ICL AIOS 2010

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Outcome of ICL A Retrospective Analysis in 63 Eyes

www.theeyefoundation.com

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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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


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Peripheral Iridotomy

11:00

1:30


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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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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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www.theeyefoundation.comLAS

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


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Horizontal Slit

Marking the 0- 180 axis


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,

F, 6

No of patients - 43

Bil 23

Ul 20

No of eyes - 63



Results


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,

F, 6

No of patients - 43

Bil 23

Ul 20

No of eyes - 63



Results

Documents

ICL AIOS 2010