outcomes after wiol – cf accommodative intraocular lens implantation institute of vision and...
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Outcomes after WIOL CF accommodative intraocular lens implantation Institute of Vision and Optics University of Crete School of Medicine Heraklion, Crete Greece Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD, Sophia I. Panagopoulou PhD Slide 2 None of the authors has financial interests or relationships to disclose None of the authors has financial interests or relationships to disclose. Financial Disclosure Slide 3 WIOL CF: Polyfocal hyperbolic optics Refractive power is maximum in the centre and gradually decreases in the periphery Slide 4 WIOL CF Features and benefits Continuous sharp edge Smooth gradual transition between central and peripheral optics Aspheric hyperboloid optics Full disc configuration Less optical complications, optimum vision qualit y Slide 5 WIOL- CF change of focus via lens deformation due to the action of natural focusing apparatus (cilliary muscle and zonules): F2F2 F1F1 Slide 6 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 Slide 7 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 / ObservationNumber of EyesAccommodation RangeTime of Evaluation Pasta J 2003792 D 3 years (67 eyes, 9 years follow-up) Pasta J et al 200626 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 2011502 D24 months Slide 8 Materials and Methods 25 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. Slide 9 Exclusion Criteria Astigmatism higher than 1.25 diopters Pre-existing ocular history corneal endothelial disease, abnormal cornea, macular degeneration, retinal degeneration, glaucoma, and chronic drug miosis. Previous refractive surgery Retinal conditions or predisposition to retinal conditions, previous history of/or predisposition to: retinal detachment or proliferative diabetic retinopathy. Amblyopia Clinically severe corneal dystrophy (e.g., Fuchs') Extremely shallow anterior chamber Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis). Aniridia Optic nerve atrophy Trauma Trauma Slide 10 Implantation Slide 11 LogMAR CDVA MeanSD [Range] LogMARUDVA MeanSD [Range] 0.25 0.160.840.62 [0.0 to 0.8][CF to 0.24] LogMARCDVA MeanSD [Range] LogMAR UDVA MeanSD [Range] 0.080.070.160.13 [0.0 to 0.22][0.0 to 0.54] PREOP Last POSTOP Last Postoperative Days/ Months MeanSD [Range] 649.32378.18 [1404 to 98] 21.6412.61 [46.8 to 3.27] Slide 12 Safety No eye has lost lines of CDVA 88% of patients gained 1 lines of CDVA Slide 13 Stability 0.00 LogMar equals at 1.00 decimal Visual Acuity Slide 14 Uncorrected Near Visual Acuity 72% of our patients had J2 or better, at the last follow up examination, measured with Birkhauser reading charts at a distance of 33cm under photopic conditions. Slide 15 Uncorrected Intermediate Visual Acuity 72% of our patients had J2 or better, at the last follow up examination, measured with Birkhauser reading charts at a distance of 66cm under photopic conditions. Slide 16 Natural Accommodation NEARNEAR FARFAR DIF.MAPDIF.MAP Slide 17 FAR NEAR Mean diff. -1.18D Max diff -7.20D Max -3.53D Range 9.35D Pseudoaccommodation assessed with the iTrace Slide 18 NEAR FAR Mean diff. -1.00D Max diff -3.66D Max -4.84D Range 6.55D Slide 19 Slit Lamp photos of patients Slide 20 AS OCT image (Visante) Slide 21 Conclusions In our patient series all patients obtained some level of accommodation which remained stable throughout the follow up period. 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 all patients obtained some level of accommodation which remained stable throughout the follow up period. No complications occurred intra or postoperatively No complications occurred intra or postoperatively. Larger series of patients and longer follow-up is necessary in order to confirm the encouraging results Slide 22