Purpose To measure the axial movement of an accommodating intraocular lens (IO L) induced by ciliary muscle contraction after application of pilocarpine. Desig n Randomized, controlled, patient and examiner masked trial with intrapatient co mparison. Participants and controls One hundred ten eyes of 55 patients with age -related bilateral cataract. Methods This study was divided into 3 parts. In th e first, the accommodating IOL (1CU) was compared with a 3-piece open-loop acr ylic IOL that served as the control. In the second, to assess the effect of caps ule fibrosis on the potential accommodating performance of the accommodating IOL , extensive polishing of the anterior capsule with a slit cannula was compared w ith standard surgery. In the third, the effect of a posterior capsulorhexis was compared with that of standard surgery. Anterior chamber depth (ACD) was assesse d with partial coherence interferometry, measured before and after topical appli cation of pilocarpine 2%, and near visual acuity (VA) was evaluated 3 months af ter surgery. Main outcome measure Pilocarpine-induced change in ACD. Results Th e accommodating IOL showed a forward movement under pilocarpine with a median am plitude of movement of -314 μm (95%confidence interval CI: -148 to -592), compared with the backward movement of 63 μm (95%CI: 161 to -41) for the ope n-loop control IOL (P=0.001). Capsule polishing and a posterior capsulorhexis h ad no effect on IOL movement with the accommodating IOL. The median near VA with distance correction was 20/60. Conclusion Pilocarpine induced a small but signi ficant forward movement of the accommodating IOL. However, the amount of movemen t was calculated to result in a refractive change of < 0.5 diopters (D) in most patients, reaching 1 D or slightly more in only single cases, with a large varia bility of movement. Neither polishing of the capsule bag nor a posterior capsulo rhexis could enhance the accommodative ability.
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