Refractive Lens Surgery

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100 N.X. Nguyen · A. Langenbucher · B. Seitz, et al. 11.1 Introduction Presbyopia remains one of the great unsolved challenges in ophthalmology. Ever since von Helmholtz [1], much research has been conducted concerning mechanisms of accommodation, presbyopia and potential solutions [2–8]. Despite excellent restoration of visual acuity and good biocompatibility of presently used posterior chamber intraocular lenses (PCIOL), there is no accommodation in pseudophakic eyes so that patients usually remain presbyopic after cataract surgery. Newer attempts surgically to correct or reduce presbyopia, including scleral expansion surgery, zonal photorefractive keratectomy, or implantation of corneal inlays, so far have achieved no or very limited success in solving the problem [9–11]. Multifocal intraocular lenses (IOLs) allow for improved uncorrected near vision, but at the cost of reduced contrast sensitivity and loss of image quality [12]. This problem has only partly been solved by the introduction of diffractive and bifocal PCIOL [13]. Therefore, in the past few years, there has been increased interest in the development of new IOL devices to achieve active, ciliary muscle-derived accommodation by optic shift principles without reducing image quality. Among these new IOLs, a new accommodative PCIOL (1CU, HumanOptics, Erlangen, Germany) has been designed after principles elaborated by K.D. Hanna. This PCIOL is intended to allow accommodation by anterior movement of the lens optic (optic shift) secondary to contraction of the ciliary muscle. 11.1.1 Definitions In the literature, various terms such as accommodation, pseudo-accommodation and apparent accommodation are being used interchangeably with regard to pseudophakic eyes. We define pseudophakic accommodation as dynamic change of the refractive state of the pseudophakic eye caused by interactions between the contracting ciliary muscle and the zonules–capsular bag–IOL, resulting in change of refraction at near fixation. Furthermore, we define pseudophakic pseudoaccommodation (apparent accommodation) as static optical properties of the pseudophakic eye independent of the ciliary muscle, resulting in improved uncorrected near vision. 11.1.2 Anatomy and Description of the 1CU Accommodative Intraocular Lens Several studies using impedance cyclography, ultrasound biomicroscopy and magnetic resonance imaging have shown that the ciliary body retains much of its contractility in older patients [5–7]. Furthermore, modern technology allows refined finite element computer methods to simulate the changes of the ciliary body–zonular–lens apparatus during accommodation. Based on these models, the 1CU PCIOL was developed to allow transmission of the contracting forces of the ciliary body into anterior movement of the lens optic to achieve pseudophakic accommodation. This focus shift principle should allow a defined amount of accommodation, theoretically 1.6–1.9 D per 1-mm anterior movement of the PCIOL optic using the Gullstrand eye. 11.1.3 1CU Posterior Chamber Intraocular Lens Based on concepts by K.D. Hanna and on finite element computer simulation models, a new acrylic hydrophilic foldable single-piece PCIOL has been designed and manufactured (Type 1CU, HumanOptics AG, Erlangen, Germany). The spherical optic has a diameter of 5.5 mm, with a total diameter of the PCIOL of 9.8 mm (Fig. 11.1). This PCIOL is intended to allow accommodation by anterior movement
Fig. 11.1. Schematic drawing of the 1CU accommodative intraocular lens of the optic (focus shift) secondary to contraction of the ciliary muscle. To achieve this aim, the lens haptics are modified with transmission elements at their fusion with the lens optic. In earlier laboratory studies in porcine eyes and human donor eyes not suitable for corneal transplantation, we have refined methods for intraocular implantation of this PCIOL. The 1CU PCIOL is CE-approved. 11.2 Indications and Contraindications At present, only patients with cataract (i.e. clinically manifest and visually disturbing lens opacities) are candidates for lens exchange with implantation of the 1CU accommodative IOL. We have carefully observed exclusion criteria, including manifest diabetic retinopathy,previous intraocular surgery,previous severe ocular trauma involving the lens, the zonules or the ciliary body, visible zonulolysis, phacodonesis, pseudoexfoliation syndrome, glaucoma, uveitis, high myopia, and high hypermetropia. Chapter 11 Presbyopia – Cataract Surgery 101 Furthermore, this kind of surgery will not result in satisfying clinical results in patients with severe age-related macular degeneration or marked glaucomatous optic atrophy. If there are problems during cataract surgery,such as radial tears of the capsulorrhexis, diameter of capsulorrhexis >5.5 mm, zonulolysis, rupture of the posterior capsule, or vitreous loss, the 1CU accommodative IOL should not be implanted and surgery should be converted to implantation of a conventional PCIOL. 11.3 Surgical Techniques and Main Outcome Measures Generally, any of the modern small-incision phacoemulsification techniques may be used to remove the lens nucleus and lens cortex before the 1CU accommodative IOL is implanted. 11.3.1 Anesthesia Phacoemulsification and implantation of the 1CU accommodative IOL may be safely performed under local or topical anesthesia. The surgeon may choose the method for cataract surgery with which he is most comfortable. No specific modifications of anesthesia are necessary for implantation of the 1CU accommodative IOL. 11.3.2 Procedure (General) Phacoemulsification of the lens nucleus and cortical cleaning are not very different from routine cataract surgery. The surgeon may choose the incision and phacoemulsification technique that he routinely uses for cataract surgery. Either a clear cornea or a sclerocorneal incision may be used. If possible, the incision should be placed in the steepest corneal meridian to reduce any pre-existing corneal astigmatism. The capsulorrhexis is of
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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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42 D.D. Koch · L.Wang Table 5.1. M
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44 D.D. Koch · L.Wang Fig. 5.4. Nu
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Page 64 and 65: 50 L.D. Nichamin surgeon the abilit
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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 106 and 107: 10.6 Postoperative Considerations C
Page 108 and 109: 10. Dell SJ (2004) Objective eviden
Page 112 and 113: 102 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
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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
Page 156 and 157: Fig. 15.4. Multifocal vs. monofocal
Page 158 and 159: 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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