The 8th Winter Refractive Surgery Meeting of the ESCRS is being held in Barcelona this year and will feature symposia and free paper sessions covering a broad range of topics including super vision, modern lamellar keratoplasty, and refractive IOLs. In addition, there will be several didactic and surgical skills training courses covering both basic and advanced techniques in refractive surgery. The meeting will also include a joint symposium of the ESCRS and the Sociedad Espaņola de Cirurgia Ocular Implanto-Refractiva (SECOIR) which addresses the question: "What's new in Anterior Segment Diseases".
New lenticular options for refractive surgery
Phakic IOLs and refractive lens exchange are gaining increasing prominence in the surgical treatment of high ametropias and presbyopia. This year's Winter ESCRS meeting will include descriptions of several new lenses that are becoming available for such procedures.
Francesco Carones MD, Milan, Italy, will be providing his preliminary results with the new multifocal lens from Alcon, the AcrySof ReSTORTM IOL (Saturday, Refractive IOLs I, 09:25-10:30). The new lens has a hybrid diffractive/refractive design which incorporates a near add of +4.0 D and which emphasises distance vision under photopic conditions and near vision under mesopic conditions.
In a study involving 10 eyes of seven patients who underwent implantation of the new lens for the treatment of cataracts or presbyopia, all eyes had 20/25 or better UCVA, 20/20 or better BSCVA, and J2 or better UCVA at near (30 cm). At intermediate distance (60 cm), all eyes could read J4 or better."All patients were extremely pleased by the results, reporting no meaningful complaints regarding night-vision or intermediate distance vision. None of them are using spectacle correction for any distance." The patients in the study included five with cataracts and two who requested refractive lens exchange. Postoperative spherical equivalent ranged from +0.25 D to -0.62 D. Wavefront analyses showed that higher-order aberrations were within normal range for healthy eyes, with no significantly induced terms.
"These very preliminary results indicate the ReSTOR pseudoaccommodative IOL is an effective device for providing an excellent range of vision from far to near after crystalline lens removal, either for cataract or refractive surgery."
New accommodating IOL
Deepak Chitkara MD. Manchester, UK, will be presenting preliminary results with a new accommodating IOL (Saturday, Refractive IOLs I, 09:25-9:31)."The lens was designed by Dr Robert Kellan from the US and manufactured by Lenstec, Inc. It is composed of HEMA, a hydrophilic acrylic material. It is injectable and/or foldable through a 2.5 mm incision, has a large 6.0 mm optic and a square edge design to prevent PCO. Implantation of the lens does not require any modification to the surgeon's usual technique," Dr Chitkara told EuroTimes.
In a study involving 25 eyes of 25 patients who underwent implantation of the lens, UCVA at three months' follow-up was 20/25 or better in 87% and uncorrected near vision was J5 or better in 57%, while 43% achieved J3 or better. In addition, distance corrected near vision was J3 or better in 60% of cases."
The Kellan accommodating IOL appears to give useful distance and near vision after removal and replacement of the crystalline lens. The accommodative effect appears to be preserved well after fibrosis of the capsule is established," Dr Chitkara said.
Laser interferometry at three months postoperative showed that the mean forward axipetal movement of the IOL was 0.67 mm before and after the instillation of 2% pilocarpine drops. The subjective mean amplitude of accommodation was 4.00D."The apparent discrepancy between the subjective accommodation and the forward movement of the IOL's optic is due to the fact that we cannot be reliably accurate with the ACD measurement of the IOLMaster. We will have a Scheimpflug device to measure ACD more accurately in the New Year and I suspect the movement of the IOL will be more accurately demonstrated."
Carlo Francesco Lovisolo MD, Milan, Italy, will be describing his preliminary results with a new Phakic IOL, the ICLV5 from Staar Surgical( Saturday, Refractive IOLs II, 14:00-15:45). The dimensions of the new lens are individually customised to match each patient's optics and intraocular anatomy.
The overall length of each IOL is calculated on the basis of VHF echographic measurements (Artemis 2, Ultralink) of anterior chamber geometry, including the irido-corneal angle width and sulcus-to-sulcus distances. The IOL's optic diameter is based on measurements of mesopic pupillary diameter, and optic geometry is based on individual wavefront analysis.
Dr Lovisolo said that in three eyes implanted with the lens for myopia ranging from -12.0 D to -14.0 D and -0.75 D to-1.25 D of cylinder, all have achieved postoperative uncorrected visual acuities of 20/15. That compared to preoperative best-corrected visual acuities of 20/20, 20/25, and 20/30.
"The major improvement of this lens in both safety and efficacy is represented by the customised features. The optic size covers the pupil's mesopic size which prevents halos and glare. The overall length perfectly fits sulcus dimensions as measured with VHF echography. This in turn means high vault height predictability with ideal clearances from central and mid-peripheral crystalline lens to prevent iatrogenic cataract. Moreover, the lens has adequate toricity to correct astigmatism, providing unbelievable visual acuities," Dr Lovisolo told EuroTimes.
