Presentation on theme: "Mr A Nylander. Clinical Experience with the Accommodative WIOL-CF acrylic IOL. zBy Arthur Nylander, zFRCS, FRCOphth, D.O. zConsultant ophthalmologist zEast."— Presentation transcript:
Mr A Nylander. Clinical Experience with the Accommodative WIOL-CF acrylic IOL. zBy Arthur Nylander, zFRCS, FRCOphth, D.O. zConsultant ophthalmologist zEast Lancashire hospitals, Lancashire, U.K. zThe author as no financial interest in these products
Mr A Nylander. East Lancahire Hospitals Serves a population of people z Burnley General Hospital z Blackburn Royal Infirmary z Rossendale General Hospaital z Seven Consultant Ophthalmologist z Five Middle Grade Doctors z Nine Trainee Doctors
Mr A Nylander. WIOL-CF Accommodative Full-Optics acrylic IOL
Mr A Nylander. WIOL-CF Main Features and Benefits zAccommodation capability > 2.25 Dioptres zLow incidence of PCO (< 1%/year) zResistance to deposits Large glare-free optics zVery good centration and position stability zPotential for full reversibility - reimplantable zAllows vitreo-retinal surgery
Mr A Nylander. WIOL-CF Posterior Chamber foldable acrylic IOL MAIN FEATURES: zAccommodating zLarge continuous aspheric optics zFills the posterior capsule zHighly biocompatible material zLarge lens implantable through a small incision
Mr A Nylander. WIOL-CF design zFull disc plano-convex lens up to 9 mm O.D. zPosterior polyfocal hyperbolic optics zOptics continuous up to the rim zImplantation: yPreformed through < 3mm incision using a 3.0mm cartridge and titanium injector.
Mr A Nylander. WIOL-CF acrylic IOL
Mr A Nylander. O.D. – 8.6 – 9.0 mm HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE MENISCOID ANTERIOR SURFACE WIOL-CF Full Optics acrylic IOL C.T. = mm
Mr A Nylander. WIOL-CF Features Benefits zHigh water content z( 42%, higher than any other IOL on the market today ) zHigh carboxylate content ( only on the current market ) zLow refractive index z Superior biocompability z High permeability z Hydrated surface with low friction vs. tissue (e.g., capsule, iris, cornea ) z Resistance to calcification z Minimized surface reflections and glare at night
Mr A Nylander. WIOL-CF Features Benefits zNegatively charged surface z(only one on the market ) zPartly dehydrated for insertion z Resistance to protein deposits z Resistance to cell attachment z Resistance to opacification of posterior capsule z No adhesion to tissues ( capsule, iris, cornea ) z Increased strength for safer folding z Non-slippery for safer grip z Smaller size for implantation
Mr A Nylander. WIOL-CF Features Benefits zFull-disc configurationz Self-centering z Excellent position stability z Maintenance of posterior capsular wall z Replaceability of WIOL-CF z Very large optical zone z Enables vitreo-retinal surgery
Mr A Nylander. WIOL-CF Features Benefits zContinuous transition between optics and rim zSharp-edged continuous rim zAspherics hyperboloid optics z No edge effects ( no glare, improved night vision ) z Resistance to PCO z Improved depth of focus z Pseudo-accommodation z Improved resistance to astigmation
Mr A Nylander. Power Calculation Chart
Mr A Nylander. Power Calculation For the WIOL-CF Lens 1.The surgeon calculates the lens power based on the A-constant for SRK-T. Letss 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. Surgical Implantation zVideo clip
Mr A Nylander. WIOL-CF accommodation Implanted in 51 eyes : Up to this date results in summary: zWIOL-CF allows a comfortable everyday life and work or sports activities without use of spectacles or contacts zGood patient preference and satisfaction. zObjective examination shows 20/20 uncorrected acuity for both near and far vision
Mr A Nylander. WIOL-CF ACCOMMODATIVE IOL zImplantation history zFirst implanted in January zImplanted 3 in 2004 zImplanted 27 in 2005 zImplanted 21 so far in 2006
Mr A Nylander. WIOL-CF ACCOMMODATIVE IOL zImplanted 51 lens in 38 patients z11 of these patients have had the lens implanted in both eyes z29 patients have had unilateral implantation. z19 males z21 females
Mr A Nylander. WIOL-CF ACCOMMODATIVE IOL zAge Distribution zYoungest Patient 43 years old zOldest Patient 87 years old
Mr A Nylander. WIOL-CF ACCOMMODATIVE IOL
Mr A Nylander. WIOL-CF ACCOMMODATIVE IOL zLens Diopters zLens come in Diopters powers from 15.0 to 30 Diopters zImplanted from 19.0 Diopters to 29.0 Diopters zNO difference in folding pattern zAll powers injected with the same behaviour zLens must unfold inside the capsular bag
Mr A Nylander. WIOL-CF Accomadative iol
Mr A Nylander. Case Study 1 zCASE 1 - Mr. S.H Aged 55 Hospital Administrator zpre op: OD OS z Add for N5 zRight Phacoemulsification Wiol-CF IOL 5/5/05 zLeft Phacoemulsification Wiol -CF IOL 16/5/05 zUnaided V.A. June 05 OD 6/4 OS 6/4-2 N8 N8 zPatient very happy zUnaided V.A. November 05 OD 6/9 OS 6/4-2 N8 N8 zRight YAG capsulotomy
Mr A Nylander. Case Study 2 zCASE 2 - Mr. M. H. Aged 52 Taxi Driver zpre op: OD OS zAdd for N5 zRight Phacoemulsification Wiol-CF IOL 5/5/05 zLeft Phacomulsification Wiol -CF IOL 24/11/05 zUnaided V.A. December 05 OD 6/9-1 OS 6/6 N5 N5 zPatient say can read without glasses. Very happy.
Mr A Nylander. Case Study 3 zCASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer zpre op: OD OS zAdd for N5 zRight Phacoemulsification +19 Wiol-CF IOL 11/01/04 zUnaided V.A. 6/6 N8. zVery Happy.
Mr A Nylander. Case Study 4 zBrought Husband of patient case 3. zMr. T.A. Aged 86 for Bilateral Cataract zRight Phacoemulsification Wiol -CF IOL 23/2/06 zLeft Phacoemulsification Wiol -CF IOL 2/3/06 zUnaided V.A. April 06 OD 6/9-1 OS 6/9 N12 N10 zPatient happy.
Mr A Nylander. WIOL-CF accommodation: subjective patient's observations zGood focus requires some effort and training zAcuity 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 eyes Near focus improves by narrowing eyes and good illumination
Mr A Nylander. WIOL-CF accommodation: subjective patient's observations Very near focusing requires conscious effort and time (1 to 2 seconds lag) Using both eyes improves significantly both near and far focus No glare or other vision problems while driving at night No degradation of peripheral vision at driving, tennis, etc. No acuity deterioration after 4 years (subjectively improved)
Mr A Nylander. Conclusion All 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. Conclusion Older 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 months No problems with YAG Capsulotomy Overall results with the WIOL-CF lens are very promising.