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Intraocular lenses for small incision surgery

Intraocular lenses for small incision surgery. Roberto Bellucci MD Ophthalmic Unit, Hospital and University of Verona, Italy Simonetta Morselli MD Ophthalmic Unit, Hospital of Bassano del Grappa, Italy Financial Interest: E (Bausch & Lomb). Requirements for MICS lenses. Thinness

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Intraocular lenses for small incision surgery

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  1. Intraocular lenses for small incision surgery Roberto Bellucci MD Ophthalmic Unit, Hospital and University of Verona, Italy Simonetta Morselli MD Ophthalmic Unit, Hospital of Bassano del Grappa, Italy Financial Interest: E (Bausch & Lomb)

  2. Requirements for MICS lenses • Thinness • To allow sub-2mm implantation • Resistance to folding / implantation • Stiffness • To maintain centration, refraction • Square edge • To reduce PCO • Easy removal

  3. Designing sub-2mm IOLs • Single-piece acrylic • Thinner optics • Refractive index • Asphericity • Optic size • Special haptic design • First attempt: The Thinoptx lens

  4. The Acri.Smart solution • Hydrophilic core, hydrophobic surfaces • Plate haptic, standard thickness • Full 6 mm optic • No square edge at haptic/optic junction

  5. The Acri.Smart IOL provided good results in clinical studies, demonstrating that MICS IOL are excellent platforms for special optic design The Acri.Smart results Alió JL, Schimchak P, Montés-Micó R, Galal A. Retinal image quality after microincision intraocular lens implantation J Cataract Refract Surg 2005; 31:1557-1560 Alió JL, Rodriguez-Prats JL, Vianello A, Galal A Visual outcome of microincision cataract surgery with implantation of an Acri.Smart lens. J Cataract Refract Surg 2005; 31:1549-1556 Kurz S, Krummenauer F, Thieme H, Dick HB Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery. J Cataract Refract Surg 2007; 33: 393-400

  6. The Acri.Smart family • Spherical Acri.Smart 46S • Hyperaspheric Acri.Smart 36A • Neutral Aspheric Acri.Smart 46LC • Toric Acri.Comfort 646TLC • Multifocal Acri.Lisa 366D • Multifocal Toric Acri.Lisa 466TD

  7. The Akreos MI60 MICS IOL • Material • 26% hydrophilic acrylic • UV blocker • Refractive index 1.458 (hydrated) • Optic • Biconvex • Aspheric anterior and posterior • Optic Body and Total length • 6.2x11.0 mm from 10.0 to 15.0 dpt • 6.0x10.7 mm from 15.5 to 22.0 dpt • 5.6x10.5 mm from 22.5 to 30.0 dpt • Haptics • One-piece • 10° average angulation

  8. Design features • Bag-related size • Four-piece haptics • Angled haptics • Progressive haptic resistance • No hole haptic • Square edge

  9. Centration and Stability • The four-loop design allows precise centration within the capsular bag, even with loose or damaged zonules • STABILITY is ensured by angulation and by four-piece haptic design that counteracts vitreous pressure

  10. Various designs, however… • Large haptic holes may prevent IOL exchange • Weak haptics will favour optic movement • Plate haptic require intact capsular bags Plate haptic Closed-loop haptic Accommodating

  11. Conclusion • Microincision lenses are not reduced versions of standard lenses • They are a new type of IOL, with specific design features • They are a good option for refractive cataract surgery • They are perfect platforms for special optic designs

  12. A look at the near future • Small incision lenses will increase popularity • Cross-linking of the material will further increase stiffness and stability • Studies on pseudoaccommodation will continue Greetings from Verona Italy

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