Transcript Intraocular lenses for small incision surgery

Intraocular lenses for
small incision surgery
Roberto Bellucci MD
Ophthalmic Unit, Hospital and University of
Verona, Italy
Simonetta Morselli MD
Ophthalmic Unit, Hospital of Bassano del
Grappa, Italy
Financial Interest: E (Bausch & Lomb)
Requirements for MICS lenses
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Thinness
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Resistance to folding / implantation
Stiffness
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To maintain centration, refraction
Square edge
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To allow sub-2mm implantation
To reduce PCO
Easy removal
Designing sub-2mm IOLs
Single-piece acrylic
 Thinner optics
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Refractive index
 Asphericity
 Optic size
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Special haptic design
 First attempt: The Thinoptx lens
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The Acri.Smart solution
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Hydrophilic core, hydrophobic surfaces
Plate haptic, standard thickness
Full 6 mm optic
No square edge
at haptic/optic
junction
The Acri.Smart results
The Acri.Smart IOL provided good results in
clinical studies, demonstrating that MICS IOL
are excellent platforms for special optic design
Alió JL, Schimchak P, Montés-Micó R, Galal A.
Retinal image quality after microincision intraocular lens
implantation
J Cataract Refract Surg 2005; 31:1557-1560
Alió JL, Rodriguez-Prats JL, Vianello A, Galal A
Visual outcome of microincision cataract surgery with
implantation of an Acri.Smart lens.
J Cataract Refract Surg 2005; 31:1549-1556
Kurz S, Krummenauer F, Thieme H, Dick HB
Contrast sensitivity after implantation of a spherical versus an aspherical intraocular
lens in biaxial microincision cataract surgery.
J Cataract Refract Surg 2007; 33: 393-400
The Acri.Smart family
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Spherical
Hyperaspheric
Neutral Aspheric
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Toric
Acri.Comfort 646TLC
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Multifocal
Acri.Lisa 366D
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Multifocal Toric
Acri.Lisa 466TD
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Acri.Smart 46S
Acri.Smart 36A
Acri.Smart 46LC
The Akreos MI60 MICS IOL
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Material
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Optic
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Biconvex
Aspheric anterior and posterior
Optic Body and Total length
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26% hydrophilic acrylic
UV blocker
Refractive index 1.458 (hydrated)
6.2x11.0 mm from 10.0 to 15.0 dpt
6.0x10.7 mm from 15.5 to 22.0 dpt
5.6x10.5 mm from 22.5 to 30.0 dpt
Haptics
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One-piece
10° average angulation
Design features
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Bag-related size
Four-piece haptics
Angled haptics
Progressive haptic
resistance
No hole haptic
Square edge
Centration and Stability
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The four-loop design allows precise
centration within the capsular bag,
even with loose or damaged zonules
STABILITY is ensured by angulation and
by four-piece haptic design that
counteracts vitreous pressure
Various designs, however…
Plate haptic
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Closed-loop haptic
Accommodating
Large haptic holes may prevent IOL exchange
Weak haptics will favour optic movement
Plate haptic require intact capsular bags
Conclusion
Microincision lenses are not reduced
versions of standard lenses
 They are a new type of IOL, with
specific design features
 They are a good option for refractive
cataract surgery
 They are perfect platforms for special
optic designs
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A look at the near future
Small incision lenses will increase
popularity
 Cross-linking of the material will further
increase stiffness and stability
 Studies on pseudoaccommodation
will continue
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Greetings from Verona
Italy