safety and efficacy of toric icl john chang jr. md director of guy hugh chan refractive surgery...
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Safety and Efficacy of Toric Safety and Efficacy of Toric ICLICL
John Chang Jr. MDDirector of Guy Hugh Chan Refractive Surgery Centre
Hong Kong Sanatorium & Hospital
April 2008 ASCRS
Toric Implantation Collamer Lens (TICL) is now in phase III of the U.S. FDA study
TICLTICLLens power range
(Visian TICL) Sphere ranges from -3D
to -23D Cylinder ranges from
+1DC to +6DC Customized axis Can correct up to -
18DS/-0.75DC or -14DS/-5.0DC
From 04/2004 to 04/2007
No. of patients: 27 No. of eyes: 42 Bilateral TICL: 15 Age range: 23 to 44
yrs Mean age: 32.1 ± 6.7
yrs Mean FU: 6 months
TICL - ResultsTICL - Results
PreOp PostOp at 12M
Mean Sphere -14.20 ± 2.83D -0.20 ± 0.42 D
Range -7.00 to -19.50D +0.50 to -1.0D
Mean cyl 2.64 ± 0.89D 0.60 ± 0.49D
Range 1.00 to 4.50D 0 to 2.0D
Mean MSE -12.88 ± 2.79D +0.10 ± 0.33D
Range -6.00 to -18.25D -0.50 to 1.13D
TICL - ResultsTICL - Results
Within ± 0.5D Within ± 1.0D
MRSE 95% 95%
Cylinder 57% 91%
PostOp Rx at 12M
TICL - StabilityTICL - Stability
TICL - Results – 12MTICL - Results – 12M
TICL - Safety – 12MTICL - Safety – 12M
No eye lost any vision
TICL - ComplicationsTICL - Complications 1 eye (2.9%) transient IOP rise at 1
month Steroid induced
1 lens rotated 15o clockwise Patient with RE preop Rx -18.75/+3.50 x100 Implanted with TICL -23.0/+3.50/099 After surgery the lens rotated clockwise by 15o
Residual Rx -2.00/+2.50x120 (20/20), UCVA 20/80 Lens dialed 6M after surgery UCVA 20/25; MRx -0.50/+1.00 x 65 (20/20)
TICL - Surgical TICL - Surgical TechniqueTechnique Same as Non Toric Laser PI 1week prior to lens implantation Temporal 3.0 - 3.2mm self sealing incision Lens injected via foldable injector into AC Lens dialed into sulcus Surgery done under topical anesthesia Toric lens supplied correct Power for Sphere and
Cylinder but axis can be different by up to 22o
During surgery the axis of the lens to be positioned is marked.
Temporal incision is made to match that axis Need to dial lens into position (surgical planner
software supplied)
TICL - Advantages & TICL - Advantages & DisadvantagesDisadvantages
Advantages Technically not difficult (Avg surgery time 25
mins) No / Minimal night vision problems Short learning curve – easier than Phaco Lens is removableDisadvantages Sizing can be difficult, Orbscan not always
reliable Sizing even more important than non-toric ICL Glaucoma? Pigment dispersion? Expensive 2 Procedures: Laser P.I. First (uncomfortable),
then lens implantation
TICL - ConclusionTICL - Conclusion
Toric ICL results very encouraging (100% 20/20 UCVA)
Transient IOP rise 2° to steroid use Accuracy as good / better than LASIK for high
myopia Much better immediate and long term stability
than LASIK. No cataract with TICL