Phakic posterior chamber IOLs

1. Cells involved in crystalline lens and capsular bag opacification2. Evolution of designs of PPCIOLs3. Relevant aspects of fixation and sizing4. Sizing issue: New studies5. Surgical implantation6. Relationship between cataract and myopia7. Cataractogenesis

• Specimens analyzed in our Center• Mechanisms• Review of the literature• Classification of cataracts after phakic IOL implantation?

White-to-white + 0.5 mm(myopic eyes)

White-to-white – 0.5 mm(hyperopic eyes)

Third generation:Staar ICL

White-to-white?

Pop M, Payette Y, Mansour M. Predicting sulcus size using ocular Pop M, Payette Y, Mansour M. Predicting sulcus size using ocular measurements. measurements. J Cataract Refract SurgJ Cataract Refract Surg 2001; 27:1033-1038. 2001; 27:1033-1038.

-43 eyes of 24 patients (34 ± 6 years)

-Spherical equivalent: -25.50 to –8.75, and +4.00 to +7.50

-Measurements: white-to-white with surgical calipers; sulcus diameter with composites of UBM photographs (50 MHz)

-Traditional estimation of sulcus size through limbal measurement is inadequate: limbus size alone cannot predict sulcus size

1

2

3

4

Werner L, Apple DJ, et al. Correlation between different measurements within the eye with relevance for phakic intraocular lens implantation.J Cataract Refract Surg 2002(in preparation)

Table I. Measurements (in mm) obtained from the first 10 eyes used in this study.

Eye # Age Gender Anterior-posterior White-to-white Anterior chamber diameter Angle-to-angle Sulcus-to-sulcus

(years) length (6-12 o'clock)* (6-12 o'clock) plastic sizer (6-12 o'clock, after fixation)* (6-12 o'clock, after fixation)*

1 59 M 24.04 11 11.75 12.5 12.75

2 59 M 24.14 11 12 12 11.75

3 62 M 23.79 10.75 11.5 11.5 11.25

4 62 M 23.92 10.75 10.75 11 11

5 54 M 24.63 11 12.5 12 11.75

6 54 M 24.45 11.5 11.5 12 11.5

7 72 F 24.31 11 11.5 11.75 11.25

8 72 F 24.46 11 11.5 11.75 12

9 70 F 23.36 10.5 11.5 11.5 11.25

10 70 F 23.29 11 11.5 12 11.5

M ± SD** 63.4 ± 7.1 - 24.03 ± 0.45 10.95 ± 0.25 11.72 ± 0.46 11.80 ± 0.40 11.60 ± 0.50

* = The measurements were performed with a surgical caliper (steps of 0.25 mm).** = Mean ± standard deviation.

Table II. Measurements (in mm) obtained from the last 12 eyes used in this study.

Eye # Age Gender Anterior-posterior White-to-white (3-9 o'clock) Anterior chamber diameter Angle-to-angle with calipers Sulcus-to-sulcus with calipers

(years) length with calipers* (3-9 o'clock) plastic sizer (3-9 o'clock, after fixation)* (3-9 o'clock, after fixation)*

11 60 M 26.15 11.50/11.52 12 11.50/11.46 11.00/11.12

12 60 M 26.59 11.50/11.41 11.5 11.50/11.60 11.25/11.25

13 74 F 23.52 11.25/11.35 12.5 11.75/11.92 11.50/11.33

14 74 F 23.74 11.50/11.51 12.25 11.75/11.92 11.25/11.06

15 69 M 23.89 12.25/12.06 11.5 11.75/11.70 11.25/10.79

16 69 M 23.93 12.00/12.08 11.5 11.75/11.66 11.25/11.18

17 67 M 26.16 12.25/12.24 12.5 12.25/12.31 11.75/11.71

18 67 M 26.01 12.50/12.44 12.75 12.00/12.19 11.50/11.72

19 56 M 26.63 11.75/12.01 12.5 11.75/11.97 11.25/11.45

20 56 M 26.27 11.75/12.02 12.5 11.75/12.16 12.25/11.96

21 63 F 25.04 11.25/11.04 11.5 11.75/11.80 11.25/10.95

22 63 F 24.23 11.75/11.43 12 11.75/11.90 11.25/11.34

M ± SD** 64.8 ± 6.1 - 25.18 ± 1.23 11.77 ± 0.40/11.75 ± 0.43 12.08 ± 0.48 11.77 ± 0.19/11.88 ± 0.25 11.39 ± 0.32/11.32 ± 0.34

* = The first measurement was performed with a surgical caliper (steps of 0.25 mm); the second measurement was performed with a digital caliper.** = Mean ± standard deviation.

White to White vs Angle to Angle(6-12 O'clock)

White to White 6-12 O'clock (mm)

10.4 10.6 10.8 11.0 11.2 11.4 11.6

Ang

le to

Ang

le 6

-12

O'c

lock

(m

m)

9.5

10.0

10.5

11.0

11.5

12.0

12.5

13.0

13.5

No correlation:White-to-white andangle-to-angle(vertical meridian)N = 10 eyes

No correlation:White-to-white andsulcus-to-sulcus(vertical meridian)N = 10 eyes

White to White vs Sulcus to Sulcus(6-12 O'clock)

White to White 6-12 O'clock (mm)

10.4 10.6 10.8 11.0 11.2 11.4 11.6

Sul

cus

to S

ulcu

s 6-

12 O

'clo

ck (

mm

)

9

10

11

12

13

14

No correlation:White-to-white andangle-to-angle(horizontal meridian)N = 12 eyes

White to White vs Angle to Angle3-9 O'clock, Caliper #2

White to White 3-9 O'clock (mm)Caliper # 2

10.8 11.0 11.2 11.4 11.6 11.8 12.0 12.2 12.4 12.6

Ang

le to

Ang

le 3

-9 O

'clo

ck (

mm

)C

alip

er #

2

11.0

11.2

11.4

11.6

11.8

12.0

12.2

12.4

12.6

12.8

13.0

No correlation:White-to-white andsulcus-to-sulcus(horizontal meridian)N = 12 eyes

White to White vs Sulcus to Sulcus3-9 O'clock, Caliper #2

White to White 3-9 O'clock (mm)Caliper #2

10.8 11.0 11.2 11.4 11.6 11.8 12.0 12.2 12.4 12.6

Sul

cus

to S

ulcu

s 3-

9 O

'clo

ck (

mm

)C

alip

er #

2

10.0

10.5

11.0

11.5

12.0

12.5

13.0

Anterior segment B-scan with ahigh-frequency digital ultrasound system:

““ARTEMIS”ARTEMIS”

Developed at the Cornell University byJ. Coleman, R. Silverman, and D.Z. Reinstein

Manufactured by UltralinkG. Wilserman and S. Phillips

Werner L, et al. Evaluation of a new ultrasound system for refractive surgeryEvaluation of a new ultrasound system for refractive surgery.Poster presented at the XX Congress of the ESCRS, Nice, France,September 2002

•15 cadaver eyes (9 phakic and 6 pseudophakic)

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Phakic cadaver eye(horizontal meridian)