tim 2007acrysof_restor.ppt

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ACRYSOF ReSTOR

IOL- A CHALLENGE INHIGH AMETROPIES

CORRECTIONAssoc. Prof. M.Filip, Carme !ra"e,

A. Filip, Marie#a Ma"$rea$, R.

Asa%iAmaOp#ime& E'e Cliic, ($c)ares#,

Romaia



AMAOPTIME+ EYE CLINIC

Between 05.06.2006 and 22.02.2007, 84 ambulatory

refractive lens exchane !"#$% &erformed'

( )ih myo&ia *8d 64 eyes+

( )ih hy&ero&ia *6d 20 eyes.

crysof "e-/" iol has been im&lanted in'

( )ih myo&ia *8d 5 eyes+

( )ih hy&ero&ia *6d eyes.

1urin this &eriod 0 crysof "e-/" iol were

im&lantated in the clinic.



PATIENT SELECTION

• All the patients 'ere correct an# completeinforme# on the proce#ure an# especially uponconnecte# ris(s; they signe# an agreement )eforesurgery"

Compa#ile pa#ie#s

• $ery moti!ate# to re#uce their glasses#epen#ency* an# 'illing to retain the a)ility tosee either close an# #istant o)+ects 'ithoutglasses;

• Bilateral implantation can#i#ates;

• P,K pc monofocal at the congener eye %thema-im e.ect occurs at )ilateral implantation&"



PATIENT SELECTION

Pa#ie# c)arac#eris#ics #o caref$ll'cosi%er

( atients who have excessive com&laints about their

&rescri&tion lasses or contact lenses+

( atients who drive at niht for their occu&ation+

( 3ndividuals who have &reexistin com&laints about

nihttime lare.



ME!ICALCONSI!ERATION

PATIENT SELECTION( e *20 years old+

( -table refraction in the last 6 months+

( atients with more than dio&ter astimatism+

( mblyo&ia+

( ower reuirements outside of lens rane

!00 dio&ters%+( atients with &revious refractive surery+

( -inificant &reexistin ocular &atholoies !e..corneal, retinal disease%.



ERATOMETRY

( 1iscontinue contact lens wear for at least 2wees, until stable eratometry readin isconfirmed+

( readins are sus&ect, below 40 dio&tersor reater than 47 dio&ters+

( o confirm irreular astimatism we use

corneal to&ora&hy, if the sus&icionremains we give up Acrysof Restorimplantation.



(IOMETRY (IOMETRY

( 9old standard' immersion biometry+9old standard' immersion biometry+

( :e &erformed this techniue at all:e &erformed this techniue at all&atients selected for "#$+&atients selected for "#$+

1;<9$-' 1;<9$-'

( <o direct corneal contact+<o direct corneal contact+

( <o corneal com&ression or tear bride+<o corneal com&ression or tear bride+

( 9ives true axial lenth+9ives true axial lenth+

( #ess o&erator de&endent#ess o&erator de&endent..



IOL PO/ERCALC*LATION

( aret emmetro&ia to achieve o&timal visual&erformance' =0.25 =0.5d s&h+

( >se 8. constant for the crysof "estor

iol+( :e use as 3/# calculation the followin

formula'

o )olladay formula for hih myo&ia, axiallenth *24.5mm+

o )offer? formula for hih hy&ero&ia, axiallenth @22mm.



TREATMENT

( Treatment before surgery:Ciprofloxacin, topical and systemic;

( Technique used: irrigationaspiration of

transparent lens !ith Alcon "egacy#eries $%%%% and implantation iol pc in

the bag;

( &ostoperative treatment: topicaltreatment: ciprofloxacin, tropicamide,

diclophenacum, dexamethasone;

( &ostoperative control at ' !ee(s.



CASE 0

• /"A" 0 female* 12 years ol#* ur)an area;/"A" 0 female* 12 years ol#* ur)an area;

• Reason for presenting: to gi!e up glasses;Reason for presenting: to gi!e up glasses;

• Ophthalmologic e-am:Ophthalmologic e-am:

B3$A R4 5"6 'ith correction 78# sphB3$A R4 5"6 'ith correction 78# sph

B3$A L4 5"8 'ith correction 78# sphB3$A L4 5"8 'ith correction 78# sph

• Refraction 'ith cycloplegia:Refraction 'ith cycloplegia: R4 : 79"1#sph75"<#cyl a- 2<9R4 : 79"1#sph75"<#cyl a- 2<9

L4 : 7<#sph72#cyl a- 255L4 : 7<#sph72#cyl a- 255

• Immersion )iometry using SRK II formula %instea# ofImmersion )iometry using SRK II formula %instea# of=o.er>? formula& 716"# to target 75"81#sph=o.er>? formula& 716"# to target 75"81#sph

• R4 Acrysof Restor iol 716"#;R4 Acrysof Restor iol 716"#;• Postoperati!e refraction R4 71#sph75"1#cyl a- 252;Postoperati!e refraction R4 71#sph75"1#cyl a- 252;

• Recommen#ation: 4-cimer after 9 months to atten#Recommen#ation: 4-cimer after 9 months to atten#emmetropia"emmetropia"



CASE 1

• B"S" 0 male* 15 years ol#* ur)an area;B"S" 0 male* 15 years ol#* ur)an area;


• Ophthalmologic e-am :Ophthalmologic e-am :

B3$A R4 2 'c >6"#sph>5"<#cyl a- 5B3$A R4 2 'c >6"#sph>5"<#cyl a- 5 B3$A L4 2 'c >9"#sph >2"#cyl a- 25B3$A L4 2 'c >9"#sph >2"#cyl a- 25

• Refraction 'ith cycloplegia:Refraction 'ith cycloplegia:

R4 : >@#sph>5"<#cyl a- 5R4 : >@#sph>5"<#cyl a- 5

L4 : >9"<#sph >2"#cyl a- 25L4 : >9"<#sph >2"#cyl a- 25

• Immersion )iometry R4 using =olla#ay formulaImmersion )iometry R4 using =olla#ay formula725"# to target 75"1#sph725"# to target 75"1#sph

• R4 Acrysof Restor iol 725"#;R4 Acrysof Restor iol 725"#;

• L4 4-cimerL4 4-cimer



CASE 19 'ee(s control :9 'ee(s control :

• Postoperati!e refraction:Postoperati!e refraction:

R4 75"#sph>5"<#cyl a- 282;R4 75"#sph>5"<#cyl a- 282;

L4 5#sph>2"1#cyl a- 8;L4 5#sph>2"1#cyl a- 8;

• $A R4 2 'ithout correction;$A R4 2 'ithout correction;

• $A L4 5"@ 'ithout correction;$A L4 5"@ 'ithout correction;

8 months control :8 months control :• Postoperati!e refraction:Postoperati!e refraction:

R4 5#sph>5"<#cyl a- 282;R4 5#sph>5"<#cyl a- 282;

L4 >5"#sph>5"<#cyl a- 9;L4 >5"#sph>5"<#cyl a- 9;

• $A R4 5"< 'ithout correction;$A R4 5"< 'ithout correction;

• $A L4 5"@ 'ithout correction;$A L4 5"@ 'ithout correction;( -litlam& examination "$' A "estor centered, &osterior

ca&sula o&acity==

• Recommen#ation: R4 laser yag at 9 months control"Recommen#ation: R4 laser yag at 9 months control"



CASE 2

• B"3" 0 female* 18 years ol#* ur)an area;B"3" 0 female* 18 years ol#* ur)an area;



B3$A R4 5"9 'c >25#sph>2"#cyl a- 29B3$A R4 5"9 'c >25#sph>2"#cyl a- 29

B3$A L4 5"< 'c >@#sph >1"#cyl a- 25B3$A L4 5"< 'c >@#sph >1"#cyl a- 25• Refraction 'ith cycloplegia:Refraction 'ith cycloplegia:

R4 : >22"1#sph>2"#cyl a- 5R4 : >22"1#sph>2"#cyl a- 5

L4 : >@"#sph >1"#cyl a- 25L4 : >@"#sph >1"#cyl a- 25

• Immersion )iometry using =olla#ay formulaImmersion )iometry using =olla#ay formula

R4725# to target >>2"2#sphR4725# to target >>2"2#sph L4 725# to target >>5"1#sphL4 725# to target >>5"1#sph

• B4 Acrysof Restor IOL 725#* after 9 months 4-cimerB4 Acrysof Restor IOL 725#* after 9 months 4-cimerfor emmetropia"for emmetropia"



CASE 2

9 'ee(s control :9 'ee(s control :


R4 >2"<#sph >2"1#cyl a- 26;R4 >2"<#sph >2"1#cyl a- 26;

L4 5#sph >1#cyl a- 2;L4 5#sph >1#cyl a- 2;

• 3$A R4 5"<;3$A R4 5"<;

• B3$A R4 2 'ith correction >2"1# cyl a- 29B3$A R4 2 'ith correction >2"1# cyl a- 29

• 3$A L4 5"<;3$A L4 5"<;

• B3$A L4 5"@ 'ith correction >2"1# cyl a- 5B3$A L4 5"@ 'ith correction >2"1# cyl a- 5

( -litlam& examination B$' A "estor well&ositioned,

• Rec": B4 4-cimer after 9 months*if necessary"Rec": B4 4-cimer after 9 months*if necessary"



CASE 3• 3"C" 0male* 88 years ol#* ur)an area;3"C" 0male* 88 years ol#* ur)an area;

• Reason for presenting: to gi!e up glasses;Reason for presenting: to gi!e up glasses;• Ophthalmologic e-am:Ophthalmologic e-am:

B3$A R4 5"8 'c >25#sph>2#cyl a-B3$A R4 5"8 'c >25#sph>2#cyl a-1515

B3$A L4 5"9 'c >22#sphB3$A L4 5"9 'c >22#sph• Refraction 'ith cycloplegia:Refraction 'ith cycloplegia:

R4 : >25"#sph>2"<#cyl a- 15R4 : >25"#sph>2"<#cyl a- 15

L4 : >25"<#sphL4 : >25"<#sph

• Immersion )iometry using =olla#ay formulaImmersion )iometry using =olla#ay formulaR4725# to target >>2"2#sphR4725# to target >>2"2#sph

L4 722# to target 75"1#sphL4 722# to target 75"1#sph

• B4 Restor 725#; after 9 months R4 4-cimerB4 Restor 725#; after 9 months R4 4-cimer

for emmetropia"for emmetropia"



CASE 3

9 'ee(s control:9 'ee(s control:• Postoperati!e refraction:Postoperati!e refraction:

R4 >2"#sph >2"<#cyl a- 2@;R4 >2"#sph >2"<#cyl a- 2@;

L4 75"1#sph 75"#cyl a- 2<9;L4 75"1#sph 75"#cyl a- 2<9;

• 3$A R4 5"1;3$A R4 5"1;• B3$A R4 5" 'ith correction >2# sph>B3$A R4 5" 'ith correction >2# sph>

2"1#cyl a- 2<2"1#cyl a- 2<

• $A L4 5"< 'ithout correction;$A L4 5"< 'ithout correction;


• Recommen#ation: R4 4-cimer after 9 months"Recommen#ation: R4 4-cimer after 9 months"



CASE 4

• C"D" 0male* 82years ol#* ur)an area;C"D" 0male* 82years ol#* ur)an area;• Reason for presenting: to gi!e up at glasses;Reason for presenting: to gi!e up at glasses;


B3$A R4 5"6 'c 7#sphB3$A R4 5"6 'c 7#sph

B3$A L4 5"6 'c 7#sphB3$A L4 5"6 'c 7#sph• Refraction 'ith cycloplegia:Refraction 'ith cycloplegia:

R4 : 79"#sphR4 : 79"#sph

L4 : 7<"#sph75"#cyl a- 2<9L4 : 7<"#sph75"#cyl a- 2<9

• Immersion )iometry using =o.er>? formulaImmersion )iometry using =o.er>? formulaR4716"# to target 75"82sphR4716"# to target 75"82sph

L4 71@"# to target 75"1#sphL4 71@"# to target 75"1#sph

• B4 RestorB4 Restor



CASE 4

9 'ee(s control :9 'ee(s control :


R4 75"1#sph 75"#cyl a- 2<5;R4 75"1#sph 75"#cyl a- 2<5; L4 75"1#sph 75"1#cyl a- 5;L4 75"1#sph 75"1#cyl a- 5;

• $A R4 5"@ 'ithout correction;$A R4 5"@ 'ithout correction;

• $A L4 5"@ 'ithout correction$A L4 5"@ 'ithout correction




RES*LTS

( ll the &atients were from urban area+

( ll the &atients were very motivated to

re#uce their #epen#ency on glasses;•Eean age of the patients 'as 1*9

years ol#;

•$isual #istur)ances as: night !isionpro)lems* glare* halos #i# not occurin our patients"



ACRYSOF RESTOR

PERSPECTI5EI pa#ie#s selec#io 6e e&cee%e% #)e

pro%$cer7s i%ica#ios

( atients with more than dio&ter astimatism $xcimer after 6 months+

( atients with hih myo&ia, where we ex&ect&osto&erative remainin myo&ia1iscussionabout $xcimer after 6 months,&reo&eratively+

( mblyo&ia+



CONCL*SIONS

F$c#ioal res$l#s• )inocular !isual acuity is 2>1 Snellen lines

superior than monocular !isual acuity;

• Patient satisfaction le!el: !ery high* e-cept case

2* 'ith a remain hyperopia 4-cimer an# case 1'ith secon#ary cataract laser FAC;

• /o patient nee#s glasses for e!ery #ay acti!ity"

The result is an increase# range of uality !isionthat #eli!ers a high le!el of spectacle free#om"

tim 2007acrysof_restor.ppt

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