mr a nylander. clinical experience with the accommodative wiol-cf acrylic iol. zby arthur nylander,...
TRANSCRIPT
Mr A Nylander.
Clinical Experience with the Accommodative WIOL-CF acrylic IOL.
By Arthur Nylander, FRCS, FRCOphth, D.O.
Consultant ophthalmologistEast Lancashire hospitals,
Lancashire, U.K.
The author as no financial interest in these products
Mr A Nylander.
East Lancahire Hospitals
Serves a population of 500000 people Burnley General Hospital
Blackburn Royal Infirmary
Rossendale General Hospaital
Seven Consultant Ophthalmologist
Five Middle Grade Doctors
Nine Trainee Doctors
Mr A Nylander.
WIOL-CF
Accommodative Full-Optics acrylic IOL
Mr A Nylander.
WIOL-CFMain Features and Benefits
Accommodation capability > 2.25 Dioptres Low incidence of PCO (< 1%/year)Resistance to deposits Large glare-free
opticsVery good centration and position stabilityPotential for full reversibility -
reimplantableAllows vitreo-retinal surgery
Mr A Nylander.
WIOL-CF Posterior Chamber foldable acrylic IOL
• MAIN FEATURES:
Accommodating Large continuous aspheric opticsFills the posterior capsule Highly biocompatible materialLarge lens implantable through a
small incision
Mr A Nylander.
WIOL-CF design
Full disc plano-convex lens up to 9 mm O.D. Posterior polyfocal hyperbolic optics
Optics continuous up to the rim
Implantation: Preformed through < 3mm incision using
a 3.0mm cartridge and titanium injector.
Mr A Nylander.
WIOL-CF acrylic IOL
Mr A Nylander.
O.D. – 8.6 – 9.0 mm
HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE
MENISCOID ANTERIOR SURFACE
WIOL-CF “Full Optics” acrylic IOL
C.T. =
1.1-1.4 mm
Mr A Nylander.
SHARP EDGE
MENISCOID ANTERIOR SURFACE
CONICAL FASETTE
WIOL-CF edge profile
HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE
OPTICAL TRANSITION ZONE
Mr A Nylander.
WIOL-CF Features Benefits
High water content
( 42%, higher than any other IOL on the market today )
High carboxylate content
( only on the current market )
Low refractive index
Superior biocompabilityHigh permeabilityHydrated surface with low friction vs. tissue (e.g., capsule, iris, cornea )
Resistance to calcification
Minimized surface reflections and glare at night
Mr A Nylander.
WIOL-CF Features Benefits
Negatively charged surface
(only one on the market )
Partly dehydrated for insertion
Resistance to protein depositsResistance to cell attachmentResistance to opacification of posterior capsuleNo adhesion to tissues ( capsule, iris, cornea )
Increased strength for safer foldingNon-slippery for safer gripSmaller size for implantation
Mr A Nylander.
WIOL-CF Features Benefits
Full-disc configuration
Self-centeringExcellent position stabilityMaintenance of posterior capsular wallReplaceability of WIOL-CFVery large optical zoneEnables vitreo-retinal surgery
Mr A Nylander.
WIOL-CF Features Benefits
Continuous transition between optics and rim
Sharp-edged continuous rim
Aspherics hyperboloid optics
No edge effects ( no glare, improved night vision )
Resistance to PCO
Improved depth of focusPseudo-accommodationImproved resistance to astigmation
Mr A Nylander.
Power Calculation Chart
Calculated Select Calculated Select Calculated Select Calculated Select Calculated Select Calculated Select Calculated Selectdioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptricpower power power power power power power power power power power power power power
(D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D)15.0 15.4 17.0 17.6 19.0 19.7 21.0 21.8 23.0 23.9 25.0 26.1 27.0 28.215.1 15.6 17.1 17.7 19.1 19.8 21.1 21.9 23.1 24.0 25.1 26.2 27.1 28.315.2 15.7 17.2 17.8 19.2 19.9 21.2 22.0 23.2 24.1 25.2 26.3 27.2 28.415.3 15.8 17.3 17.9 19.3 20.0 21.3 22.1 23.3 24.2 25.3 26.4 27.3 28.515.4 15.9 17.4 18.0 19.4 20.1 21.4 22.2 23.4 24.4 25.4 26.5 27.4 28.615.5 16.0 17.5 18.1 19.5 20.2 21.5 22.3 23.5 24.5 25.5 26.6 27.5 28.715.6 16.1 17.6 18.2 19.6 20.3 21.6 22.4 23.6 24.6 25.6 26.7 27.6 28.815.7 16.2 17.7 18.3 19.7 20.4 21.7 22.6 23.7 24.7 25.7 26.8 27.7 28.915.8 16.3 17.8 18.4 19.8 20.5 21.8 22.7 23.8 24.8 25.8 26.9 27.8 29.015.9 16.4 17.9 18.5 19.9 20.6 21.9 22.8 23.9 24.9 25.9 27.0 27.9 29.116.0 16.5 18.0 18.6 20.0 20.7 22.0 22.9 24.0 25.0 26.0 27.1 28.0 29.216.1 16.6 18.1 18.7 20.1 20.9 22.1 23.0 24.1 25.1 26.1 27.2 28.1 29.316.2 16.7 18.2 18.8 20.2 21.0 22.2 23.1 24.2 25.2 26.2 27.3 28.2 29.416.3 16.8 18.3 18.9 20.3 21.1 22.3 23.2 24.3 25.3 26.3 27.4 28.3 29.616.4 16.9 18.4 19.1 20.4 21.2 22.4 23.3 24.4 25.4 26.4 27.5 28.4 29.716.5 17.0 18.5 19.2 20.5 21.3 22.5 23.4 24.5 25.5 26.5 27.6 28.5 29.816.6 17.1 18.6 19.3 20.6 21.4 22.6 23.5 24.6 25.6 26.6 27.7 28.6 29.916.7 17.2 18.7 19.4 20.7 21.5 22.7 23.6 24.7 25.7 26.7 27.9 28.7 30.016.8 17.4 18.8 19.5 20.8 21.6 22.8 23.7 24.8 25.8 26.8 28.0 28.8 30.116.9 17.5 18.9 19.6 20.9 21.7 22.9 23.8 24.9 25.9 26.9 28.1 28.9 30.2
Correction of optical power of WIOL - CF10. 00
15. 00
10. 00 15. 00
O pt ická mohut nost WI O L - CF ( D)
Mini
mál ní
zao
stř
ení , Doln í rozli
šov
ací
me z (D)
Minimální zaostření Dolní rozlišovací mez
Mr A Nylander.
Power Calculation For the WIOL-CF Lens
• 1.The surgeon calculates the lens power based on the 119.5 A-constant for SRK-T. Lets’s assume that the calculated value is 21.5d.
• • 2.Surgeon corrects the calculated value using the correction chart.
The value of 22.5d (right red column) relates to the value 21.5d (left blue column).
• 3.Finally, the value of +0.5d is added to the corrected value.
Therefore surgeon implants WIOL-CF of the dioptric power of 22.8 (23.0)d.
• • 4.Anterior surface is the flat (plano) surface of the lens, posterior
surface is the convex surface of the lens, it is easy to recognise from the side view.
• 5.Lens has to be rinsed by isotonic saline solution and positioned posterior (convex) side down into the cartridge. Procedure of folding is shown in the following video.
Mr A Nylander.
Surgical Implantation
Video clip
Mr A Nylander.
WIOL-CF accommodation• Implanted in 51 eyes : • Up to this date results in summary:
WIOL-CF allows a comfortable everyday life and work or sports activities without use of spectacles or contacts
Good patient preference and satisfaction.
Objective examination shows 20/20 uncorrected acuity for both near and far vision
Mr A Nylander.
WIOL-CF ACCOMMODATIVE IOL
Implantation historyFirst implanted in January 2004.Implanted 3 in 2004Implanted 27 in 2005Implanted 21 so far in 2006
Mr A Nylander.
WIOL-CF ACCOMMODATIVE IOL
Implanted 51 lens in 38 patients11 of these patients have had the
lens implanted in both eyes29 patients have had unilateral
implantation.19 males 21 females
Mr A Nylander.
WIOL-CF ACCOMMODATIVE IOL
Age DistributionYoungest Patient 43 years oldOldest Patient 87 years old
Mr A Nylander.
WIOL-CF ACCOMMODATIVE IOL
AGE DISTRIBUTION
0
10
20
30
40
50
60
70
80
90
100
Number of Patients
Mr A Nylander.
WIOL-CF ACCOMMODATIVE IOL
Lens DioptersLens come in Diopters powers from 15.0 to
30 Diopters Implanted from 19.0 Diopters to 29.0
DioptersNO difference in folding patternAll powers injected with the same
behaviourLens must unfold inside the capsular bag
Mr A Nylander.
WIOL-CF Accomadative iol
Diopter Powers used
0
5
10
15
20
25
30
35
Number of Patients
Series1
Mr A Nylander.
Case Study 1
CASE 1 - Mr. S.H Aged 55 Hospital Administrator pre op: OD -1.00/-0.75@25 OS -2.25/-1.00@135 Add +1.75 for N5 Right Phacoemulsification +21.5 Wiol-CF IOL 5/5/05 Left Phacoemulsification + 21.5 Wiol -CF IOL 16/5/05 Unaided V.A. June 05 OD 6/4 OS 6/4-2 N8 N8 Patient very happy Unaided V.A. November 05 OD 6/9 OS 6/4-2 N8 N8 Right YAG capsulotomy
Mr A Nylander.
Case Study 2
CASE 2 - Mr. M. H. Aged 52 Taxi Driver pre op: OD +0.50/-0.75@50 OS +0.75/-0.50@50 Add +2.25 for N5 Right Phacoemulsification +23.5 Wiol-CF IOL
5/5/05 Left Phacomulsification + 23.5 Wiol -CF IOL
24/11/05 Unaided V.A. December 05 OD 6/9-1 OS 6/6 N5
N5 Patient say can read without glasses. Very happy.
Mr A Nylander.
Case Study 3
CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer pre op: OD +0.50/-0.75@50 OS +0.75/-0.50@50 Add +2.75 for N5 Right Phacoemulsification +19 Wiol-CF IOL
11/01/04 Unaided V.A. 6/6 N8. Very Happy.
Mr A Nylander.
Case Study 4
Brought Husband of patient case 3. Mr. T.A. Aged 86 for Bilateral Cataract Right Phacoemulsification + 26.5 Wiol -CF IOL
23/2/06 Left Phacoemulsification + 26.5 Wiol -CF IOL
2/3/06 Unaided V.A. April 06 OD 6/9-1 OS 6/9 N12 N10 Patient happy.
Mr A Nylander.
WIOL-CF accommodation: subjective patient's
observationsGood focus requires some effort and training
Acuity degrades by fatigue, (e.g.after long work on poor computer screens or reading of low-quality print in poor light conditions)
•Far focus improves and double vision disappears by widely opening eyes
•Near focus improves by narrowing eyes and good illumination
Mr A Nylander.
WIOL-CF accommodation: subjective patient's observations
• Very near focusing requires conscious effort and time (1 to 2 seconds lag)
• Using both eyes improves significantly both near and far focus
• No glare or other vision problems while driving at night
• No degradation of peripheral vision at driving, tennis, etc.
• No acuity deterioration after 4 years (subjectively improved)
Mr A Nylander.
Conclusion
• All patients obtained some accommodation.
• Accommodation range from N12 to N5 Mostly N8.
• Better accommodation with 6/9 or 6/6 vision than 6/4 or 6/5.
• Encourage patients to use their accommodation.
Mr A Nylander.
Conclusion
• Older patients need more encouragement than younger patients.
• Correction factor appears to be accurate.
• PCO in 2 out of 51 cases.
• 1 YAG Capsulotomy at 18 months
• No problems with YAG Capsulotomy
• Overall results with the WIOL-CF lens are very promising.