1. 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)

2. 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

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

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

5. 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:
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:
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:

6. 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

7. The Akreos MI60 MICS IOL Material Optic Optic Body and Total length
26% hydrophilic acrylic
UV blocker
Refractive index (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

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

9. 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

10. 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

11. 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

12. 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