1. Safety and Efficacy of Toric ICL
April 2008 ASCRS
John Chang Jr. MD
Director of Guy Hugh Chan Refractive Surgery Centre
Hong Kong Sanatorium & Hospital

2. Toric Implantation Collamer Lens (TICL) is now in phase III of the U.S. FDA study

3. TICL Lens power range (Visian TICL) Sphere ranges from -3D to - 23D
Cylinder ranges from +1DC to +6DC
Customized axis
Can correct up to -18DS/- 0.75DC or -14DS/-5.0DC
From 04/2004 to 04/2007
No. of patients: 27
No. of eyes: 42
Bilateral TICL: 15
Age range: 23 to 44 yrs
Mean age: 32.1 ± 6.7 yrs
Mean FU: 6 months

4. TICL - Results PreOp PostOp at 12M Mean Sphere -14.20 ± 2.83D
Range
-7.00 to D
+0.50 to -1.0D
Mean cyl
2.64 ± 0.89D
0.60 ± 0.49D
1.00 to 4.50D
0 to 2.0D
Mean MSE
± 2.79D
+0.10 ± 0.33D
-6.00 to D
-0.50 to 1.13D

5. TICL - Results PostOp Rx at 12M Within ± 0.5D Within ± 1.0D MRSE 95%
Cylinder
57%
91%

6. TICL - Stability

7. TICL - Results – 12M

8. TICL - Safety – 12M
No eye lost any vision

9. TICL - Complications 1 eye (2.9%) transient IOP rise at 1 month
Steroid induced
1 lens rotated 15o clockwise
Patient with RE preop Rx /+3.50 x100
Implanted with TICL -23.0/+3.50/099
After surgery the lens rotated clockwise by 15o
Residual Rx -2.00/+2.50x120 (20/20), UCVA 20/80
Lens dialed 6M after surgery
UCVA 20/25; MRx -0.50/+1.00 x 65 (20/20)

10. TICL - Surgical Technique
Same as Non Toric
Laser PI 1week prior to lens implantation
Temporal mm self sealing incision
Lens injected via foldable injector into AC
Lens dialed into sulcus
Surgery done under topical anesthesia
Toric lens supplied correct Power for Sphere and Cylinder but axis can be different by up to 22o
During surgery the axis of the lens to be positioned is marked.
Temporal incision is made to match that axis
Need to dial lens into position (surgical planner software supplied)

11. TICL - Advantages & Disadvantages
Technically not difficult (Avg surgery time 25 mins)
No / Minimal night vision problems
Short learning curve – easier than Phaco
Lens is removable
Disadvantages
Sizing can be difficult, Orbscan not always reliable
Sizing even more important than non-toric ICL
Glaucoma? Pigment dispersion?
Expensive
2 Procedures: Laser P.I. First (uncomfortable), then lens implantation

12. TICL - Conclusion Toric ICL results very encouraging (100% 20/20 UCVA)
Transient IOP rise 2° to steroid use
Accuracy as good / better than LASIK for high myopia
Much better immediate and long term stability than LASIK.
No cataract with TICL