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Session Title: Phakic IOL Implantation II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 09:34
Venue: E104-105 (First Floor)
First Author: : M.Le Loir FRANCE
Co Author(s): : B. Cochener
Posterior phakic implantation represents first-line indication for the correction of high ametropia. First models of phalic IOL in Collamer (ICL Staar) showed a high level of refractive efficacy, (ICL © Staar) but anatomic safety was significantly improved with last model V4 (4th generation) and V4c (Aquaport © with a central pin-hole). This last model with an optimized design allows an implantation without peripheral iridectomy but requires an evaluation of postoperative visual acuity.
36 eyes of 18 high ametropic patients (6 myopic, 10 myopic with combined astigmatism and 2 hyperopic) were implanted with Visian ICL V4c. Selection criteria were a preoperative best corrected visual acuity superior to 0.8 Jaeger 1, a regular corneal topography, an endothelial corneal integrity verified by specular microscope and retinal integrity assessed by macular OCT. Visual quality was objectively evaluated by OQAS © (Visiotronics), and Wavefront aberrometry whereas subjective evaluation required a questionnaire of life.
Postoperative uncorrected visual acuity was 0.9 Jaeger 1 in 91% of implanted eyes, and 45% eyes gained one line or more of Best corrected visual acuity. We reported neither a case of significant loss of endothelial density nor a single case of induced cataract but 2 cases of high intraocular preassure medically treated. In spite of a high level of patient satisfaction (100% patient would redo the surgery), 31% of implanted eyes presented an increase of MTF, 27% patients complained of a higher rate of glare and a loss of contrast sensitivity. One patient reported glare and halos without impact on his quality of life. Neither an explantation nor a postoperative peripheral iridectomy was required.
Visian ICL V4C model allows excellent refractive efficacy and anatomic safety. The central pin hole would allow an easier aqueous humor flow into the anterior chamber without peripheral iridectomy, but may induce in minority of implanted eyes, a lower contrast sensitivity and an higher rate of glare
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