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

2. 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

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

4. 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

5. 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

6. 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)

7. 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

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

9. 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

11. 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 .

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

13. 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

14. 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

15. 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