Vitrectomy Improves Contrast Sensitivity in Multifocal Pseudophakia with Vision Degrading Myodesopsia: Vitrectomy Improves Contrast Sensitivity in Multifocal Pseudophakia.
Academic Article
Overview
abstract
PURPOSE: Multifocal intraocular lenses (MFIOL) are associated with degradation in contrast sensitivity function (CSF), yet the contribution of vitreous is not known, nor is the benefit of vitrectomy. DESIGN: Prospective, non-randomized clinical study METHODS: 180 eyes of 180 patients (55 MFIOL, 60 monofocal intraocular lenses (MIOL), 65 phakic) with symptomatic vitreous opacities were enrolled. Vitreous structure was assessed with quantitative ultrasonography (QUS). Vision was evaluated with visual acuity and CSF measurements. RESULTS: Vitreous echodensity was the same in all lens cohorts, yet CSF was worse in MFIOL eyes (p<0.001). In 86 subjects who elected vitrectomy, there was 68% greater vitreous echodensity and 31% worse CSF than observation controls (p<0.0001 for each). Pre-operatively, CSF was 25% worse in MFIOL than MIOL (p=0.014). Post-operatively, vitreous echodensity decreased by 55%, 51%, and 52%, while CSF improved by 37% 48% in and 43% in in MFIOL, MIOL, and phakic eyes respectively (p<0.0001 for each). NEI Visual Function Questionnaire analyses showed improved visual well-being. CONCLUSION: Patients with vision degrading myodesopsia who elected vitrectomy had greater vitreous echodensity and worse CSF than controls, yet no other differences in age, sex, or myopia. MFIOL eyes had worse CSF than MIOL and phakic eyes, very possibly due to combined effects of the MFIOL and vitreous opacification. Limited vitrectomy reduced vitreous echodensity and improved CSF in all eyes. All patients with CSF-degrading vitreous opacities benefitted from limited vitrectomy, including those with MFIOL. Since MFIOL eyes had 37% improvement in CSF, patients with MFIOL and vision degrading myodesopsia merit consideration of vitrectomy.
