ASCRS/ESCRS Survey on Foldable IOLs Requiring Explantation or Secondary Intervention 2005 Update

ASCRS/ESCRS Survey on Foldable IOLs RequiringExplantation or Secondary Intervention

2005 Update

Nick Mamalis, MDProfessor of Ophthalmology

John A. Moran Eye CenterUniversity of Utah, Salt Lake City

Co-Authors

Brian Haugen, MDJonathan Haymore, MDNatalya Romaniv, MD

Ophthalmic Research Fellows

Materials and MethodsMaterials and Methods

• 8th annual survey of ASCRS/ESCRS 8th annual survey of ASCRS/ESCRS membersmembers

• Foldable IOL Foldable IOL complications/explantations - 2005complications/explantations - 2005

• Intermountain Ocular Research Intermountain Ocular Research Center - University of UtahCenter - University of Utah

• Cataract Clinical CommitteeCataract Clinical Committee

Materials and MethodsMaterials and Methods

• Signs and symptoms/complaintsSigns and symptoms/complaints

• Pre-op visual acuityPre-op visual acuity

• Complications requiring IOL Complications requiring IOL removal/exchange/secondary removal/exchange/secondary interventionintervention

Materials and MethodsMaterials and MethodsFoldable IOL DesignsFoldable IOL Designs

• One-piece, plate-type lensesOne-piece, plate-type lenses

• One-piece lenses with hapticsOne-piece lenses with haptics

• Three-piece lensesThree-piece lenses

• Multifocal lensesMultifocal lenses

Materials and MethodsMaterials and MethodsFoldable IOL MaterialsFoldable IOL Materials

• SiliconeSilicone

• Acrylic (hydrophobic)Acrylic (hydrophobic)

• Hydrogel (hydrophilic acrylic)Hydrogel (hydrophilic acrylic)

• CollamerCollamer

Survey Lens Totals 2005Survey Lens Totals 2005

2% 11%

30%

9%20%

10%

18%

Multifocal,Silicone

One Piece (plate),Silicone

One Piece with Haptics,Acrylic

One Piece with Haptics,Hydrogel

Three Piece,Acrylic

Three Piece,Hydrogel

Three Piece,Silicone

ComplicationsComplicationsThree-Piece Silicone IOLThree-Piece Silicone IOL

• Dislocation / decentration seen most Dislocation / decentration seen most commonlycommonly

0%

10%

20%

30%

40%

50%

60%

70%

80%

Three Piece,Silicone

% o

f C

om

plic

ati

on

Calcification/opacification

Damaged IOL - Cracked or torn during insertion

Dislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsOne-Piece (Plate Silicone)One-Piece (Plate Silicone)

• Dislocation / decentrationDislocation / decentration

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

One Piece (plate),Silicone

% o

f Co

mp

licat

ion

Calcification/opacification

Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsThree-Piece AcrylicThree-Piece Acrylic

• Dislocation / decentrationDislocation / decentration• Incorrect lens powerIncorrect lens power• Glare/optical aberrationsGlare/optical aberrations

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Three Piece,Acrylic

% o

f Co

mp

licat

ion

Calcification/opacification

Damaged IOL - Cracked or tornduring insertionDislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsOne-Piece with Haptics AcrylicOne-Piece with Haptics Acrylic

• Incorrect lens powerIncorrect lens power• Dislocation / decentrationDislocation / decentration

0%

5%

10%

15%

20%

25%

30%

35%

One Piece with Haptics,Acrylic

% o

f C

om

pli

ca

tio

n

Calcification/opacification

Damaged IOL - Cracked or torn duringinsertion

Dislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsThree-Piece HydrogelThree-Piece Hydrogel

• Calcification / opacificationCalcification / opacification• Damaged IOLDamaged IOL

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Three Piece,Hydrogel

% o

f Co

mp

licat

ion

Calcification/opacification

Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsOne-Piece with Haptics HydrogelOne-Piece with Haptics Hydrogel

• Calcification / opacificationCalcification / opacification

0%

10%

20%

30%

40%

50%

60%

One Piece w ith Haptics,Hydrogel

% o

f Com

plic

atio

n

Calcification/opacification

Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

ComplicationsComplicationsMultifocal SiliconeMultifocal Silicone

• Glare / optical aberrationsGlare / optical aberrations

• Incorrect lens powerIncorrect lens power

0%

10%

20%

30%

40%

50%

60%

Multifocal,Silicone

% o

f C

om

plic

ati

on

Calcification/opacification

Damaged IOL - Cracked or torn during insertion

Dislocation/Decentration

Glare/optical aberrations

Incorrect lens power

Infection/endophthalmitis

Operative complications

Removed during retinal surgery

Retinal problems/RD

Unknown

Pre-operative Visual AcuityPre-operative Visual Acuity20052005

0%

10%

20%

30%

40%

50%

60%

Mult

ifoca

l,Silic

one

One P

iece (

plate)

,Silic

one

One P

iece w

ith H

aptic

s,Acr

ylic

One P

iece w

ith H

aptic

s,Hyd

roge

l

Three

Piec

e,Acr

ylic

Three

Piec

e,Hyd

roge

l

Three

Piec

e,Silic

one

% o

f V

isu

al A

cu

ity

20/20 - 20/40

20/200 - 20/400

20/50 - 20/100

Unknown

Worse than 20/400

Post Explant Visual AcuityPost Explant Visual Acuity20052005

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mult

ifoca

l,Silic

one

One P

iece (

plate

),Silic

one

One P

iece w

ith H

aptic

s,Acr

ylic

One P

iece w

ith H

aptic

s,Hyd

roge

l

Three

Piec

e,Acry

lic

Three

Piec

e,Hyd

roge

l

Three

Piec

e,Silic

one

% o

f V

isu

al A

cu

ity

20/20 - 20/40

20/200 - 20/400

20/50 - 20/100

Less than 20/400

Unknown

DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications

• Dislocation/decentration overall Dislocation/decentration overall most common reason for IOL most common reason for IOL explantationexplantation

• Followed by incorrect lens powerFollowed by incorrect lens power

• Damaged IOLDamaged IOL

DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications

• Continuing trends in complications Continuing trends in complications over eight years over eight years

• Several differences in complications Several differences in complications over this period of timeover this period of time

Three-Piece, SiliconeThree-Piece, Silicone

0%

10%

20%

30%

40%

50%

60%

70%

80%

Damaged IOL - cr acked/ tor n

dur ing inser tion

Dislocation/ decentr ation Glar e/ optical aber r ations Incor r ect lens power

1998

1999

2000

2001

2002

2003

2004

2005

Three-Piece, AcrylicThree-Piece, Acrylic

0%

10%

20%

30%

40%

50%

60%

70%

Dislocation/decentration Glare/optical aberrations Incorrect lens pow er

1998

1999

2000

2001

2002

2003

2004

2005

One-Piece (Plate) SiliconeOne-Piece (Plate) Silicone

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Damaged IOL - Cracked/tornduring insertion

Dislocation/decentration Incorrect lens power

1998

1999

2000

2001

2002

2003

2004

2005

DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications

• Calcification of hydrophilic acrylic Calcification of hydrophilic acrylic (hydrogel) IOLs the next most common (hydrogel) IOLs the next most common reason for explantationreason for explantation

• Calcification on both the lens surface as Calcification on both the lens surface as well as substance of the lenswell as substance of the lens

DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications

• Glare/optical aberration continues Glare/optical aberration continues to be seen as a reason for IOL to be seen as a reason for IOL removalremoval

• Other reasons such as damaged Other reasons such as damaged IOL during insertion seen less IOL during insertion seen less frequentlyfrequently

ConclusionsConclusionsAvoidance of Complications Using Avoidance of Complications Using Foldable IOLsFoldable IOLs

• Good surgical technique essentialGood surgical technique essential

• CCC with capsular bag fixation of the CCC with capsular bag fixation of the IOLIOL

ConclusionsConclusionsAvoidance of Complications UsingAvoidance of Complications UsingFoldable IOLsFoldable IOLs

• Need for accurate IOL Need for accurate IOL measurementsmeasurements

• Necessity for use of new Necessity for use of new technologies for axial length technologies for axial length measurements and calculationsmeasurements and calculations

ConclusionsConclusionsAvoidance of Complications UsingAvoidance of Complications UsingFoldable IOLsFoldable IOLs

• Ongoing vigilance regarding newer Ongoing vigilance regarding newer IOL materialsIOL materials

• Hydrophilic acrylic (hydrogel) IOLsHydrophilic acrylic (hydrogel) IOLs

ConclusionsConclusionsASCRS/ESCRS SurveyASCRS/ESCRS Survey

• Ongoing yearly data collectionOngoing yearly data collection

• Forms available by ASCRS/ESCRS Forms available by ASCRS/ESCRS fax on demand-web sitefax on demand-web site

• Please submit survey forms on Please submit survey forms on explanted foldable IOLsexplanted foldable IOLs