Outcomes after WIOL – CF accommodative intraocular lens implantation
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Transcript of Outcomes after WIOL – CF accommodative intraocular lens implantation
Outcomes after WIOL – CF accommodative Outcomes after WIOL – CF accommodative intraocular lens implantationintraocular lens implantation
IInstitute of nstitute of VVision and ision and OOpticspticsUniversity of Crete School of MedicineUniversity of Crete School of Medicine
Heraklion, Crete GreeceHeraklion, Crete Greece
Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD, Sophia I. Panagopoulou PhD
None of the authors has financial interests or None of the authors has financial interests or relationships to discloserelationships to disclose.
Financial Disclosure
WIOL – CF: Polyfocal hyperbolic opticsWIOL – CF: Polyfocal hyperbolic optics
Refractive power is maximum in the centre and gradually decreases in the periphery
WIOL – CF Features and benefits
Continuous sharp edgeContinuous sharp edge
Smooth gradual transition between central and peripheral opticsSmooth gradual transition between central and peripheral optics
Aspheric hyperboloid opticsAspheric hyperboloid optics
Full disc configuration Full disc configuration
Less optical complications, optimum vision qualitLess optical complications, optimum vision qualityy
WIOL- CF change of focus via WIOL- CF change of focus via lens deformation due to the action of natural focusing lens deformation due to the action of natural focusing
apparatus (cilliary muscle and zonules): apparatus (cilliary muscle and zonules):
F2F1
Clinical experience so far
11 key scientific publications and presentations
Results for 476 WIOL-CF eyes recorded in clinical trials adding to more than 500 eye-years of clinical-trial reported experience
Predominantly investigator driven studies and publications
WIOL-CF consistently shows accommodation range of more than 2D, that corresponds to the accomodation range of natural crystalline lens in 42-50 years of age. The range is stable over the long-term (up to 9 years)
Study / Observation Number of Eyes Accommodation Range Time of Evaluation
Pasta J 2003 79 2 D3 years
(67 eyes, 9 years follow-up)
Pasta J et al 2006 26 2.2 D (young active: 2-3 D) over 12 m
Nylander A et al 2006 51 ˃ 2.25 D Up to 24 months
Pallikaris IG 2011 50 2 D 24 months
Materials and MethodsMaterials and Methods25 patients (50 eyes)
Mean age: 65, 3 ± 8,4 years (range from 53to 83 years)
12 male, 13 female
All patients underwent routine cataract surgery and WIOL – CF accommodative intraocular lens implantation .
Exclusion CriteriaExclusion CriteriaAstigmatism higher than 1.25 dioptersAstigmatism higher than 1.25 dioptersPre-existing ocular historyPre-existing ocular history corneal corneal endothelial disease, abnormal cornea, macular endothelial disease, abnormal cornea, macular degeneration, retinal degeneration, glaucoma, and chronic drug miosis.degeneration, retinal degeneration, glaucoma, and chronic drug miosis.Previous refractive surgeryPrevious refractive surgeryRetinal conditions or predisposition to retinal conditions, previous history of/or Retinal conditions or predisposition to retinal conditions, previous history of/or predisposition to: retinal detachment or proliferative diabetic retinopathy.predisposition to: retinal detachment or proliferative diabetic retinopathy.AmblyopiaAmblyopiaClinically severe corneal dystrophy (e.g., Fuchs')Clinically severe corneal dystrophy (e.g., Fuchs')
Extremely shallow anterior chamberExtremely shallow anterior chamberRecurrent anterior or posterior segment inflammation of unknown etiology, or any disease Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).producing an inflammatory reaction in the eye (e.g. iritis or uveitis).AniridiaAniridiaOptic nerve atrophyOptic nerve atrophy TraumaTrauma
Implantation
LogMAR CDVA Mean±SD [Range]
LogMARUDVA Mean±SD [Range]
0.25 ± 0.16 0.84±0.62
[0.0 to 0.8] [CF to 0.24]
LogMARCDVA Mean±SD [Range]
LogMAR UDVA Mean±SD
[Range]
0.08±0.07 0.16±0.13
[0.0 to 0.22] [0.0 to 0.54]
PREOP
Last POSTOP
Last Postoperative Days/ Months
Mean±SD [Range]
649.32±378.18 [1404 to 98]21.64±12.61 [46.8 to 3.27]
Safety
No eye has lost lines of CDVA88% of patients gained ≥ 1 lines of CDVA
Stability
0.00 LogMar equals at 1.00 decimal Visual Acuity
Uncorrected Near Visual AcuityUncorrected Near Visual Acuity
72% 72% of our patients had of our patients had J2 or betterJ2 or better, at the last follow – up examination, measured with , at the last follow – up examination, measured with Birkhauser reading charts at a distance of 33cm under photopic conditions.Birkhauser reading charts at a distance of 33cm under photopic conditions.
Uncorrected Intermediate Visual AcuityUncorrected Intermediate Visual Acuity
72% 72% of our patients had of our patients had J2 or betterJ2 or better, at the last follow – up examination, measured with , at the last follow – up examination, measured with Birkhauser reading charts at a distance of 66cm under photopic conditions.Birkhauser reading charts at a distance of 66cm under photopic conditions.
Natural Accommodation
NEAR
FAR
DIF.MAP
FAR
NEAR
Mean diff.-1.18D
Max diff -7.20D
Max -3.53D
Range 9.35D
Pseudoaccommodation assessed with the iTrace
Pseudoaccommodation assessed with the iTracePseudoaccommodation assessed with the iTrace
NEAR
FAR
Mean diff.-1.00DMax diff
-3.66D
Max -4.84D
Range 6.55D
Slit Lamp photos of patients
AS – OCT image (Visante)
ConclusionsConclusions
WIOL – CF can be considered a very promising alternative solution for patients that lead an active life and require good vision near, intermediate and far. In our patient series In our patient series all all patients obtained some level of accommodation which patients obtained some level of accommodation which remained stable throughout the follow – up period.remained stable throughout the follow – up period.
No complications occurred intra or postoperativelyNo complications occurred intra or postoperatively.
Larger series of patients and longer follow-up is necessary in order to confirm the encouraging results