intraocular lenses for small incision surgery roberto bellucci md ophthalmic unit, hospital and...
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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