Pilocarpine-induced shift of an accommodating intraocular lens: AT-45 Crystalens

J Cataract Refract Surg. 2005 Jul;31(7):1290-7. doi: 10.1016/j.jcrs.2005.03.055.


Purpose: To measure the shift of an accommodating plate-haptic intraocular lens (IOL) along the visual axis induced by ciliary muscle contraction after application of pilocarpine.

Setting: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

Methods: Fifty-four eyes of 28 patients with age-related cataract comprised this prospective study. Each patient received an AT-45 silicone accommodating IOL (Crystalens, Eyeonics Corp.) after standardized cataract surgery. In a subgroup of 24 eyes, capsular bag fibrosis was reduced by extensive polishing of the anterior capsule with a slit cannula. Assessment included measurements of anterior chamber depth, assessed with partial coherence interferometry, before and after application of pilocarpine 2% and evaluation of near visual acuity 1 month and 3 months postoperatively.

Results: A slight backward shift of the IOL of 151 mum in the nonpolished group (P < .001) and 122 mum in the polished group (P < .005) could be detected after application of pilocarpine. Polishing the capsule did not influence IOL shift. The median near visual acuity with distance correction 1 month and 3 months postoperatively was J5 and J4, respectively, in the nonpolished group and J6 at both times in the polished group.

Conclusions: Pilocarpine induced a counterproductive active backward shift of the AT-45 IOL. Polishing of the capsular bag had no impact on accommodative ability. The reading performance of patients with the AT-45 IOL patients at 1 and 3 months was not significantly different from that of with a standard IOL under similar testing methods.

MeSH terms

  • Accommodation, Ocular / drug effects
  • Aged
  • Aged, 80 and over
  • Ciliary Body / drug effects*
  • Foreign-Body Migration / etiology*
  • Humans
  • Lens Implantation, Intraocular
  • Lenses, Intraocular*
  • Middle Aged
  • Miotics / adverse effects*
  • Muscle Contraction / drug effects*
  • Muscle, Smooth / drug effects
  • Phacoemulsification
  • Pilocarpine / adverse effects*
  • Prospective Studies
  • Prosthesis Design


  • Miotics
  • Pilocarpine