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ASCRS 2008, Chicago. Assessment of a triple procedure in patients with ICL-induced cataracts ~ICL TM removal, phacoemulsification and intraocular lens implantation. Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD. Kitasato Univ. School of Medicine,JAPAN. - PowerPoint PPT Presentation
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Assessment of a triple procedure in patients with ICL-induced cataracts ~ICLTM removal, phacoemulsification and intraocular lens implantation
Daisuke Aizawa,MD
Kazutaka Kamiya,MD
Tetsuya Ikeda,MD
Kimiya Shimizu,MD
Kitasato Univ. School of Medicine,JAPAN
ASCRS 2008, Chicago
Department of Ophthalmology2008
Kitasato University School of Medicine
ICLTM implantation has advantages over LASIK
in high myopic correction. ( Aizawa et.al. APSCRS 2007 )
Introduction
On the other hand, cataracts are among the complications of this procedure.
We assessed the triple procedure of ICL removal, PEA and IOL implantation.
Department of Ophthalmology2008
Kitasato University School of Medicine
Age (at ICL implantation time) 46.9 ± 2.8 (37 ~ 57) y.o.
Pre-op refraction -15.1 ± 5.8 (-10.4 ~ -24.0) D
Axial length 29.3 ± 1.9 (26.1 ~ 32.0) mm
ICL type Ver. II: 9 eyes, Ver. IV: 1 eye
Period (implant to extraction) 4.0 ± 2.1 (1.6 ~ 8.1) years
Age (when ICL extraction) 51.1 ± 4.2 (45 ~ 62) y.o.
10 eyes of 8 patients (6 eyes of male, 4 eyes of female)
Objects & Methods
IOL MasterTM was used for axial length measurement. ( SRK-T )
Operation ・ Topical anesthesia
・ ICL extraction via 3 mm temporal corneal incision
・ PEA+IOL through the same incision
Department of Ophthalmology2008
Kitasato University School of Medicine
0.0
0.1
1.0
10.0
ICL術前 ICL術後 白内障術前 白内障術後
矯正視力裸眼視力
Vis
ual a
cuity
0.310.68
0.73 1.10
*
*
*
1.050.81
0.73
0.02
Before ICL After ICL Cataract After ICL removal implantation implantation formation and IOL implantation
P < 0.001 ( Wilcoxon signed rank test )
BSCVA UCVA
Safety index = 1.51 Efficacy index = 0.93
Results 1 Visual acuity
Department of Ophthalmology2008
0.0
1.0
2.0
3.0
4.0
5.0
6.0
0.0 1.0 2.0 3.0 4.0 5.0 6.0
undercorrection
overcorrection
Kitasato University School of Medicine
< ±0.5D : 80%< ±1.0D : 90%
Attempted (D)
Ach
ieve
d (D
)
Results 2,3 Predictability, Manifest refraction (SE)
-25.0
0.0
ICL術前 ICL術後 白内障術前 白内障術後
-2.9 -2.0
-15.1
-1.6
Man
ifest
ref
ract
ion
(D)
Before ICL After ICL Cataract After ICL removal implantation implantation formation and IOL implantation
-25
0
Ach
ieve
d (D
)
Attempted (D)0 1 2 3 4 5 6
0
1
2
3
4
5
6
Manifest refraction (SE)Predictability
Department of Ophthalmology2008
Kitasato University School of Medicine
0.0
20.0
ICL術前 白内障術前 白内障術後
13.212.9
N.S.
13.5
IOP
(m
mH
g)
( Wilcoxon signed rank test )
Results 4,5 IOP, Endothelial cell density
Before ICL Cataract After ICL removal implantation formation and IOL implantation
0
3000
ICL術前 白内障術前 白内障術後
25262296
*
*Cell loss 9.1%
2555
Co
rnea
l en
dot
hel
ial c
ell
den
sity
(ce
lls/㎜
2)
P < 0.01 ( Wilcoxon signed rank test )
Before ICL Cataract After ICL removal implantation formation and IOL implantation
0
20
0
3000IOP Endothelial cell density
Department of Ophthalmology2008
Kitasato University School of Medicine
Ages atimplant’n/extraction
Pre-op refraction( D )
ICLtenure of use
(years)
ICLversion
Vaulting ( μm )
Cataract type
53 / 55 -10.4 2.4 Ⅱ 148.8 nuclear
37 / 44 -10.8 7.4 Ⅱ 171.7 nuclear
44 / 46 -13.0 2.1 Ⅱ 0 ant’r, subcapsular
44 / 46 -12.0 2.2 Ⅱ 0 ant’r, subcapsular
48 / 51 -17.8 2.8 Ⅱ 0 ant’r, subcapsular
48 / 51 -16.4 3.4 Ⅱ 0 nuclear
46 / 48 -14.4 1.6 Ⅱ 262.7 nuclear
53 / 56 -24.0 2.7 Ⅱ 102.6 nuclear
44 / 52 -16.0 8.1 Ⅱ 181.0 nuclear
57 / 62 -18.5 5.4 Ⅳ 0 nuclear
Mean 46.9 / 51.1 -15.1 4.0 - 86.7 -
Results 6 Vaulting (ICL to lens)
Department of Ophthalmology2008
Nuclear cataract (7 eyes) → common in high myopia
・ Age at ICL removal (present study): 51.1 ± 4.2 y.o.
・ Age at cat. operation in high myopia: 56.8 ± 10.0 y.o.
・ Average age at cat. operation: 63.4 ± 8.9 y.o.
high myopia occur cat. earlier Anterior subcapsular cat. (3 eyes) → suspected ICL-induced
・ after crystalline lens exposure to ICL
・ as a nutritional disturbance as changes in the dynamic
state of aqueous humor
Kitasato University School of Medicine
( Trinidade F et al. J Cataract Refract Surg. 1998 )
( K.Fujisawa et al ; Graefes Arch Clin Exp Ophthalmol. 2006 )
( Shimizu JSCRS 2007 )
Assessment 1 Cataract type
Department of Ophthalmology2008
・ version II: anterior-subcapsular (3 eyes / 9 patients)
nuclear (6 eyes / 9 patients)
・ version IV: nuclear (1 eye / 1 patient)
Version IV lenses have higher vaulting.
We consider that is the reason why ASC is unlikely.
Kitasato University School of Medicine
Ver.Ⅱ Ver.Ⅲ Ver.Ⅳ
Optical zone larger Vaulting: +0.17mm
Assessment 2 Lens Version & Cataract Type
Department of Ophthalmology2008
0
10
20
30
40
50
60
70
80
90
100
Kitasato University School of Medicine
*** IOL master, (SRK-T) (Shimizu et.al. JSCRS 2007)
** IOL master, (SRK-T, Double-K method) (Iida et. al. JSCRS 2006)
Predictability of IOL power calculation in ICL implanted eyes is almost equal to that in unoperated high myopic eyes without any specific calculation method.
ICLImplantedeye
LASIKeye
highmyopiceye
* IOL master, (SRK-T)90% 90.5%
60-80%
****
(%)
Assessment 3 Predictability (error < ±1.0D)
Predictability of cataract surgery
**
Department of Ophthalmology2008
Kitasato University School of Medicine
2.27 1.51
8.11
5.55
3.67
2.15
0
2
4
6
8
10
12
20代 30代 40代 50代
( Shimizu, JSCRS 2007 )
ICL implanted eyes
high myopic eyes
regular eyes
Cataract occurs earlier in high myopia. Pseudo-accommodation is greater in IOL eyes in high
myopia. In high myopic eyes in patients in their 50s, breadth of
accommodation and pseudo-accommodation after cataract surgery and implantation with ICLs are approximately the same.
Acc
om
mo
da
tion
an
d
Pse
ud
o-a
cco
mm
od
atio
n
(D)
Accommodation and Pseudo-accommodation
20’s 30’s 40’s 50’s
Assessment 4 Changes in accommodation
Department of Ophthalmology2008
Kitasato University School of Medicine
Cataracts occurred frequently in elderly persons and in cases of old type ICL implantations.
Even if cataracts are formed,
Conclusions
the ICL can be removed easily,IOL power can be calculated enough predictably,no decrease in area of distinct vision,and good visual performance is maintained.