Refractive Lens Surgery

total diameter of 13 mm, 360° sharp edge
and 0° haptic angulation (Fig. 14.3, model:
MA60D3).
The AcrySof ReSTOR lens is already marketed
in Europe, and Food and Drug Administration
approval in the USA for a cataract
indication is avoilable.
Chapter 14 AcrySof ReSTOR Pseudo-accommodative IOL 139
Fig. 14.2.
AcrySof
ReSTOR
in vitro
Fig. 14.3. Implanted MA60D3 (investigative lens)
14.2 Preoperative Considerations
Beside routine preoperative ophthalmologic
examinations and detailed discussion of the
pros and cons of a ReSTOR lens implantation,
the following points are worth considering in
the preoperative patient selection and preparation
of the surgery:
∑ Currently the ReSTOR IOL is available
from 16 to 25 D, thus an early preoperative
IOL calculation is necessary to assure that
an IOL with the desired power is available.
However,the diopter range will be expanded
in the future by Alcon.
∑ Patients with significant pre-existing ocular
pathology (e.g. age-related macular degeneration,
diabetic maculopathy, etc.)
should not be considered for implantation.
We also strongly recommend amblyopic
eyes not to be considered.
∑ It is extremely important for patient satisfaction,
in refractive lens exchange procedures,
to achieve a distance emmetropia of
0 to +0.5 D, thus a meticulous biometry is
necessary. If possible, two independent
technicians should perform the biometry,
as best possible IOL calculations are crucial.
Furthermore, the A-constant of the
ReSTOR lens (118.2 D for ultrasound
measurements and 118.6 for IOL Master)
is subject to further evaluation and should
be customized by the surgeon to achieve
best refractive results.
∑ Corneal astigmatism greater than 1.5 D is
difficult to correct accurately by incisional
procedures within the framework of a refractive
lens exchange surgery; thus we
recommend either not to consider such
patients for ReSTOR IOL implantation or
to plan for a secondary post-implantation
refractive procedure, e.g. laser-assisted insitu
keratomileusis (LASIK), in cases of
unsatisfactory visual results. Generally,
limiting the amount of preoperative
corneal astigmatism to less than 1 D is advised.