Welcome to Eurotimes

By Roibeard O’hÉineacháin

NICE — A majority of cataract patients implanted with the CrystaLensTM (AT-45 C&C Vision) IOL can read comfortably without reading glasses whether they need distance correction or not, a Belgian ophthalmologist told the XX ESCRS Congress.
In a study involving 47 eyes of 25 cataract patients implanted with the CrystaLens accommodative IOL, only two of 22 patients who received the implants in both eyes required reading glasses after a follow-up of at least three months, Erik Mertens MD said.

“Implantation of the accommodative AT-45 IOL affords patients the ability to become less dependent on glasses after extracapsular cataract extraction compared to monofocal IOLs. The glare and halos seen with multifocal IOLs do not occur with this new IOL,” he noted.
Binocular UCVA was 20/25 or better in 91%; 20/32 or better in 95%; and 20/40 or better in all eyes. Near UCVA was J1 or better in 23%; J2 or better in 73%; and J3 or better in 91%.
Monocular UCVA was 20/25 or better in 74%; 20/32 or better in 89%; and 20/40 or better in all. Monocular near UCVA was J1 or better in 21%; J2 or better in 51%; and J3 or better in 83%.

Monocular distance corrected near vision was J1 or better in 16%; J2 or better in 38%; and J3 or better in 84%. Binocular distance corrected near vision was J1 or better in 41%; J2 or better in 71%; and J3 or better in 94%.
The CrystaLens has two hinged haptics with polyamide loops which become fixed in the capsule during capsular shrinkage in the early postoperative period.

After implantation, the contraction of the ciliary muscle causes an increased pressure on the vitreous, which in turn pushes the optic forward.
The IOL has a 4.5 mm optic and a total length of 10.5 mm. It is made of a third-generation silicone material (Biosil). The lens is currently under FDA evaluation and may be approved by the end of the year.
The prospective study involved 15 women and 10 men aged 57 to 83. All were able to achieve a BCVA of 20/30 or better preoperatively and had undergone no previous ocular surgery.

Most had less than 1.0 D of corneal astigmatism preoperatively but a few patients with greater than 1.0 D of cylinder did receive the IOLs. Correction of the pre-existing astigmatism was achieved by limbal relaxing incisions.
Dr Mertens and his associates performed extracapsular cataract extraction on all eyes and implantation of a CrystaLens IOL. They implanted the lens through a 3.2 mm to 3.5 mm clear corneal incision and a 4.0 mm to 6.0 mm capsulorhexis.
Prior to surgery they performed immersion biometry in 36 eyes and optical coherence tomography using the IOLMasterTM in 11 eyes.

All patients received one drop of atropine immediately after surgery to paralyse the ciliary muscle during the period of early capsular fibrosis.
“I found out that the best size of the capsulorhexis was 5.0 mm. In the beginning I did a smaller 4.0 mm capsulorhexis but sometimes I found that part of the anterior capsule would get behind the lens and another part would get in front of it.

“The result would be tilting. I also found that a larger 6.0 mm capsulorhexis was too large and now I perform a 5.0 mm. I am very happy with this approach,” he said.
Dr Mertens noted that it is important to inform patients that it can take up to a couple of months before they will be able to read well. He recommended forbidding patients from using reading glasses or other aids during that time to encourage the activity of the ciliary muscles.

“In our study 81% of eyes achieved J3 or better and were therefore much less dependent on reading glasses. The lens also provides good intermediate vision and card players are very pleased with that. Therefore we feel justified in describing the implantation of the CrystaLens as refractive lens surgery,” he added.

Top