Intraocular lenses for small incision surgery
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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
Thinness
Resistance to folding / implantation
Stiffness
To maintain centration, refraction
Square edge
To allow sub-2mm implantation
To reduce PCO
Easy removal
Designing sub-2mm IOLs
Single-piece acrylic
Thinner optics
Refractive index
Asphericity
Optic size
Special haptic design
First attempt: The Thinoptx lens
The Acri.Smart solution
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
Spherical
Hyperaspheric
Neutral Aspheric
Toric
Acri.Comfort 646TLC
Multifocal
Acri.Lisa 366D
Multifocal Toric
Acri.Lisa 466TD
Acri.Smart 46S
Acri.Smart 36A
Acri.Smart 46LC
The Akreos MI60 MICS IOL
Material
Optic
Biconvex
Aspheric anterior and posterior
Optic Body and Total length
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
One-piece
10° average angulation
Design features
Bag-related size
Four-piece haptics
Angled haptics
Progressive haptic
resistance
No hole haptic
Square edge
Centration and Stability
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
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
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
Greetings from Verona
Italy