Post on 31-Mar-2015
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Alois DexlAlois DexlAlois DexlAlois Dexl
No Financial Interest !No Financial Interest !
University Eye ClinicUniversity Eye Clinic
Paracelsus Medical University SalzburgParacelsus Medical University Salzburg
Chairman: Prim. Univ.-Prof. Dr. Günther GrabnerChairman: Prim. Univ.-Prof. Dr. Günther Grabner
University Eye ClinicUniversity Eye Clinic
Paracelsus Medical University SalzburgParacelsus Medical University Salzburg
Chairman: Prim. Univ.-Prof. Dr. Günther GrabnerChairman: Prim. Univ.-Prof. Dr. Günther Grabner
Verisyse™ for Verisyse™ for Correction of AphakiCorrection of Aphakiaa
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
AphakiaAphakia
Aphakia = absence of natural crystalline lens
Western World: very uncommon Phako / ECCE with IOL-implantation
in the capsular bag
Reasons After complicated cataract surgery
Post-traumatic dislocation of crystalline lens Capsular loss
Ectopia lentis Marfan syndrome, Weill-Marhesani syndrome, hyperlysinaemia,
homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome
Aphakia = absence of natural crystalline lens
Western World: very uncommon Phako / ECCE with IOL-implantation
in the capsular bag
Reasons After complicated cataract surgery
Post-traumatic dislocation of crystalline lens Capsular loss
Ectopia lentis Marfan syndrome, Weill-Marhesani syndrome, hyperlysinaemia,
homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Conservative Correction ?Conservative Correction ?
Spectacles Reduced peripheral vision Ring scotoma (prismatic effect) „Jack in the box“ Aniseokonia
Contact lenses Fitting, removal, cleaning…
Spectacles Reduced peripheral vision Ring scotoma (prismatic effect) „Jack in the box“ Aniseokonia
Contact lenses Fitting, removal, cleaning…
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Surgical CorrectionSurgical Correction Angle supported AC-IOL
Endothelial cell loss (1 year: 6-45%) Pseudophakic bullous keratopathy (PBK) UGH-syndrome
Scleral fixation of PC-IOL Choroidal haemorrhage Retinal detachment Vitreous incarceration Chronic inflammation IOL-iris contact IOL decentration Pigmentary dispersion High aqueous flare CME
Angle supported AC-IOL Endothelial cell loss (1 year: 6-45%) Pseudophakic bullous keratopathy (PBK) UGH-syndrome
Scleral fixation of PC-IOL Choroidal haemorrhage Retinal detachment Vitreous incarceration Chronic inflammation IOL-iris contact IOL decentration Pigmentary dispersion High aqueous flare CME
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Surgical CorrectionSurgical Correction
Iris-Claw aphakic IOL
Best choice for primary or secondary implantation in aphakic eyes Safer then open-loop-angle supported AC-IOLs Surgery easier, shorter and safer then sclera sutured IOLs Some cases of PBK Endothelial cell loss – caused by surgical trauma ?
Iris-Claw aphakic IOL
Best choice for primary or secondary implantation in aphakic eyes Safer then open-loop-angle supported AC-IOLs Surgery easier, shorter and safer then sclera sutured IOLs Some cases of PBK Endothelial cell loss – caused by surgical trauma ?
Prof. Jan Worst Model 205T Worst Iris Claw® Lens
Model 205Y or VRSA54 ARTISAN™ VERISYSE ™
Aphakia Lens
1978 1986
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Verisyse® AphakiaVerisyse® Aphakia
VRSA54 Verisyse
Primary or secondary implantation after ICCE, ECCE and Phaco
Dioptric power: +2,0 D to +30,0 D (14.5 to 24.5 in 0.5 D steps)
Optical Diameter: 5.0 mm Overall Diameter: 8.5 mm Biconvex design
A-constant:115 for AC implantation116.8 for retropupillary implantation (ULIB)
VRSA54 Verisyse
Primary or secondary implantation after ICCE, ECCE and Phaco
Dioptric power: +2,0 D to +30,0 D (14.5 to 24.5 in 0.5 D steps)
Optical Diameter: 5.0 mm Overall Diameter: 8.5 mm Biconvex design
A-constant:115 for AC implantation116.8 for retropupillary implantation (ULIB)
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
1996 – 2005: 78 = 8 / year
2006 – 2009: 50 = 14 / year
2009 – 2010: 22 = 22 / year
1996 – 2005: 78 = 8 / year
2006 – 2009: 50 = 14 / year
2009 – 2010: 22 = 22 / year
Total 150
University Eye Clinic Salzburg 1996 – 2010
Aphakic Iris claw IOL
FrequencyFrequency
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
SUBLUXATED lenses 82
Primary surgery (Marfan´s syndrome) 25
Posttraumatic 25
Spontaneous IOL dislocation (PEX) 32
FrequencyFrequency
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Positioning of Verisyse® AphakiaPositioning of Verisyse® Aphakia
Anterior
Posterior Risk of endothelial cell loss decreases AC is deeper Distance from haptics to endothelium is larger Irido-corneal angle is wider
Anterior
Posterior Risk of endothelial cell loss decreases AC is deeper Distance from haptics to endothelium is larger Irido-corneal angle is wider
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Advantages
Very safe for corneal endothelium
Produces less glare
Only a very small of HOA1
„Physiological“ space for an IOL is behind the iris
Advantages
Very safe for corneal endothelium
Produces less glare
Only a very small of HOA1
„Physiological“ space for an IOL is behind the iris
1 Kaymak C, Mester U. paper at ESCRS-Meeting, Lissabon 2005
.
Posterior approachPosterior approach
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Disadvantages
Extensive anterior vitrectomy required
Special intruments are useful in order to avoid IOL-
drop into the vitreous cavity during implantation
Disadvantages
Extensive anterior vitrectomy required
Special intruments are useful in order to avoid IOL-
drop into the vitreous cavity during implantation
Posterior approachPosterior approach
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Sekundo, Eur J Ophthalmol 2008
Special instruments usefull to avoid a tilting of the IOL during implantation Special instruments usefull to avoid a tilting of the IOL during implantation procedureprocedure
Posterior approachPosterior approach
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Mohr et al. Ophthalmologe 2002 48 aphakic cases 2/48 reversible CME
Wolter-Roessler et al. Klin Monatsbl Augenheilkd. 2008 48 aphakic cases, 14 Months 2/48 reversible CME 2/48 traumatic haptic dislocation 1/48 retinal detachment 1/48 pupillary block > iridectomy mandatory
Hara et al. J Refract Surg. 2011 11 eyes retropupillary Verisyse
No complications 21 eyes transscleral sutured IOL
5/21 ciliary choroidal body haemmorhage 1/21 CME 1/21 IOL dislocation
Mohr et al. Ophthalmologe 2002 48 aphakic cases 2/48 reversible CME
Wolter-Roessler et al. Klin Monatsbl Augenheilkd. 2008 48 aphakic cases, 14 Months 2/48 reversible CME 2/48 traumatic haptic dislocation 1/48 retinal detachment 1/48 pupillary block > iridectomy mandatory
Hara et al. J Refract Surg. 2011 11 eyes retropupillary Verisyse
No complications 21 eyes transscleral sutured IOL
5/21 ciliary choroidal body haemmorhage 1/21 CME 1/21 IOL dislocation
Posterior approachPosterior approach
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at
Anterior chamber IOL´s Angle-supported Iris-claw
Anterior chamber IOL´s Angle-supported Iris-claw
Posterior chamber IOL´s Sclera-fixated Iris-sutured
Posterior chamber IOL´s Sclera-fixated Iris-sutured
Posteriorly
enclavated
Iris-claw lens
VERY FEW COMPARATIVE LONG-TERM studies Need for a prospective, long-term (multi-center) study
Decision tree for the very different clinical situations
ConclusionConclusion
University Eye Clinic Salzburg Paracelsus Medical University alois@dexl.at 16