Verisyse™ for Correction of Aphakia No Financial Interest ! Alois Dexl University Eye Clinic Paracelsus Medical University Salzburg Chairman: Prim. Univ.-Prof. Dr. Günther Grabner

Aphakia Aphakia = absence of natural crystalline lens Western World: very uncommon Phako / ECCE with IOL-implantation in the capsular bag Reasons After complicated cataract surgery Post-traumatic dislocation of crystalline lens Capsular loss Ectopia lentis Marfan syndrome, Weill-Marhesani syndrome, hyperlysinaemia, homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome

Conservative Correction ? Spectacles Reduced peripheral vision Ring scotoma (prismatic effect) „Jack in the box“ Aniseokonia Contact lenses Fitting, removal, cleaning…

Surgical Correction Angle supported AC-IOL Scleral fixation of PC-IOL Endothelial cell loss (1 year: 6-45%) Pseudophakic bullous keratopathy (PBK) UGH-syndrome Scleral fixation of PC-IOL Choroidal haemorrhage Retinal detachment Vitreous incarceration Chronic inflammation IOL-iris contact IOL decentration Pigmentary dispersion High aqueous flare CME

Surgical Correction Iris-Claw aphakic IOL Best choice for primary or secondary implantation in aphakic eyes Safer then open-loop-angle supported AC-IOLs Surgery easier, shorter and safer then sclera sutured IOLs Some cases of PBK Endothelial cell loss – caused by surgical trauma ? Prof. Jan Worst Model 205T Worst Iris Claw® Lens Model 205Y or VRSA54 ARTISAN™ VERISYSE ™ Aphakia Lens 1978 1986

Verisyse® Aphakia VRSA54 Verisyse Primary or secondary implantation after ICCE, ECCE and Phaco Dioptric power: +2,0 D to +30,0 D (14.5 to 24.5 in 0.5 D steps) Optical Diameter: 5.0 mm Overall Diameter: 8.5 mm Biconvex design A-constant: 115 for AC implantation 116.8 for retropupillary implantation (ULIB)

University Eye Clinic Salzburg 1996 – 2010 Frequency University Eye Clinic Salzburg 1996 – 2010 Aphakic Iris claw IOL 1996 – 2005: 78 = 8 / year 2006 – 2009: 50 = 14 / year 2009 – 2010: 22 = 22 / year Total 150

Frequency SUBLUXATED lenses 82 Primary surgery (Marfan´s syndrome) 25 Posttraumatic 25 Spontaneous IOL dislocation (PEX) 32

Positioning of Verisyse® Aphakia Anterior Posterior Risk of endothelial cell loss decreases AC is deeper Distance from haptics to endothelium is larger Irido-corneal angle is wider

Posterior approach Advantages Very safe for corneal endothelium Produces less glare Only a very small  of HOA1 „Physiological“ space for an IOL is behind the iris 1 Kaymak C, Mester U. paper at ESCRS-Meeting, Lissabon 2005 .

Posterior approach Disadvantages Extensive anterior vitrectomy required Special intruments are useful in order to avoid IOL-drop into the vitreous cavity during implantation

Sekundo, Eur J Ophthalmol 2008 Posterior approach Sekundo, Eur J Ophthalmol 2008 Special instruments usefull to avoid a tilting of the IOL during implantation procedure

Posterior approach Mohr et al. Ophthalmologe 2002 48 aphakic cases 2/48 reversible CME Wolter-Roessler et al. Klin Monatsbl Augenheilkd. 2008 48 aphakic cases, 14 Months 2/48 reversible CME 2/48 traumatic haptic dislocation 1/48 retinal detachment 1/48 pupillary block > iridectomy mandatory Hara et al. J Refract Surg. 2011 11 eyes retropupillary Verisyse No complications 21 eyes transscleral sutured IOL 5/21 ciliary choroidal body haemmorhage 1/21 CME 1/21 IOL dislocation

Conclusion VERY FEW COMPARATIVE LONG-TERM studies Need for a prospective, long-term (multi-center) study Anterior chamber IOL´s Angle-supported Iris-claw Posteriorly enclavated Iris-claw lens Posterior chamber IOL´s Sclera-fixated Iris-sutured Decision tree for the very different clinical situations