Intraocular lenses for small incision surgery

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)

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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

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Designing sub-2mm IOLs

• Single-piece acrylic
• Thinner optics
• Refractive index
• Asphericity
• Optic size
• Special haptic design
• First attempt The Thinoptx lens

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The Acri.Smart solution

• Hydrophilic core, hydrophobic surfaces
• Plate haptic, standard thickness
• Full 6 mm optic
• No square edge
• at haptic/optic
• junction

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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 311557-1560
• 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 311549-1556
• 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

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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

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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

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Design features

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

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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

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Various designs, however
Plate haptic
Closed-loop haptic
Accommodating

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

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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

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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