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Alois Dexl Alois Dexl No Financial Interest ! No Financial Interest ! University Eye Clinic University Eye Clinic Paracelsus Medical University Salzburg Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner Chairman: Prim. Univ.-Prof. Dr. Günther Grabner Verisyse™ for Verisyse™ for Correction of Aphaki Correction of Aphaki a a
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Page 1: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

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

Page 2: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 3: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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…

Page 4: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 5: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 6: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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)

Page 7: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 8: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

SUBLUXATED lenses 82

Primary surgery (Marfan´s syndrome) 25

Posttraumatic 25

Spontaneous IOL dislocation (PEX) 32

FrequencyFrequency

Page 9: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 10: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

Page 11: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 12: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 13: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 14: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 15: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected]

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

Page 16: Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

University Eye Clinic Salzburg Paracelsus Medical University [email protected] 16


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