MFIOL grupi sa 0.95±0.07 (0.65-1) u usporedbi sa 0.87±0.15 (0.40-1) u LASIK grupi, što je statistički značajno (p=0.000004). 4). Rezultat zadovoljstva pacijenta u MFIOL grupi je bio 4.48+/-0.69 (3-5) u usporedbi sa 3.58±0.59 (2-4) u LASIK grupi, što je statistički značajno (p=0.01). Pri usporedbi kratkovidnih pacijenata u MFIOL grupi u usporedbi sa LASIK grupom analizirali smo i pronašli:
1). Manifestna refrakcija u MFIOL grupi je bila 0.32±0.65D (1.25-2.00) u odnosu na -0.61±0.37D (-1.75-0) u LASIK grupi 6 mjeseci poslijeoperacijski, što je statistički značajno (p=3.72E-23). 2). Šest mjeseci poslijeoperacijski UCNVA u MFIOL grupi je bila 1.43±0.47 (1-3) u usporedbi sa 1.06±0.23 (1-2) u LASIK grupi, što je statistički značajno (p=5.59E-10). LASIK grupa je imala bolju statističku UCNVA u odnosu na MFIOL grupu. 3). Šest mjeseci poslijeoperacijski UCDVA je bila veća u MFIOL grupi sa 0.94±0.08 (0.65-1) u usporedbi sa 0.87±0.17 (0,30-1) u LASIK grupi, što je statistički značajna razlika (p=0.000003). 4) Rezultat zadovoljstva pacijenta u MFIOL grupi je bio 3.54±0.79 (2-4) u usporedbi sa 4.54±0.89 (3-5) u LASIK grupi, što je bilo statistički značajno (p=0.009). Kratkovidni pacijenti u LASIK grupi su bili više zadovoljni nego kratkovidni pacijenti u MFIOL grupi. -----
ZAKLJUČAK: Obje kirurške procedure: kirurgija leće s ugradnjom MFIOL i LASIK su pokazale učinkovitost i sigurnost s niskom učestalošću komplikacija. Sveukupna manifestna refrakcija u podgrupama dalekovidnih i kratkovidnih pacijenata u obje procedure se značajno smanjila 6 mjeseci poslijeoperacijski. Nekorigirana vidna oštrina na blizinu je statistički značajna između podgrupa dalekovidnih i kratkovidnih pacijenata u MFIOL grupi i u LASIK grupi. Nekorigiriana vidna oštrina na blizinu u grupi dalekovidnih pacijenata je statistički bolja nego nekorigiriana vidna oštrina na blizinu u grupi kratkovidnih pacijenata kod MFIOL-a. Međutim, u LASIK grupi bilo je obrnuto u korist kratkovidnih pacijenata. Dodatno, postoji statistički značajna razlika između nekorigiriana vidna oštrina na blizinu dalekovidnih pacijenata u MFIOL grupi u odnosu na LASIK grupu i kratkovidnih pacijenata u MFIOL grupi u odnosu na LASIK grupu. Dalekovidni pacijenti u MFIOL grupi su imali bolju nekorigiriana vidna oštrina na blizinu nego u LASIK grupi. Slično, kratkovidni pacijenti u LASIK grupi su imali bolju nekorigirianu vidnu oštrinu na blizinu nego kratkovidni pacijenti u MFIOL grupi.
Keywords
Adults
Middle Aged
Keratomileusis
Laser In Situ
Patient Satisfaction
Hyperopia
Presbyopia
Lens Implantation
Intraocular
Myopia 3
Myopia
Biometry
Vision Tests
Visual Acuity
Cornea
Surveys and Questionnaires
Keywords (croatian)
Odrasli
Srednje godine
Keratomileusis
Laser In Situ
Zadovoljstvo pacijenta
Hipermetropija
Dalekovidost
Ugradnja leće
intraokularno
Kratkovidnost 3
Kratkovidnost
Biometrija
Ispitivanja vida
Oštrina vida
Rožnica
Ankete i upitnici
Language croatian URN:NBN urn:nbn:hr:105:667565 Study programme Title: Biomedicine and Health Sciences Type of resource Text Extent 83 str. File origin Born digital Access conditions Open access Terms of use Repository Dr Med - University of Zagreb School of Medicine Digital Repository Created on 2021-05-18 08:32:12
