Intraocular lenses for small incision surgery Roberto Bellucci MD Ophthalmic Unit, Hospital and University of Verona, Italy Simonetta Morselli MD Ophthalmic Unit, Hospital of Bassano del Grappa, Italy Financial Interest: E (Bausch & Lomb)

Requirements for MICS lenses Thinness To allow sub-2mm implantation Resistance to folding / implantation Stiffness To maintain centration, refraction Square edge To reduce PCO Easy removal

Designing sub-2mm IOLs Single-piece acrylic Thinner optics Refractive index Asphericity Optic size Special haptic design First attempt: The Thinoptx lens

The Acri.Smart solution Hydrophilic core, hydrophobic surfaces Plate haptic, standard thickness Full 6 mm optic No square edge at haptic/optic junction

The Acri.Smart results The Acri.Smart IOL provided good results in clinical studies, demonstrating that MICS IOL are excellent platforms for special optic design Alió JL, Schimchak P, Montés-Micó R, Galal A. Retinal image quality after microincision intraocular lens implantation J Cataract Refract Surg 2005; 31:1557-1560 Alió JL, Rodriguez-Prats JL, Vianello A, Galal A Visual outcome of microincision cataract surgery with implantation of an Acri.Smart lens. J Cataract Refract Surg 2005; 31:1549-1556 Kurz S, Krummenauer F, Thieme H, Dick HB Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery. J Cataract Refract Surg 2007; 33: 393-400

The Acri.Smart family Spherical Acri.Smart 46S Hyperaspheric Acri.Smart 36A Neutral Aspheric Acri.Smart 46LC Toric Acri.Comfort 646TLC Multifocal Acri.Lisa 366D Multifocal Toric Acri.Lisa 466TD

The Akreos MI60 MICS IOL Material Optic Optic Body and Total length 26% hydrophilic acrylic UV blocker Refractive index 1.458 (hydrated) Optic Biconvex Aspheric anterior and posterior Optic Body and Total length 6.2x11.0 mm from 10.0 to 15.0 dpt 6.0x10.7 mm from 15.5 to 22.0 dpt 5.6x10.5 mm from 22.5 to 30.0 dpt Haptics One-piece 10° average angulation

Design features Bag-related size Four-piece haptics Angled haptics Progressive haptic resistance No hole haptic Square edge

Centration and Stability The four-loop design allows precise centration within the capsular bag, even with loose or damaged zonules STABILITY is ensured by angulation and by four-piece haptic design that counteracts vitreous pressure

Various designs, however… Plate haptic Closed-loop haptic Accommodating Large haptic holes may prevent IOL exchange Weak haptics will favour optic movement Plate haptic require intact capsular bags

Conclusion Microincision lenses are not reduced versions of standard lenses They are a new type of IOL, with specific design features They are a good option for refractive cataract surgery They are perfect platforms for special optic designs

A look at the near future Small incision lenses will increase popularity Cross-linking of the material will further increase stiffness and stability Studies on pseudoaccommodation will continue Greetings from Verona Italy