The IOL= The IOL-VIP System

Report
Dominic McHugh
Royal Society of Medicine
2010
ARMD
 Leading cause of blindness (“SVL”) in the Western
World
 2.7 million in the UK have some loss.
 54% increase in >75s over the next 25 yrs.
ARMD
Quality of Life
With ARMD Without ARMD
Home Care 23%
Falls
16%
Falls With Fractures3.5%
Healthcare Costs€12,579
(£8,521)
5%
8.3%
1.5%
€1,300
(£885)
LVA Possibilities
Surgical Rehabilitation for ARMD
• Hanita Ben-Sira implant
Galileian telescope 2x
IOL+spectacle
• Intraocular Miniature Telescope
Galileian telescope 2.2- 3.5x intra (Lipshitz)
Difficulty
maintaining
coaxial
alignment
Monovision
VF 20°
11 mm incision
•
IOL-VIP System
BCC IOL in the capsular bag = telescope ocular
BCX IOL in AC= telescope objective
IOL-VIP System
PC IOL
-66D
AC IOL
+55D
IOL CHARACTERISTICS
ANTERIOR CHAMBER IOL (BCX)
Optic
Optic
Material
Diameter
Thickness
PC IOL (BCC)
PMMA with UV filter
5.0
1.5mm
Material
Diameter
Thickness
PMMA with UV filter
5.0
1.5mm
Haptics
Haptics
Loop shape
Material
Angle
Z
PMMA-1P
10°
Loop shape
Material
Angle
C
PMMA-1P
7°
IOL power
+55.00 D
IOL power
-66.00 D
Inclusion criteria for IOL-VIP
surgery
•Bilateral stable macular degeneration/macular hole
•VA 6/18-6/60
•Adequate endothelial cell count
•Adequate AC depth
•Good peripheral field
•Predicted benefit by IOL-VIP simulator
Exclusion criteria for IOL-VIP Surgery
•Active exudative macular degeneration
•Glaucoma
•PAS
•Cornea guttata
•Endothelial cell count < 1600 cell/mm2
•Shallow anterior chamber with depth < 3 mm
•Corneal diameter < 11 mm
IOL-VIP
Proposed mechanism of
action
Prismatic deviation of
Image to PRL.
Image magnificiation
~1.3
Image shift to PRL (MP)
Pre-op
Post-op
RE preop BCVA : 0.25
postop BCVA: 0.5
(Fasciani et al, 2008)
LE preop BCVA : 0.3
postop BCVA: 0.7
IOL-VIP Simulator Prism
IOL-VIP
Preoperative assessment
Best VA without and with simulator prism, rotated to
achieve PRL
IOL-VIP System
Optimal simulator orientation determines
relative IOL position
Right Eye
Left Eye
12
9
9
3
12
6
9
6
12
3
6
12
3
9
6
3
IOL-VIP System
Optimal simulator orientation
determines relative IOL position
Right Eye
Left Eye
12
12
1-2
9
1-2
9
3
8-7
3
8-7
6
6
1-2
1-2
9
12
3
8-7
8-7
6
• Corneal tunnel (superior/temporal depending on
IOL orientation
•Large (6-7 mm) CCC
•Phacoemulsification if phakic
•Enlarge corneal incision to 7 mm
•PC IOL: bag if phakic, sulcus if pseudophakic
•PI+miochol
•A/C IOL
•Corneal sutures
IOL-VIP
Surgery
IOL-VIP
Visual Outcome
Orzalesi et al
2007
IOL-VIP
Postoperative findings
•Low surgical complication rate
•Endothelial cell loss 7%
•PCO 18%
•High hyperopia in emmetropes;
better if myopic
•Recent availability of “bespoke”
implants
Advantages
• Improves reading/distance vision in suitable cases (6/18-
6/60 pre op; small-moderate central scotoma)
•Patients comment favourably on scotoma shifting away
from centre
Disadvantages
•Careful selection required: pathology; psychology; costs
•Lengthy (6 week) postoperative rehabilitation training
•Suture removal
•Refractive error : hyperopia and astigmatism (reduced
with new implants

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