icl aios 2010
TRANSCRIPT
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Outcome of ICL A Retrospective Analysis in 63 Eyes
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Introduction
In depth understanding of the eye and its behavior to
refractive surgeries has led to introduction newer technologies
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Introduction
Limited corneal thickness - keratorefractive
Growing awareness of corneal endothelial changes - anterior
chamber and iris clipped lenses
Clear lens extraction (CLE) - loss of accommodation and
retinal detachment is of grave concern
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Introduction
ICL has emerged as a favoured
procedure
Its more anatomical
Preservation of accommodation
Potentially reversible
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Period March 2007
Follow up 6 weeks -1 year
Number of eyes 63
Number of patients 43
Materials andMethods
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Materials and Methods
Inclusion criteria
Limited Corneal thickness
No previous ophthalmic surgery
No ocular pathology
Contd
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Materials and Methods
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Materials and Methods
Clinical evaluation
Visual acuity
Accurate refraction
Slit lamp evaluation
Retinal evaluation Specular microscopy
Orbscan
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Lens power calculation (parameters)
Manifest refraction
K values
Horizontal white-to-white measurement (calipers)
AC Depth (endo)
Central pachymetry
Materials and Methods
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Peripheral Iridotomy
11:00
1:30
Materials and Methods
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Surgical Procedure
Outcome of ICL A Retrospective analysis in 63 eyes
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Results
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Results
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M
F
Results
No of patients - 43 Male-Female Ratio - 3:5
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Results
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Results
TORSPH
Total number of
eyes 63
Spherical ICL 43
Toric ICL 20
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Results
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Results
Out of the 43 patients, except 6, the rest retained their
BCVA after the procedure.
One patient had Retinal detachment and glaucoma.
Five of them had residual refractive error ranging from0.75 D sph - -6.0D sph and
astigmatism ranging from -0.75 D cyl - 1.25 D cyl
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Normal 48
Pigmentation 13
Ant sub cap opacification 1
Glaucoma & RD 1
Results
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Conclusion
Our long term experience with ICLs showedgood visual outcome
It is an ideal procedure in the armamentarium
of refractive surgeon
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A PRESENTATION FROM
THE EYE FOUNDATIONCOIMBATORE - TIRUPUR
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Results
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SPHERICALEQUIVALENT
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No of eyes - 63
No of patients - 43
Age group - 18 yrs - 48 yrs (M 25.9)
Male-female ratio was - 3:5
Results
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SPHERICAL
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SPHERICAL
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Total number of
eyes -63
spherical ICL - 43
Toric ICL - 20
Results
SPH
TOR
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No of patients - 43 Male-female ratio was -
Results
17
2
SEX
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< 50
microns
ICL is Very Thin
Collagen copolymer
COLLAMER
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Foot Plates
< 50
microns
Alignment marks
ICL is Very Thin
Collagen copolymer
COLLAMER
Leading
right
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Additional markings have been etched on the horizontal
axis to allow accurate alignment.
Toric ICL
PositioningM
arkings
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Conclusion
Our short term results quite encouraging
Long term study needed for more complete conclusion
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,
F, 6
No of patients - 43
Bil 23
Ul 20
No of eyes - 63
Age group -16 yrs to 48yrs
Male-female ratio was3:5
Results
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Introduction
In keratorefractive -corneal thickness becomes a limiting
factor,
anterior chamber and iris clipped lenses- growing awareness of
corneal endothelial changes with,
Clear lens extraction (CLE) risk has been used with goodresults in high myopia, there is always a grave of retinal
detachment and consequent loss of accommodation must be
considered.
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L
3
L
No of patients - 43
Bilateral - 23
Unilateral - 20
Results
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6/ 8;
6/ ;
6/6;
Results
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Results
Sl
noEye Sph Cyl Axis V/A
Corneal
thicknessSPM Othereye
1 OD -18.00 -2.75 15 6/18 548 2697 Zyo
2 OS -7.00 -1.00 180 6/6 453 3611 PhakicIOL
3 OD -15.00 -1.25 180 6/6 5 526 2733
4 OS -7.00 -1.75 20 6/6 478 3115 ZYO(TS)
5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL
6 OS -9.00 -2.00 180 6/6 525 3063 Tor ICL
7 OD -10.00 -0.50 40 6/12 497 3603 Zyo
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Results
Sl
noEye Sph Cyl Axis V/A
Corneal
thicknessSPM Othereye
1 OD -18.00 -2.75 15 6/18 548 2697 Zyo
2 OS -7.00 -1.00 180 6/6 453 3611 PhakicIOL
3 OD -15.00 -1.25 180 6/6 5 526 2733
4 OS -7.00 -1.75 20 6/6 478 3115 ZYO(TS)
5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL
6 OS -9.00 -2.00 180 6/6 525 3063 Tor ICL
7 OD -10.00 -0.50 40 6/12 497 3603 Zyo
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Materials and Methods
ICL
Myopia - 7D to 18D
Toric ICL
Myopia - 12D & 9D
Astigmatism - 2.50D
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Posterior Chamber Phakic IOL
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COLLAMER:T
he Material
Collagen copolymer: Highly biocompatible
Hydrophilic: repels proteins
Affinity for fibronectin
Refractive index = 1.45
Elastic: Gentle unfolding
Tensile strength: Strong, ResistsTearing
UV Chromophore (covalently bound) Lathe Cut: many design options!
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Clinical Indications
Mild to high Myopia, with/without astigmatism
Mild - moderate Hyperopia
Stable Keratoconus Thin Cornea
Dry eyes
Large mesopic pupil (>7mm)
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SurgicalT
echnique
- Two Paracentesis
- Viscoelastic injection (HPMC)
- Temporal, clear corneal incision (3.2mm)
- Injection of ICL - Injection of viscoelastic on top of ICL
- Positioning of ICL behind iris
- Irrigation (and aspiration) of viscoelastic
- (Constriction of pupil for surgical iridectomy)
- 2-4 hours post-op check
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2 hour post-op exam
IOP check
use caution if IOP > 24 mmHg or 10 mmHg higher than pre-op
IOP Elevation
- Retained Viscoelastic burp and recheck
- Non-patent Iridotomies back to the Yag laser Check PIs
ACD should look deep
Check ICL vault
low vault is common at 2 and 24 hour check
(real vault after 1 week)
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Post-op medication
Follow the normal cataract routine
Antibiotic 3-4x / day for one week
Steroids/NSAID 3-4x / day for 2 weeks
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ICLICL
Comparison of Induced
Spherical & Coma (-8D patient)
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IKLAS
IK
Comparison of Induced
Spherical & Coma (-8D patient)
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Immediate Pre-Op
Topical Anesthetic
per routine
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Immediate Pre-Op
Cataract prep and drape
Normal sterile technique
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SurgicalT
echnique
Remember: NO TOUCH ZONE
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Immediate Pre-Op Minimum 8mm dilation
Pre-treat: Tropicamide, Phenylepherine and NSAID
Borderline Size Well Dilated Pupil
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Immediate Pre-Op
Topical Anesthetic
per routine
O t f ICL A R t ti A l i i 63 E
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Horizontal Slit
Marking the 0- 180 axis
O t f ICL A R t ti A l i i 63 E
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Horizontal Slit
Marking the 0- 180 axis
O t f ICL A R t ti A l i i 63 E
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,
F, 6
No of patients - 43
Bil 23
Ul 20
No of eyes - 63
Age group -16 yrs to 48yrs
Male-female ratio was3:5
Results
O t f ICL A R t ti A l i i 63 E
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Outcome of ICL A Retrospective Analysis in 63 Eyes
,
F, 6
No of patients - 43
Bil 23
Ul 20
No of eyes - 63
Age group -16 yrs to 48yrs
Male-female ratio was3:5
Results