ASCRS/ESCRS Survey on Foldable IOLs Requiring Explantation or Secondary Intervention 2005 Update

Nick Mamalis, MD Professor of Ophthalmology John A. Moran Eye Center University of Utah, Salt Lake City

Co-Authors Brian Haugen, MD Jonathan Haymore, MD Natalya Romaniv, MD Ophthalmic Research Fellows

Materials and Methods 8th annual survey of ASCRS/ESCRS members 8th annual survey of ASCRS/ESCRS members Foldable IOL complications/explantations Foldable IOL complications/explantations Intermountain Ocular Research Center - University of Utah Intermountain Ocular Research Center - University of Utah Cataract Clinical Committee Cataract Clinical Committee

Materials and Methods Signs and symptoms/complaints Signs and symptoms/complaints Pre-op visual acuity Pre-op visual acuity Complications requiring IOL removal/exchange/secondary intervention Complications requiring IOL removal/exchange/secondary intervention

Materials and Methods Foldable IOL Designs One-piece, plate-type lenses One-piece, plate-type lenses One-piece lenses with haptics One-piece lenses with haptics Three-piece lenses Three-piece lenses Multifocal lenses Multifocal lenses

Materials and Methods Foldable IOL Materials Silicone Silicone Acrylic (hydrophobic) Acrylic (hydrophobic) Hydrogel (hydrophilic acrylic) Hydrogel (hydrophilic acrylic) Collamer Collamer

Survey Lens Totals 2005

Complications Three-Piece Silicone IOL Dislocation / decentration seen most commonly Dislocation / decentration seen most commonly

Complications One-Piece (Plate Silicone) Dislocation / decentration Dislocation / decentration

Complications Three-Piece Acrylic Dislocation / decentration Dislocation / decentration Incorrect lens power Incorrect lens power Glare/optical aberrations Glare/optical aberrations

Complications One-Piece with Haptics Acrylic Incorrect lens power Incorrect lens power Dislocation / decentration Dislocation / decentration

Complications Three-Piece Hydrogel Calcification / opacification Calcification / opacification Damaged IOL Damaged IOL

Complications One-Piece with Haptics Hydrogel Calcification / opacification Calcification / opacification

Complications Multifocal Silicone Glare / optical aberrations Glare / optical aberrations Incorrect lens power Incorrect lens power

Pre-operative Visual Acuity 2005

Post Explant Visual Acuity 2005

Discussion Foldable IOL Complications Dislocation/decentration overall most common reason for IOL explantation Dislocation/decentration overall most common reason for IOL explantation Followed by incorrect lens power Followed by incorrect lens power Damaged IOL Damaged IOL

Discussion Foldable IOL Complications Continuing trends in complications over eight years Continuing trends in complications over eight years Several differences in complications over this period of time Several differences in complications over this period of time

Three-Piece, Silicone

Three-Piece, Acrylic

One-Piece (Plate) Silicone

Discussion Foldable IOL Complications Calcification of hydrophilic acrylic (hydrogel) IOLs the next most common reason for explantation Calcification of hydrophilic acrylic (hydrogel) IOLs the next most common reason for explantation Calcification on both the lens surface as well as substance of the lens Calcification on both the lens surface as well as substance of the lens

Discussion Foldable IOL Complications Glare/optical aberration continues to be seen as a reason for IOL removal Glare/optical aberration continues to be seen as a reason for IOL removal Other reasons such as damaged IOL during insertion seen less frequently Other reasons such as damaged IOL during insertion seen less frequently

Conclusions Avoidance of Complications Using Foldable IOLs Good surgical technique essential Good surgical technique essential CCC with capsular bag fixation of the IOL CCC with capsular bag fixation of the IOL

Conclusions Avoidance of Complications Using Foldable IOLs Need for accurate IOL measurements Need for accurate IOL measurements Necessity for use of new technologies for axial length measurements and calculations Necessity for use of new technologies for axial length measurements and calculations

Conclusions Avoidance of Complications Using Foldable IOLs Ongoing vigilance regarding newer IOL materials Ongoing vigilance regarding newer IOL materials Hydrophilic acrylic (hydrogel) IOLs Hydrophilic acrylic (hydrogel) IOLs

Conclusions ASCRS/ESCRS Survey Ongoing yearly data collection Ongoing yearly data collection Forms available by ASCRS/ESCRS fax on demand-web site Forms available by ASCRS/ESCRS fax on demand-web site Please submit survey forms on explanted foldable IOLs Please submit survey forms on explanted foldable IOLs