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Dermot 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 said.
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," he said.

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 complications:
"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."

Dr Camille Budo, MD,
camille.budo@skynet.be

Philippe Sourdille, MD,
philippe.sourdille@wanadoo.fr

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