outcomes after wiol – cf accommodative intraocular lens implantation institute of vision and...

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Outcomes after WIOL – CF Outcomes after WIOL – CF accommodative intraocular lens accommodative intraocular lens implantation implantation I I nstitute of nstitute of V V ision and ision and O O ptics ptics University of Crete School of University of Crete School of Medicine Medicine Heraklion, Crete Greece Heraklion, Crete Greece Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD

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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

WIOL – CF Accommodative IOLWIOL – CF Accommodative IOL

Lens characteristics were selected to Lens characteristics were selected to secure secure adequate contact with the adequate contact with the biggest part of the posterior capsule biggest part of the posterior capsule but not alteration of the capsule but not alteration of the capsule shape. shape.

Large continuous aspheric optics Large continuous aspheric optics assures lens centricity and assures lens centricity and reduces reduces reflections and halosreflections and halos that can cause that can cause night vision problems.night vision problems.

The lens design is intended to provide The lens design is intended to provide up to up to 2.0 diopters 2.0 diopters of“pheudoaccommodation” of“pheudoaccommodation” capability capability facilitating near vision. facilitating near vision.

WIOL – CF geometryWIOL – CF geometry

WIOL – CF Material features and benefitsWIOL – CF Material features and benefits

The WIOL - CF accommodative design is based on theThe WIOL - CF accommodative design is based on the

biomimetic principle – imitation of the crystalline lens.biomimetic principle – imitation of the crystalline lens.

Large diameter, no haptics, hydro gel material used, high Large diameter, no haptics, hydro gel material used, high water content (41%) and lens geometry simulate some of water content (41%) and lens geometry simulate some of the the key properties key properties of the crystalline lens itself. of the crystalline lens itself.

Advantages:Advantages: No decentration problems No decentration problems (lens is self – (lens is self – centered after impantation), centered after impantation), no haptics complicationsno haptics complications

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 qualityLess optical complications, optimum vision quality

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):

WIOL – CF can be WIOL – CF can be inserted through a inserted through a 2.8mm incision.2.8mm incision.

Once the lens is inserted, it unfolds inside the capsule and

gradually hydrates by the fluid present in the eye.

Complete hydration is succeeded within the first 48 hours

and full equilibrium with the eye fluids is achieved.

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 .

Mean follow up 11,44 ± 2,46 months

(range from 9 to 17 months)

Exclusion CriteriaExclusion Criteria

Astigmatism higher than 1.25 dioptersAstigmatism higher than 1.25 diopters

Pre-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 surgery

Retinal 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.

AmblyopiaAmblyopia

Clinically 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 Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).

AniridiaAniridia

Optic nerve atrophyOptic nerve atrophy

TraumaTrauma

 

Implantation

Safety

No eye has lost lines of CDVA at 1 year postoperatively88% of patients gained ≥ 1 lines of CDVA

Decimal CDVA Mean±SD [Range]

Decimal UDVA Mean±SD [Range]

0.61 ± 0.19 0.31±0.17

[0.2 to 1] [CF to 0.7]

Decimal CDVA Mean±SD [Range]

Decimal UDVA Mean±SD

[Range]

0.82±0.13 0.74±019

[0.4 to 1] [0.2 to 1]

PREOP

POSTOP

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 one year postoperatively, measured with , at one year postoperatively, 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 one year postoperatively, measured with , at one year postoperatively, 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

Higher Order Aberrations

Contrast Sensitivity at 1 year postoperativelyContrast Sensitivity at 1 year postoperatively

InnovationInnovationPeripheral capsule reconstruction ring and Peripheral capsule reconstruction ring and

accommodative IOL (WIOL - CF) implantationaccommodative IOL (WIOL - CF) implantationIntraoperative photos Intraoperative photos

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

Thank you for your attentionThank you for your attention

Cornea and corneal refractive surgery module

February 6 – 10, 2012 Lugano, Switzerland

www.esaso.ch