Collamer copolymer lens for hyperopia and astigmatism First experience with Collamer copolymer lens for hyperopia and astigmatism Jaime Aramberri (SPAIN) Ó k u l a r Vitoria-Gasteiz Financial Disclosure: Staar Surgical has paid travelling costs to this meeting

INTRODUCTION Since 2010 Visian ICL (Staar Surgical) can correct mixed astigmatism and hyperopic astigmatism This is the first phakic IOL than can correct such refractive defects through small incision (2.7 mm) This poster presents the first cases implanted in the world with > 6 months follow up.

PATIENTS AND METHODS Seeking for refractive surgery Hyperopia and astigmatism No general or ocular illness No familiar hystory of glaucoma ACD (endoth.-lens): > 2.8 mm ( Scheimpflug image) Personal nomogram combining: Sulcus to sulcus (UBM) ACD (Scheimpflug) HWTW (Scheimpflug) INCLUSION CRITERIA ICL SIZING Corneal marks: Slit lamp Topical anesthesia (5% lydocaine) 2.75 mm temporal limbar incision Healon™, Acetil coline; SURGERY Subj/Obj cyclo refraction Total aberrometry (COAS, Wavefront Sci) Scheimpflug tomography (Sirius, CSO; Galilei, Ziemer) Corneal Hysteresis (ORA, Reichert) Ocular biometry (Lenstar, Haag Streit) UBM (Vumax II ,Sonomed) YAG iridotomy (x2) ICL sph and cy calcs by STAAR PREOP STUDY 6 months Vault measurent: OCT (RTVue, OptoVue) FOLLOW UP

RESULTS AGE   SPH CYL AXIS SPH CYCLO Sph Eq BCVA P. J. 27 OD 4 -3 10 5.5 1 OS 6.25 -3.75 155 7.5 5.62 S. A. 42 5 -2.5 20 7 5.75 0.45 L. 29 6.75 -4.75 15 7.75 5.37 0.9 8.5 -5.75 173 9.5 6.62 0.55 7.50 5.63 0.90 1.72 1.32 1.44 0.95 0.26 PREOP MEDIAN STD DEV SURGERY ICL SIZE ICL SPH ICL CYL ICL AXIS UCVA BCVA VAULT SPH CYL AXIS Sph Eq 17/06/2010 12.6 2 4 97 1 640 10/06/2010 4.5 5.5 67 620 07/06/2010 3.5 118 0.45 600 0.5 -0.5 20 0.25 12.1 6 82 0.95 200 31/05/2010 3 103 0.50 350 -1.25 170 -0.12 4.50 5.50 -0.50 0.00 1.56 1.17 0.29 0.28 197 0.27 0.51 0.17 POSTOP MEDIAN STD DEV

VECTOR ANALYSIS (Alpins method) RESULTS VECTOR ANALYSIS (Alpins method) SPH PREOP CYL PREOP AXIS PREOP SPH POSTOP CYL POSTOP AXIS POSTOP TIA TIA AXIS SIA SIA AXIS DV DV AXIS ERROR MAGNITUDE ANGLE OF ERROR CORRECTION ANGLE ADJUSTM. COEFF. INDEX OF SUCCES 4 -3 10 0.01 3 2.99 180 -0.01 60 1.00 0.00 6.25 -3.75 155 3.75 3.74 5 -2.5 20 0.5 -0.5 2.5 2.00 -0.50 80 1.25 0.20 6.75 -4.75 15 4.75 4.26 14 -0.49 -1 1.12 0.11 8.5 -5.75 173 -1.25 165 5.75 4.56 175 -1.19 2 45 1.26 0.22 0.50 1.32 1.03 0.51 0.48 0.13 0.10 MEDIAN STD DEV PREOP / POSTOP SIA

SUBJECTIVE VISUAL QUALITY SPH CYCLO Eq Sph CYL 0=Very bad 1=Bad 2=Regular 3=Godd 4=Very good All eyes were scored 4 Surgical Incidences: No incidence was reported. Lens manipulation was undistinguishable from other models (ICH, ICM or TICM) Postop Incidences: Eye nº 5 had a postop Rx = +1 sph -2.75 cyl x 165º since first postop day. Misalignment was surgically corrected on Oct 5th Safety index: (BCVA postop / BCVA preop): 1.00 Efficacy index: (UCVA postop / BCVA preop): 0.99

DISCUSSION First cases implanted with the new hyperopic toric ICL show an excellent efficacy / safety balance in 6 months follow up. Postoperative UCVA was very close to preop BCVA showing a very accurate sphere and cylinder lens calculation. There was no difference between BCVA pre and postop. No patient lost VA lines and all of them were subjectively satisfied with visual quality. No haloes or other optic secondary effects were reported. Cartridge loading, intraocular injection, unfolding and sulcus placement maneouvres were similar to other ICL models

DISCUSSION The new hyperopic toric (VTICH) ICL corrects such errors through small incision (2.75 mm) There are some design differences respect the old ICH (hyperopic) or TICM (toric myopic) models: 4 penetrating holes 2 longer alignment marks Stored in BSS: The available dioptric range is: 0 to +10 (sph) and 0.5 to 6 (cyl) Optical zone is 5.73 mm for all hyperopic toric ICLs.

CONCLUSSIONS First experience with the new hyperopic toric (VTICH) ICL is very promising Refractive correction efficacy is high: Both in terms of Sph. Equivalent and astigmatism Safety is very good with no VA impairment or optical side effects

Thank You jaimearamberri@telefonica.net