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Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University.

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Presentation on theme: "Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University."— Presentation transcript:

1 Alois Dexl No Financial Interest ! University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner Verisyse for Correction of Aphakia

2 University Eye Clinic Salzburg Paracelsus Medical University Aphakia Aphakia = absence of natural crystalline lens Western World: very uncommon Phako / ECCE with IOL-implantation in the capsular bag Reasons After complicated cataract surgery Post-traumatic dislocation of crystalline lens Capsular loss Ectopia lentis Marfan syndrome, Weill-Marhesani syndrome, hyperlysinaemia, homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome Aphakia = absence of natural crystalline lens Western World: very uncommon Phako / ECCE with IOL-implantation in the capsular bag Reasons After complicated cataract surgery Post-traumatic dislocation of crystalline lens Capsular loss Ectopia lentis Marfan syndrome, Weill-Marhesani syndrome, hyperlysinaemia, homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome

3 University Eye Clinic Salzburg Paracelsus Medical University Conservative Correction ? Spectacles Reduced peripheral vision Ring scotoma (prismatic effect) Jack in the box Aniseokonia Contact lenses Fitting, removal, cleaning… Spectacles Reduced peripheral vision Ring scotoma (prismatic effect) Jack in the box Aniseokonia Contact lenses Fitting, removal, cleaning…

4 University Eye Clinic Salzburg Paracelsus Medical University Surgical Correction Angle supported AC-IOL Endothelial cell loss (1 year: 6-45%) Pseudophakic bullous keratopathy (PBK) UGH-syndrome Scleral fixation of PC-IOL Choroidal haemorrhage Retinal detachment Vitreous incarceration Chronic inflammation IOL-iris contact IOL decentration Pigmentary dispersion High aqueous flare CME Angle supported AC-IOL Endothelial cell loss (1 year: 6-45%) Pseudophakic bullous keratopathy (PBK) UGH-syndrome Scleral fixation of PC-IOL Choroidal haemorrhage Retinal detachment Vitreous incarceration Chronic inflammation IOL-iris contact IOL decentration Pigmentary dispersion High aqueous flare CME

5 University Eye Clinic Salzburg Paracelsus Medical University Surgical Correction Iris-Claw aphakic IOL Best choice for primary or secondary implantation in aphakic eyes Safer then open-loop-angle supported AC-IOLs Surgery easier, shorter and safer then sclera sutured IOLs Some cases of PBK Endothelial cell loss – caused by surgical trauma ? Iris-Claw aphakic IOL Best choice for primary or secondary implantation in aphakic eyes Safer then open-loop-angle supported AC-IOLs Surgery easier, shorter and safer then sclera sutured IOLs Some cases of PBK Endothelial cell loss – caused by surgical trauma ? Prof. Jan Worst Model 205T Worst Iris Claw ® Lens Model 205Y or VRSA54 ARTISAN VERISYSE Aphakia Lens

6 University Eye Clinic Salzburg Paracelsus Medical University Verisyse ® Aphakia VRSA54 Verisyse Primary or secondary implantation after ICCE, ECCE and Phaco Dioptric power: +2,0 D to +30,0 D (14.5 to 24.5 in 0.5 D steps) Optical Diameter: 5.0 mm Overall Diameter: 8.5 mm Biconvex design A-constant: 115 for AC implantation for retropupillary implantation (ULIB) VRSA54 Verisyse Primary or secondary implantation after ICCE, ECCE and Phaco Dioptric power: +2,0 D to +30,0 D (14.5 to 24.5 in 0.5 D steps) Optical Diameter: 5.0 mm Overall Diameter: 8.5 mm Biconvex design A-constant: 115 for AC implantation for retropupillary implantation (ULIB)

7 University Eye Clinic Salzburg Paracelsus Medical University 1996 – 2005:78=8 / year 2006 – 2009:50=14 / year 2009 – 2010:22=22 / year 1996 – 2005:78=8 / year 2006 – 2009:50=14 / year 2009 – 2010:22=22 / year Total 150 University Eye Clinic Salzburg 1996 – 2010 Aphakic Iris claw IOL Frequency

8 University Eye Clinic Salzburg Paracelsus Medical University SUBLUXATED lenses 82 Primary surgery (Marfan´s syndrome)25 Posttraumatic25 Spontaneous IOL dislocation (PEX)32 Frequency

9 University Eye Clinic Salzburg Paracelsus Medical University Positioning of Verisyse ® Aphakia Anterior Posterior Risk of endothelial cell loss decreases AC is deeper Distance from haptics to endothelium is larger Irido-corneal angle is wider Anterior Posterior Risk of endothelial cell loss decreases AC is deeper Distance from haptics to endothelium is larger Irido-corneal angle is wider

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11 Advantages Very safe for corneal endothelium Produces less glare Only a very small of HOA 1 Physiological space for an IOL is behind the iris Advantages Very safe for corneal endothelium Produces less glare Only a very small of HOA 1 Physiological space for an IOL is behind the iris 1 Kaymak C, Mester U. paper at ESCRS-Meeting, Lissabon Posterior approach

12 University Eye Clinic Salzburg Paracelsus Medical University Disadvantages Extensive anterior vitrectomy required Special intruments are useful in order to avoid IOL- drop into the vitreous cavity during implantation Disadvantages Extensive anterior vitrectomy required Special intruments are useful in order to avoid IOL- drop into the vitreous cavity during implantation Posterior approach

13 University Eye Clinic Salzburg Paracelsus Medical University Sekundo, Eur J Ophthalmol 2008 Special instruments usefull to avoid a tilting of the IOL during implantation procedure Posterior approach

14 University Eye Clinic Salzburg Paracelsus Medical University Mohr et al. Ophthalmologe aphakic cases 2/48 reversible CME Wolter-Roessler et al. Klin Monatsbl Augenheilkd aphakic cases, 14 Months 2/48 reversible CME 2/48 traumatic haptic dislocation 1/48 retinal detachment 1/48 pupillary block > iridectomy mandatory Hara et al. J Refract Surg eyes retropupillary Verisyse No complications 21 eyes transscleral sutured IOL 5/21 ciliary choroidal body haemmorhage 1/21 CME 1/21 IOL dislocation Mohr et al. Ophthalmologe aphakic cases 2/48 reversible CME Wolter-Roessler et al. Klin Monatsbl Augenheilkd aphakic cases, 14 Months 2/48 reversible CME 2/48 traumatic haptic dislocation 1/48 retinal detachment 1/48 pupillary block > iridectomy mandatory Hara et al. J Refract Surg eyes retropupillary Verisyse No complications 21 eyes transscleral sutured IOL 5/21 ciliary choroidal body haemmorhage 1/21 CME 1/21 IOL dislocation Posterior approach

15 University Eye Clinic Salzburg Paracelsus Medical University Anterior chamber IOL´s Angle-supported Iris-claw Anterior chamber IOL´s Angle-supported Iris-claw Posterior chamber IOL´s Sclera-fixated Iris-sutured Posterior chamber IOL´s Sclera-fixated Iris-sutured Posteriorly enclavated Iris-claw lens VERY FEW COMPARATIVE LONG-TERM studies Need for a prospective, long-term (multi-center) study Decision tree for the very different clinical situations Conclusion

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