New IOL Tackles Anterior-Capsule-Related
McGrath in Paris
THE Concept 360 intraocular lens (Cornéal) provides an effective
barrier against posterior capsule opacification and incorporates
several design features to increase capsular bag transparency, according
to research presented at the annual meeting of the French Implant
and Refractive Surgery Association (SAFIR).
"The results thus far are certainly very encouraging. The design
of the 360 lens seems to guard against the incidence of secondary
cataracts, is well tolerated in most patients and gives an excellent
refractive outcome," reported Camille Budo MD.
He reported his experience with the Concept lenses in 17 eyes. He
performed phacoemulsification using conventional techniques and
implanted all intraocular lenses with forceps, requiring a 4.0 mm
incision, although Cornéal has since developed an injector
that can be used with a 3.0 mm incision.
No intraoperative complications and no adverse effects occurred
and no patients required postoperative ocular or systemic treatment
or further surgery. In terms of refraction, 97% of patients were
less than half a dioptre from the desired refraction.
As with any IOL that is angulated, the surgeon must check that the
lens is correctly oriented, clockwise, before closing the injector,
He performed intraoperative aspiration of the epithelial cells lining
the internal surface of the anterior capsule in every case, except
for one patient, in whom the anterior capsule subsequently became
slightly opacified. He utilised a dispersive viscoelastic for phacoemulsification.
"With a follow-up of one year, this intraocular lens presents
excellent results. All implants were perfectly centred except one
case which was decentred by 1.0 mm and no posterior capsule folds
were observed," he reported
Dr Budo acknowledged that a longer follow-up was needed to properly
assess the Concept lens' ability to prevent posterior fibrosis.
He noted that although the follow-up is not yet sufficient to assess
the capacity to control cell proliferation on the posterior capsule,
the anterior capsule remains very transparent.
The Concept 360 is a single-piece hydrophilic acrylic IOL, with
10% posterior angulation of the haptics, to guarantee consistent
IOL placement, posterior capsular contact and capsular bending.
The main distinguishing feature of this lens is the presence of
six identical loops, which together form a circular, closed capsular
tension ring after it is placed in the bag.
The ring is formed from open loops and can adapt to different bag
diameters. This design innovation was geared towards maintaining
the advantages of sharp-edged lenses, he explained.
He added that another advantage of the new IOL is that less lens
material is accumulated since the haptics also occupy the space
between the equator of the lens and the periphery of the IOL optic.
"Square-edge intraocular lenses have considerably reduced posterior
capsulotomy rates, which is already an important breakthrough,"
Philippe Sourdille MD of the Clinique Sourdille in Nantes echoed
Dr Budo's positive appraisal of the Concept lens. Dr Sourdille said
that he had implanted more than 300 eyes with the 360 lens and experienced
no IOL-related complications.
"We have experienced no Nd: YAG capsulotomies and no posterior
capsule folds after more than two years of follow-up. In 2% of cases,
one of the six haptics overlapped the next haptic, without any consequences.
The volume of the IOL seems to prevent the formation of newly formed
lens material in the whole capsular bag," he said.
Dr Sourdille noted that the question of contact between the anterior
capsule and the IOL optic was central to reducing complications
such as anterior capsule opacification and capsulophimosis.
"This IOL is particularly effective at preventing lens epithelial
cells from migrating onto the surface of the anterior capsule and
causing capsulophimosis. This can result in a whole range of problems:
blood-aqueous barrier rupture, traction on the ciliary body and
hypotony, not to mention tilt and decentration of the lens."
Dr Sourdille noted that preventing or delaying anterior capsule/IOL
contact seemed to guard against the possibility of anterior-capsule-related
"Bringing all this data together, it's clear that combining
sharp-edge technology, posterior angulation of the haptics, capsular
tension ring effect and enduring non-contact between the anterior
capsule and the IOL optic seems to increase capsular bag transparency.
Further study is needed but the results so far are certainly encouraging."
Camille Budo, MD,
Philippe Sourdille, MD,