Refractive Lens Surgery

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10.6 Postoperative Considerations Cycloplegia is essential in the early postoperative period with the Crystalens. Patients are typically placed on cyclopentolate 1%, three times a day for a week after surgery. This ensures that the ciliary muscle is at rest as the Crystalens orients itself in the correct posteriorly vaulted position. Inadequate cycloplegia can allow the lens to shift anteriorly in this critical time period.A classification scheme for anterior vaults has been developed, which differentiates those vaults arising due to inadequate cycloplegia (type 1) from those resulting from wound leaks (type 2) (Figs. 10.10, 10.11). Contractile forces of the capsule must also be monitored more closely with the Crystalens, as the extremely deformable plate haptics that allow accommodative movement of the optic can also be influenced by fibrotic contraction of the capsule. This can result in changes in the position of the lens within the capsular bag, with induced refractive error. The treatment for this phenomenon is straightforward, and involves a YAG capsulotomy of the fibrotic areas of the posterior capsule. This allows the lens to return to its correct position. Chapter 10 The Eyeonics Crystalens 95 Fig. 10.10. Type I anterior vaults Fig. 10.11. Type II anterior vaults
96 S.J. Dell FINAL COMMENTS The Crystalens represents a significant advance in intraocular lens technology,and provides surgeons with a novel method of restoring the accommodative abilities of pseudophakic patients. For surgeons willing to invest the time and effort necessary to optimize biometry, surgical technique and postoperative care, the results are very rewarding. Patients receiving the Crystalens experience a high degree of spectacle independence and patient satisfaction, and they have typically been willing to pay a premium price for the technology. As a refractive surgical device, the lens has proved popular as an attractive alternative to keratorefractive surgery for many presbyopes, especially those with hyperopia. Given the limitations of hyperopic keratorefractive procedures, refractive lens exchange with the Crystalens is a very attractive option for this subset of patients.These hyperopic presbyopes are typically some of the happiest patients to receive accommodative refractive lens exchange. Their preoperative condition renders them unable to function well at any distance, and with the Crystalens, they experience improved functionality at all distances. For myopes, and in particular long axial length myopes, concerns regarding retinal tears after refractive lens exchange will continue to generate controversy. The true incremental risk of refractive lens exchange with modern micro-incisional surgery will be debated for years to come. The Crystalens may offer a theoretic advantage over other lens styles in this group of patients as well. As the Crystalens vaults extremely far posteriorly, it compresses and stabilizes the anterior vitreous face. Many of these patients have shorter vitreous cavity lengths than they did when they were phakic. This stabilization of the anterior vitreous face may offer some protection against vitreoretinal traction in this group of high-risk patients. Only time and careful epidemiological study will resolve this issue. References 1. Coleman PJ (1986) On the hydraulic suspension theory of accommodation. Trans Am Ophthalmol Soc 84:846–868 2. Busacca A (1955) La physiologie du muscle ciliaire étudiée par la gonioscopie. Ann Ocul 188:1–21 3. Thornton S (1991) Accommodation in pseudophakia. In: Percival SPB (ed) Color atlas of lens implantation. Mosby, St Louis, pp 159–162 4. Kammann J, Cosmar E,Walden K (1998) Vitreous-stabilizing, single-piece, mini-loop, platehaptic silicone intraocular lens. J Cataract Refract Surg 24:98–106 5. Cumming JS, Ritter JA (1994) The measurement of vitreous cavity length and its comparison pre- and postoperatively. Eur J Implant Refract Surg 6:261–272 6. Steinert R, Aker BL, Trentacost DJ et al (1999) A prospective comparative study of the AMO ARRAY zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens. Ophthalmology 106:1243–1255 7. Lindstrom RL (1993) Food and Drug Administration study update. One-year results from 671 patients with the 3 M multifocal intraocular lens. Ophthalmology 100:91–97 8. Dell SJ (2003) C&C vision AT-45 Crystalens. Paper presented at the American Society of Cataract and <strong>Refractive</strong> <strong>Surgery</strong> annual meeting; 10–16 Apr 2003, San Francisco, CA 9. Dick HB, Kaiser S (2002) Dynamic aberrometry during accommodation of phakic eyes and eyes with potentially accommodative intraocular lenses. Ophthalmologe 99:825–834
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Refractive Lens Surgery I. H. Fine
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Editors I. Howard Fine, MD Mark Pac
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Preface The first recorded time a h
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X Contents Chapter 14 AcrySof ReSTO
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Contributors Jorge L. Alio, MD, PhD
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1 The Crystalline Lens as a Target
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2 CORE MESSAGES Refractive Lens Exc
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na that have been observed with som
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piration through two separate incis
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6 R.S. Hoffman · I.H. Fine · M. P
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8 R.S. Hoffman · I.H. Fine · M. P
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10 R.S. Hoffman · I.H. Fine · M.
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12 M. Packer · I.H. Fine · R.S. H
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22 J.T. Holladay 4.1 Introduction T
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24 J.T. Holladay but only seven pre
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26 J.T. Holladay from morning to ni
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28 J.T. Holladay 4.3.2.2.3 Corneal
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30 J.T. Holladay rienced this condi
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32 J.T. Holladay many of these pati
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34 J.T. Holladay IOL eRx V 1336 =
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36 J.T. Holladay raised. A more tho
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38 J.T. Holladay rior segment laser
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40 D.D. Koch · L.Wang corneal refr
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Page 58 and 59: 44 D.D. Koch · L.Wang Fig. 5.4. Nu
Page 60 and 61: 46 D.D. Koch · L.Wang Fig. 5.5. Ce
Page 62 and 63: 48 D.D. Koch · L.Wang ∑ Double-K
Page 64 and 65: 50 L.D. Nichamin surgeon the abilit
Page 66 and 67: 52 L.D. Nichamin Table 6.1. The Nic
Page 68 and 69: 54 L.D. Nichamin 3.2 mm, its neglig
Page 70 and 71: 56 L.D. Nichamin Fig. 6.4. The Nich
Page 72 and 73: 58 L.D. Nichamin References 1. Anon
Page 74 and 75: 60 S. Bylsma aphakic state. In cont
Page 76 and 77: 62 S. Bylsma length),underwent full
Page 78 and 79: 64 S. Bylsma K-Astigmatism
Page 80 and 81: 66 S. Bylsma STIOL in the reversed
Page 82 and 83: 68 S. Bylsma about the dynamics at
Page 84 and 85: 8 Correction of Keratometric Astigm
Page 86 and 87: Fig. 8.2. AcrySof toric IOL implant
Page 88 and 89: Fig. 8.3. Mean absolute residual cy
Page 90 and 91: References 1. Hoffer KJ (1980) Biom
Page 92 and 93: 80 M. Packer · I.H. Fine · R.S. H
Page 98 and 99: 10 The Eyeonics Crystalens Steven J
Page 100 and 101: Fig. 10.3. Under binocular conditio
Page 102 and 103: Fig. 10.6. Anterior movement of the
Page 104 and 105: Fig. 10.7. One- and 3-year data fro
Page 108 and 109: 10. Dell SJ (2004) Objective eviden
Page 110 and 111: 100 N.X. Nguyen · A. Langenbucher
Page 122 and 123: 12 CORE MESSAGES Synchrony IOL H. B
Page 124 and 125: Fig. 12.1. The single-piece silicon
Page 126 and 127: 12.5 Clinical Results Clinical tria
Page 128 and 129: Fig. 12.6. Retroillumination photog
Page 130 and 131: References 1. Fisher RF (1973) Pres
Page 132 and 133: 124 F.M. Sarfarazi 13.1 The Nature
Page 134 and 135: 126 F.M. Sarfarazi Fig. 13.4. Lens
Page 136 and 137: 128 F.M. Sarfarazi Fig. 13.5. Mecha
Page 138 and 139: 130 F.M. Sarfarazi Fig. 13.9. Secon
Page 140 and 141: 132 F.M. Sarfarazi Fig. 13.14. Sche
Page 142 and 143: 134 F.M. Sarfarazi Fig. 13.18. Work
Page 144 and 145: 136 F.M. Sarfarazi References 1. Ma
Page 146 and 147: 138 A. Mirshahi · E.Terzi · T. Ko
Page 152 and 153: 15 The Tecnis Multifocal IOL Mark P
Page 154 and 155: Fig. 15.1. The Alcon AcrySof multif
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Fig. 15.4. Multifocal vs. monofocal
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16 Blue-Light-Filtering Intraocular
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Fig. 16.2. Cultured human RPE cells
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tion to benefiting from less exposu
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16.7 Blue-Light-Filtering IOLs and
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15. Marshall J, Mellerio J, Palmer
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17 CORE MESSAGES The Light-Adjustab
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Fig. 17.2 a-c. Cross-sectional sche
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17.4 Animal Studies Dr. Nick Mamali
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Fig. 17.8. A laser interferogram (l
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enhanced visual function that remai
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13. Mather R, Karenchak LM, Romanow
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174 S. Norrby Fig. 18.1. Small cale
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176 S. Norrby Fig. 18.3. Scheimpflu
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178 S. Norrby Fig. 18.4. Schematic
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180 S. Norrby there was fibrin form
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182 S. Norrby material had a Young
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184 S. Norrby Koopmans et al. [28]
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186 S. Norrby 40. De Groot JH, Zuru
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188 L. Nordan · M. Morris regular
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190 L. Nordan · M. Morris produce
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20 CORE MESSAGES Bimanual Ultrasoun
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for an irrigating manipulator or ch
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5. Tsuneoka H, Shiba T, Takahashi Y
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200 J.L. Alio · A. Galal · J.-L.R
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22 CORE MESSAGES The Infiniti Visio
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Fig. 22.3. The AquaLase handpiece u
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23 CORE MESSAGES The Millennium Ros
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Fig. 23.1. Bausch & Lomb’s new cu
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Fig. 23.2. Advanced flow system car
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Fig. 23.5. Pulse or burst mode with
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24 CORE MESSAGES The Staar Sonic Wa
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Fig. 24.2. The tip undergoes compre
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the sonic tip moves back and forth
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25 CORE MESSAGES AMO Sovereign with
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Fig. 25.3. Schematic diagram of cav
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the Sovereign Compact (see Fig. 25.
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234 M. Packer · R.S. Hoffman · I.
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27 Conclusion: The Future of Refrac
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240 Subject Index Contrast sensitiv
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242 Subject Index P Pachymetry 53,
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