Visual And Microperimetry Outcomes Of A Novel Iol For Extended Macular Vision In Age Related Macular Degeneration: A Case Report

To assess the improvement of best corrected visual acuity (BCVA) and fixation stability indices namely bivariate contour ellipse area (BCEA) 63% and BCEA 95% (assessed by MAIA microperimetry (MP)), in patients with bilateral stable advanced age related macular degeneration (saAMD) e.g. geographic atrophy (GA), following bilateral implantation of EyeMax Mono IOL (Sharpview Ophthalmology, London, UK), an extended macular vision IOL designed to improve image quality across the macula up to 10o from the fovea. Additionally, macula was assessed preoperatively using spectral domain OCT (SD-OCT) and fundus autofluorescence (FAF) to evaluate the impact of ellipsoid zone (EZ) disruption and GA size on the visual outcome.

Eye Clinic Sulzbach, Germany

We report the outcomes of bilateral implantation of the EyeMax Mono IOL in 4 patients with GA. In all cases, we rendered the patients slightly hypermetropic postoperatively to utilize image magnification using spectacles. BCVA was assessed pre- and 1 month postoperatively. Patient 1 was a 76-year-old male: his preoperative logMAR BCVA was 1 (OD) and 1 (OS) and improved to 0.22 and 0.5 respectively. SD-OCT showed the size EZ disruption area to be 1412 and 2136 µm respectively and the size of GA to be 3.11/ 3.53mm2 respectively. MP showed OD BCEA 63% pre- and postoperatively to be 7.7°² and 11.8°² and OD BCEA 95% to be 17.8°² and 35.5°² respectively with fixation changing from relatively unstable to unstable while OS BCEA 65% was 17.8°² and 6°² and OS BCEA 95% was 53.2°² and 17.9°² respectively with fixation improving from unstable to relatively unstable. Patient 2 was a 76-year-old female: preoperative CDVA was 1.3 (OD) and 0.4 (OS) and 1.3 (OD) and 0.22 (OS) postoperatively. Patient 3 was a 70-year-old male: preoperative BCVA was 1 (OD) and 0.7 (OS) and 1 (OD) and 0.5 (OS) postoperatively. Patient 4 was 82 years old with bilateral AMD and OD disciform scar and OS branch retinal vein occlusion. Preoperative CDVA was 1 (OD) and 0.3 (OS) and postoperatively was 1.00 (OD) and 0.1 (OS), with postoperative BCEA 63% of 5.9°² and 2.1°² and BCEA 95% of 17.8°² and 6.3°². The remaining MP data is to be collected; inclusion of further suitable patients into this series is planned.

EyeMax Mono IOL for extended macular vision can effectively improve visual acuity in dry AMD eyes with improvement in fixation stability. Factors like EZ disruption and GA size can affect the outcome of extended macular vision.