The efficacy of accommodative versus monofocal intraocular lenses for cataract patients: A systematic review and meta-analysis

• Published in: Medicine (Baltimore) Vol. 97; no. 40; p. e12693
• Main Authors: Zhou, Hongwei, Zhu, Chongyan, Xu, Wenya, Zhou, Fang
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.10.2018
• Subjects: accommodative intraocular lenses; cataract; Cataract Extraction - methods; Humans; Lens Implantation, Intraocular - methods; Lenses, Intraocular - classification; meta-analysis; monofocal intraocular lenses; Patient Satisfaction; systematic review; Systematic Review and Meta-Analysis; Visual Acuity
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000012693

We performed a systematic review and meta-analysis to evaluate whether accommodative intraocular lenses (AC-IOLs) are superior for cataract patients compared with monofocal IOLs (MF-IOLs). Pubmed, Embase, Cochrane library, CNKI, and Wanfang databases were searched through in August 2018 for AC-IOLs versus MF-IOLs in cataract patients. Studies were pooled under either fixed-effects model or random-effects model to calculate the relative risk (RR), weighted mean difference (WMD), or standard mean difference (SMD) and their corresponding 95% confidence interval (CI). Distance-corrected near visual acuity (DCNVA) was chosen as the primary outcome. The secondary outcomes were corrected distant visual acuity (CDVA), pilocarpine-induced IOL shift, contrast sensitivity, and spectacle independence. Seventeen studies, involving a total of 1764 eyes, were included. Our results revealed that AC-IOLs improved DCNVA (SMD = -1.84, 95% CI = -2.56 to -1.11) and were associated with significantly greater anterior lens shift than MF-IOLs (WMD = -0.30, 95% CI = -0.37 to -0.23). Furthermore, spectacle independence was significantly better with AC-IOLs than with MF-IOLs (RR = 3.07, 95% CI = 1.06-8.89). However, there was no significant difference in CDVA and contrast sensitivity between the 2 groups. Our study confirmed that AC-IOLs can provide cataract patients with DCNVA and result in more high levels of spectacle independence than MF-IOLs. Further studies with larger data set and well-designed models are required to validate our findings.