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25. Kongress der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII)

Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie

10.03. - 12.03.2011, Frankfurt/Main

Importance of IOL alignment on refractive outcome

Meeting Abstract

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  • M.J. Tassignon - Edegem, Belgien

Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie. 25. Kongress der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII). Frankfurt/Main, 10.-12.03.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgii069

DOI: 10.3205/11dgii069, URN: urn:nbn:de:0183-11dgii0692

Published: March 9, 2011

© 2011 Tassignon.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Most phakic eyes do not have significant lens tilt or decentration; however, pseudophakic eyes are different. At the moment of implantation, the IOL may be perfectly centered along the line of sight and assume the physiological tilt of the capsular bag, which is essentially the best postoperative situation for which any surgeon can hope. But after the IOL is implanted it comes into contact with residual lens epithelial cells (LECs) on the capsular bag, and a strong immune reaction flares up, causing the LECs to start proliferating and differentiating.

The visual consequences of this reaction depend greatly on its severity, which can range from a few scattered clusters of LECs to strong anterior capsular contraction combined with posterior capsule opacification (PCO). The former will not result in significant visual effects for the patient; the latter will cause displacement of the IOL, resulting in considerable reduction in visual acuity and contrast sensitivity and an increase in glare effects.

Currently, we are unable to predict how strongly residual LECs will respond to the presence of an IOL. Although certain choices in lens material and edge designs can help reduce the effects of LEC reaction, an undesired lens dislocation is still a possibility for any in-the-bag IOL design, causing the lens to move to a suboptimal position and resulting in suboptimal vision quality.

For this reason, our department introduced the Morcher 89A Bag-in-the-Lens (BIL; Morcher GmbH, Stuttgart, Germany) IOL, which requires both anterior and posterior capsulorhexes for implantation. The edges of both capsulorhexes are positioned into a groove between two flat elliptical haptics, much as a bicycle tire is put into the rim of a wheel. This moves the LECs away from the optical zone to an area where they can do no harm, resulting in a 0% PCO rate. Moreover, the double rhexis method causes the BiL to assume the physiological tilt of the capsular bag and to have good postoperative rotational [1] and translational stability.This stability recently gave us the confidence to successfully introduce a toric version of the BiL [2]. This experience suggests that the BiL is an ideal platform to implement many of the innovations described above without having to worry about undesired postoperative IOL repositioning.


References

1.
Rozema JJ, Gobin L, Verbruggen K, Tassignon MJ. Changes in rotation after implantation of a bag-in-the-lens intraocular lens. J Cataract Refract Surg. 2009;35:1385-1388.
2.
Verbruggen KHM, Rozema JJ, Gobin L, Coeckelbergh T, De Groot V, Tassignon MJ. Intra¬ocular lens centration and visual outcomes after bag-in-the-lens implantation. J Cataract Refract Surg. 2007;33:1267-1272.