1. Pearls for Success with the Synchrony Dual-Optic Accommodating IOL Preloaded Injector Víctor M. Bohórquez, MD Ricardo Alarcón, MD ServiOftalmos Bogotá, Colombia The authors have no financial interest in Visiogen ASCRS Financial Interest Codes, D & E

2. SYNCHRONY SURGICAL PEARLS  Synchrony has a 3-dimentional configuration that demands a detailed surgical plan  It is the first lens that completely fills the capsular bag without stretching it INITIAL STEPS  5.5 mm Corneal Marker  2 paracenthesis 180° apart  CCC 5.0 mm rounded, tear free.

3. CAPSULAR CLEAN-UP  Through removal of cortex  Polishing or vacuuming of the underside of the anterior lens capsule is recommended to prevent fibrosis  Bimanual I/A – high flow, high vacuum  Capsule should look crystal clear

4. The IOL comes preloaded in the disposable injector. The two optics are displaced first. This allows easy and controlled unfolding. The system is filled with BSS prior to folding the lens for delivery. SYNCHRONY IOL PREPARATION

5. IOL DELIVERY  Cohesive viscoelastic is used to fill the capsular bag  Increase incision size to 3.8 mm  Introduce the tip of the injector in the capsular bag  The preloaded, disposable injector is used to deliver the IOL

6. VISCOELASTIC REMOVAL  Viscoelastic removal is best achieved using bimanual I/A  Access the space between the 2 optics for I/A  I/A underneath the posterior optic is acceptable

7. SYNCHRONY IOL 2 years after surgery The equator is clear, without Soemmering’s ring formation

8. Cyclo When accommodation is relaxed, the two optics are close together, providing emmetropia Near Forward movement of the anterior optic is achieved with near stimulation of the fellow eye. IOL MOVEMENT AFTER 2 YEARS ULTRASOUND BIOMICROSCOPY

9. Mechanism of Action Movement is maintained over time iTrace confirms mechanism of action at 2 years in the same eyes UBM demonstrates mechanism of action at 1 year

10. SYNCHRONY IOL Evolution of Distance-corrected Near Vision over time DCNVA remains stable over time, meaning capsular fibrosis is not a factor with this dual optic IOL. After 24 months, over 90% of patients can read 0.3 logMAR (20/40 Snellen) logMAR 61.9% 95.2%

11. SUMMARY  The Synchrony Dual Optic Accommodating IOL is a viable option for presbyopia correction  Its delivery with the preloaded injector through a small incision is easy, controlled and safe  A meticulous technique has allowed us to obtain excellent results  No Interlenticular Opacification has been seen in over 200 patients with up to 3 years of follow-up