Dermot McGrath in Rome

Philippe Sourdille

THE new ICARE phakic IOL (Corneal) holds promise for the safe and effective treatment of myopia and hyperopia and offers several advantages over existing lenses, according to Philippe Sourdille MD.

"The experience with it to date has been very encouraging. The ICARE IOL is the first anterior chamber lens that can be implanted with an injector. It is simple to use, gives a good refractive outcome and is very well tolerated," Dr Sourdille told a session of the 7th ESCRS Winter Refractive Surgery Meeting. The single-piece IOL is made from acrylic hydrogel containing 26% water, a highly biocompatible and minimally traumatic material for tissues. It has an optical diameter of 5.75mm and an overall length of 12mm to 13.5mm.

Dr Sourdille explained that because the lens is soft, one-piece and foldable, it can be injected through a small incision (3.0mm), thereby reducing the chances of astigmatism and limiting manipulations inside the eye.

He also noted that the special haptic design of the IOL ensured a minimum of trauma and faster recovery for patients. ICARE has four independent support points to avoid pressure on the angle structures and iris and to ensure stable positioning. The optical zone is also kept large to avoid problems of dazzle and halos.

"Corneal has optimised the positioning of the haptics to avoid contact with the endothelium and the iris. The concept of the ICARE lens is that it is placed in the angle, not pressed as with rigid or semi-rigid haptics. It is not clipped to intraocular tissues, as is the case with the Artisan lens.

"Because the transmission forces are equally distributed on the angle, lens centration and stability are enhanced. Also, since the surface of contact with ICARE is much larger than other lenses, it means there is less chance of penetrating into trabecular tissue," Dr Sourdille said.

He reported that multi-centre trials involving the ICARE lenses were ongoing in several European countries. While he acknowledged that a longer follow-up was needed for more definitive results, initial data suggested that the new lens addressed many of the problems observed hitherto with angle-supported intraocular lenses, particularly their consequences for the iris.

"We have limited clinical data to date, of course, with only 10 months follow-up, but the data we do have is very positive. A maximum of 151 eyes have been implanted with ICARE lenses in four European countries: Italy, Poland, Spain and France. What we know already is that the system was optically stable (+/- 0.5 D), except one case where there was a refractive surprise, in one case of highly myopic anisometropia," he said.

Dr Sourdille stressed the significance of the clinical gonioscopic findings, since these readings had identified difficulties with previous angle-supported lenses.

"This adaptability of the ICARE lens is achieved without coming closer to the corneal endothelium or exerting pressure on the uveal tissue. This is vitally important and is one of the main features of this new lens.

"It has also been shown that even after six months, a gentle pressure exerted on the corneal lens will slightly move the haptic foot plates, which is an excellent sign, indicating that there is no tissue reaction around the foot plates. This had been a problem with previous versions of angle-supported lenses," Dr Sourdille said.
He also noted that the ICARE lens had an aesthetic advantage over other phakic IOLs (reflection of hydrophobic materials), since it was not noticeable in the eye after implantation.

"Cosmetic appearance is important, since most of the patients receiving these implants are young and don’t want to have reflections in their eyes as they might have with PMMA or other hydrophobic material. This lens is not visible in the eye and that's a major plus," he said.

Summing up the advantages of the new lens, Dr Sourdille said that ICARE should not be categorised as simply another refractive AC IOL.
"I believe it is a new anatomical and clinical reality. Obviously, it needs, like any angle-supported lens, a precise preoperative measurement and to date the ultrasonographic measurements we have are by far the best way to obtain that.

"The ICARE lens is tissue-friendly and produces stable refractive results and is very easy to implant. This is all that we can say to date, but obviously it seems to be an improvement on current angled-supported lenses," Dr Sourdille said.

Philippe Sourdille MD
Le Chaigne, Touzac, France
Email: hilippe.sourdille@wanadoo.fr