Intraocular lenses for Intraocular lenses for small incision surgerysmall incision surgery

Roberto Bellucci MDOphthalmic Unit, Hospital and University of Verona, Italy

Simonetta Morselli MDOphthalmic Unit, Hospital of Bassano del Grappa, Italy

Financial Interest: E (Bausch & Lomb)

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

Designing sub-2mm IOLs Single-piece acrylic Thinner optics

Refractive index Asphericity Optic size

Special haptic design First attempt: The Thinoptx lens

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

at haptic/optic junction

The Acri.Smart IOL provided good results in clinical studies, demonstrating that MICS IOL are excellent platforms for special optic design

Alió JL, Schimchak P, Montés-Micó R, Galal A.Retinal image quality after microincision intraocular lens

implantationJ Cataract Refract Surg 2005; 31:1557-1560

Alió JL, Rodriguez-Prats JL, Vianello A, Galal AVisual 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 HBContrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery.

J Cataract Refract Surg 2007; 33: 393-400

The Acri.Smart results

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 ToricAcri.Lisa 466TD

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

Design features Bag-related size Four-piece haptics Angled haptics Progressive haptic

resistance No hole haptic Square edge

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

Plate haptic Closed-loop haptic Accommodating

Various designs, however…

Large haptic holes may prevent IOL exchange Weak haptics will favour optic movement Plate haptic require intact capsular bags

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

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 Greetings from Verona ItalyItaly