1. Outcomes after WIOL – CF accommodative intraocular lens implantation
Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD, Sophia I. Panagopoulou PhD
Institute of Vision and Optics
University of Crete School of Medicine
Heraklion, Crete Greece

2. Financial Disclosure
None of the authors has financial interests or relationships to disclose.

3. WIOL – CF: Polyfocal hyperbolic optics
Refractive power is maximum in the centre and gradually decreases in the periphery

4. WIOL – CF Features and benefits
Continuous sharp edge
Smooth gradual transition between central and peripheral optics
Aspheric hyperboloid optics
Full disc configuration
Less optical complications, optimum vision quality

5. WIOL- CF change of focus via lens deformation due to the action of natural focusing apparatus (cilliary muscle and zonules): F1 F2
The mechanism for near focus depends on the lens deformation due to the action of natural focusing apparatus (cilliary muscle and zonules). The WIOL-CF curving during the near-focusing (seen in the focusing eye by high-resolution ultrasonic microscopy) leads to an increase in refractive powerof the lens. This refractive power increase assists the near vision (e.g., for reading).

6. Clinical experience so far
11 key scientific publications and presentations
Results for 476 WIOL-CF eyes recorded in clinical trials adding to more than 500 eye-years of clinical-trial reported experience
Predominantly investigator driven studies and publications

7. (67 eyes, 9 years follow-up)
WIOL-CF consistently shows accommodation range of more than 2D, that corresponds to the accomodation range of natural crystalline lens in years of age. The range is stable over the long-term (up to 9 years)
Study / Observation
Number of Eyes
Accommodation Range
Time of Evaluation
Pasta J 2003 79
2 D
3 years
(67 eyes, 9 years follow-up)
Pasta J et al 2006 26
2.2 D
(young active: 2-3 D)
over 12 m
Nylander A et al 2006 51
˃ 2.25 D
Up to 24 months
Pallikaris IG 2011 50
24 months
1: Clinical Evaluation Report. J Pasta, Central Military Hospital, Prague, April February 2003
3: 3rd generation WIOL-CF, group II. J Pasta, J Hubackova, P Stehlicek, VA Stoy, CMH ( ESCRS congress Barcelona 2008); surgeries:
11: WIOL-CF study results. IG Pallikaris, Institute of Vision and Optics, University of Crete School of Medicine
7: Clinical Experience with the Accommodative WIOL-CF acrylic IOL. A Nylander, A El-Gendy, East Lancashire Hospitals NHS Trust, UK, 2006; (11th Winter Refractive Surgery Meeting Athens); surgeries:
13: Pseudoaccommodation of the full optics IOL. J Pasta, VA Stoy, Dept of Ophtalmology, Central Military Hospital (Europian Ophtalmologic Surgery Society Congress Proceeding of the XXII Congress of the ESCRS Munich 2003); surgeries: 1993 – 1994 (WIOL-C) – 2003 (WIOL-CF, 2nd generation); over 9 years follow-up

8. Materials and Methods 25 patients (50 eyes)
Mean age: 65, 3 ± 8,4 years (range from 53to 83 years)
12 male, 13 female
All patients underwent routine cataract surgery and WIOL – CF accommodative intraocular lens implantation .

9. Exclusion Criteria Astigmatism higher than 1.25 diopters
Pre-existing ocular history corneal endothelial disease, abnormal cornea, macular degeneration, retinal degeneration, glaucoma, and chronic drug miosis.
Previous refractive surgery
Retinal conditions or predisposition to retinal conditions, previous history of/or predisposition to: retinal detachment or proliferative diabetic retinopathy.
Amblyopia
Clinically severe corneal dystrophy (e.g., Fuchs')
Extremely shallow anterior chamber
Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).
Aniridia
Optic nerve atrophy
Trauma

10. Implantation

11. PREOP Last POSTOP LogMAR CDVA Mean±SD [Range] LogMARUDVA Mean±SD
Last Postoperative
Days/ Months
Mean±SD [Range]
649.32± [1404 to 98]
21.64± [46.8 to 3.27]
LogMAR CDVA Mean±SD
[Range]
LogMARUDVA Mean±SD
0.25 ± 0.16
0.84±0.62
[0.0 to 0.8]
[CF to 0.24]
Last POSTOP
LogMARCDVA Mean±SD
[Range]
LogMAR UDVA Mean±SD
0.08±0.07
0.16±0.13
[0.0 to 0.22]
[0.0 to 0.54]

12. Safety No eye has lost lines of CDVA
88% of patients gained ≥ 1 lines of CDVA

13. 0.00 LogMar equals at 1.00 decimal Visual Acuity
Stability
0.00 LogMar equals at 1.00 decimal Visual Acuity

14. Uncorrected Near Visual Acuity
72% of our patients had J2 or better, at the last follow – up examination, measured with Birkhauser reading charts at a distance of 33cm under photopic conditions.

15. Uncorrected Intermediate Visual Acuity
72% of our patients had J2 or better, at the last follow – up examination, measured with Birkhauser reading charts at a distance of 66cm under photopic conditions.

16. Natural Accommodation
NEAR
DIF.MAP
FAR

17. Pseudoaccommodation assessed with the iTrace
NEAR
Range 9.35D
Max
-3.53D
FAR
Mean diff.
-1.18D
Max diff
-7.20D

18. Pseudoaccommodation assessed with the iTrace
NEAR
Range 6.55D
Max
-4.84D
Mean diff.
-1.00D
Max diff
-3.66D
FAR

19. Slit Lamp photos of patients

20. AS – OCT image (Visante)

21. Conclusions
WIOL – CF can be considered a very promising alternative solution for patients that lead an active life and require good vision near, intermediate and far. In our patient series all patients obtained some level of accommodation which remained stable throughout the follow – up period.
No complications occurred intra or postoperatively.
Larger series of patients and longer follow-up is necessary in order to confirm the encouraging results