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