Presentation on theme: "Clinical Experience with the Accommodative WIOL-CF acrylic IOL."— Presentation transcript:
1 Clinical Experience with the Accommodative WIOL-CF acrylic IOL. 3/25/2017Clinical Experience with the Accommodative WIOL-CF acrylic IOL.By Arthur Nylander,FRCS, FRCOphth, D.O.Consultant ophthalmologistEast Lancashire hospitals, Lancashire, U.K.The author as no financial interest in these productsMr A Nylander.
2 East Lancahire Hospitals 3/25/2017East Lancahire HospitalsServes a population of peopleBurnley General HospitalBlackburn Royal InfirmaryRossendale General HospaitalSeven Consultant OphthalmologistFive Middle Grade DoctorsNine Trainee DoctorsMr A Nylander.
4 WIOL-CF Main Features and Benefits 3/25/2017WIOL-CF Main Features and BenefitsAccommodation capability > 2.25 DioptresLow incidence of PCO (< 1%/year)Resistance to deposits Large glare-free opticsVery good centration and position stabilityPotential for full reversibility - reimplantableAllows vitreo-retinal surgerySome clinical results will be presented in the second part. Let me summarize the main reasons why we are interested in this lens:Mr A Nylander.
5 WIOL-CF Posterior Chamber foldable acrylic IOL 3/25/2017WIOL-CF Posterior Chamber foldable acrylic IOLMAIN FEATURES:AccommodatingLarge continuous aspheric opticsFills the posterior capsuleHighly biocompatible materialLarge lens implantable through a small incisionThis lens has the following main features:Mr A Nylander.
6 WIOL-CF design Full disc plano-convex lens up to 9 mm O.D. 3/25/2017WIOL-CF designFull disc plano-convex lens up to 9 mm O.D.Posterior polyfocal hyperbolic opticsOptics continuous up to the rimImplantation:Preformed through < 3mm incision using a 3.0mm cartridge and titanium injector.Mr A Nylander.
8 WIOL-CF “Full Optics” acrylic IOL 3/25/2017WIOL-CF “Full Optics” acrylic IOLMENISCOID ANTERIOR SURFACEC.T. =mmThe profile shows the posterior surface which a hyperboloid and anterior is a modified spheric surface, or meniscoid.HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULEO.D. – 8.6 – 9.0 mmMr A Nylander.
9 WIOL-CF edge profile MENISCOID ANTERIOR SURFACE 3/25/2017WIOL-CF edge profileMENISCOID ANTERIOR SURFACEOPTICAL TRANSITION ZONECONICAL FASETTEThe lens has a sharp rim which then blends into the optical part via a narrow conical fasette. This rim may be one of the reasons why the lens is very resistant to posterior capsule opacification.SHARP EDGEHYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULEMr A Nylander.
10 WIOL-CF Features Benefits 3/25/2017WIOL-CF Features BenefitsHigh water content( 42%, higher than any other IOL on the market today )High carboxylate content( only on the current market )Low refractive indexSuperior biocompabilityHigh permeabilityHydrated surface with low friction vs. tissue (e.g., capsule, iris, cornea )Resistance to calcificationMinimized surface reflections and glare at nightMr A Nylander.
11 WIOL-CF Features Benefits 3/25/2017WIOL-CF Features BenefitsNegatively charged surface(only one on the market )Partly dehydrated for insertionResistance to protein depositsResistance to cell attachmentResistance to opacification of posterior capsuleNo adhesion to tissues ( capsule, iris, cornea )Increased strength for safer foldingNon-slippery for safer gripSmaller size for implantationMr A Nylander.
12 WIOL-CF Features Benefits 3/25/2017WIOL-CF Features BenefitsFull-disc configurationSelf-centeringExcellent position stabilityMaintenance of posterior capsular wallReplaceability of WIOL-CFVery large optical zoneEnables vitreo-retinal surgeryMr A Nylander.
13 WIOL-CF Features Benefits 3/25/2017WIOL-CF Features BenefitsContinuous transition between optics and rimSharp-edged continuous rimAspherics hyperboloid opticsNo edge effects ( no glare, improved night vision )Resistance to PCOImproved depth of focusPseudo-accommodationImproved resistance to astigmationMr A Nylander.
14 Power Calculation Chart 3/25/2017Power Calculation ChartMr A Nylander.
15 Power Calculation For the WIOL-CF Lens 3/25/2017Power Calculation For the WIOL-CF Lens1.The surgeon calculates the lens power based on the A-constant for SRK-T. Lets’s assume that the calculated value is 21.5d.2.Surgeon corrects the calculated value using the correction chart. The value of 22.5d (right red column) relates to the value 21.5d (left blue column).3.Finally, the value of +0.5d is added to the corrected value. Therefore surgeon implants WIOL-CF of the dioptric power of 22.8 (23.0)d.4.Anterior surface is the flat (plano) surface of the lens, posterior surface is the convex surface of the lens, it is easy to recognise from the side view.5.Lens has to be rinsed by isotonic saline solution and positioned posterior (convex) side down into the cartridge. Procedure of folding is shown in the following video.Mr A Nylander.
16 Surgical Implantation 3/25/2017Surgical ImplantationVideo clipMr A Nylander.
17 WIOL-CF accommodation 3/25/2017WIOL-CF accommodationImplanted in 51 eyes :Up to this date results in summary:WIOL-CF allows a comfortable everyday life and work or sports activities without use of spectacles or contactsGood patient preference and satisfaction.Objective examination shows 20/20 uncorrected acuity for both near and far visionNow some personal experience. My right eye was implanted more than 4 yeas ago and my left eye 2 years ago. In summary, this lens allow me a normal active life without spectacles – reading, night driving, sports, etc.Objective examination shows 20/20 vision both for near and far vision.Mr A Nylander.
18 WIOL-CF ACCOMMODATIVE IOL 3/25/2017WIOL-CF ACCOMMODATIVE IOLImplantation historyFirst implanted in January 2004.Implanted 3 in 2004Implanted 27 in 2005Implanted 21 so far in 2006Mr A Nylander.
19 WIOL-CF ACCOMMODATIVE IOL 3/25/2017WIOL-CF ACCOMMODATIVE IOLImplanted 51 lens in 38 patients11 of these patients have had the lens implanted in both eyes29 patients have had unilateral implantation.19 males21 femalesMr A Nylander.
20 WIOL-CF ACCOMMODATIVE IOL 3/25/2017WIOL-CF ACCOMMODATIVE IOLAge DistributionYoungest Patient 43 years oldOldest Patient 87 years oldMr A Nylander.
21 WIOL-CF ACCOMMODATIVE IOL 3/25/2017WIOL-CF ACCOMMODATIVE IOLMr A Nylander.
22 WIOL-CF ACCOMMODATIVE IOL 3/25/2017WIOL-CF ACCOMMODATIVE IOLLens DioptersLens come in Diopters powers from 15.0 to 30 DioptersImplanted from 19.0 Diopters to 29.0 DioptersNO difference in folding patternAll powers injected with the same behaviourLens must unfold inside the capsular bagMr A Nylander.
23 WIOL-CF Accomadative iol 3/25/2017WIOL-CF Accomadative iolMr A Nylander.
24 Case Study 1 CASE 1 - Mr. S.H Aged 55 Hospital Administrator 3/25/2017Case Study 1CASE 1 - Mr. S.H Aged 55 Hospital Administratorpre op: OD OSAdd for N5Right Phacoemulsification Wiol-CF IOL 5/5/05Left Phacoemulsification Wiol -CF IOL 16/5/05Unaided V.A. June 05 OD 6/4 OS 6/4-2 N8 N8Patient very happyUnaided V.A. November 05 OD 6/9 OS 6/4-2 N8 N8Right YAG capsulotomyMr A Nylander.
25 Case Study 2 CASE 2 - Mr. M. H. Aged 52 Taxi Driver 3/25/2017Case Study 2CASE 2 - Mr. M. H. Aged 52 Taxi Driverpre op: OD OSAdd for N5Right Phacoemulsification Wiol-CF IOL 5/5/05Left Phacomulsification Wiol -CF IOL 24/11/05Unaided V.A. December 05 OD 6/9-1 OS 6/6 N5 N5Patient say can read without glasses. Very happy.Mr A Nylander.
26 Case Study 3 CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer 3/25/2017Case Study 3CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainerpre op: OD OSAdd for N5Right Phacoemulsification +19 Wiol-CF IOL 11/01/04Unaided V.A. 6/6 N8.Very Happy.Mr A Nylander.
27 Case Study 4 Brought Husband of patient case 3. 3/25/2017Case Study 4Brought Husband of patient case 3.Mr. T.A. Aged 86 for Bilateral CataractRight Phacoemulsification Wiol -CF IOL 23/2/06Left Phacoemulsification Wiol -CF IOL 2/3/06Unaided V.A. April 06 OD 6/9-1 OS 6/9 N12 N10Patient happy.Mr A Nylander.
28 WIOL-CF accommodation: subjective patient's observations 3/25/2017WIOL-CF accommodation: subjective patient's observationsGood focus requires some effort and trainingAcuity degrades by fatigue, (e.g.after long work on poor computer screens or reading of low-quality print in poor light conditions)Far focus improves and double vision disappears by widely opening eyesNear focus improves by narrowing eyes and good illuminationIn addition to the objective results presented by Professor Pasta later, I have made some subjective observations:Mr A Nylander.
29 WIOL-CF accommodation: subjective patient's observations 3/25/2017WIOL-CF accommodation: subjective patient's observationsVery near focusing requires conscious effort and time (1 to 2 seconds lag)Using both eyes improves significantly both near and far focusNo glare or other vision problems while driving at nightNo degradation of peripheral vision at driving, tennis, etc.No acuity deterioration after 4 years (subjectively improved)Mr A Nylander.
30 Conclusion All patients obtained some accommodation. 3/25/2017ConclusionAll patients obtained some accommodation.Accommodation range from N12 to N5 Mostly N8.Better accommodation with 6/9 or 6/6 vision than 6/4 or 6/5.Encourage patients to use their accommodation.Mr A Nylander.
31 3/25/2017ConclusionOlder patients need more encouragement than younger patients.Correction factor appears to be accurate.PCO in 2 out of 51 cases.1 YAG Capsulotomy at 18 monthsNo problems with YAG CapsulotomyOverall results with the WIOL-CF lens are very promising.Mr A Nylander.