gms | German Medical Science

Increasing experience and evolving technology in corneal inlays and their implantation has made them a favorable therapeutic option in presbyopic patients. Above all, the patient selection for an appropriate procedure and counseling is important. Data on the Flexivue Microlens and KAMRA inlay have shown that the thinner the inlay the better.

For all three known corneal inlays (KAMRA, Raindrop and Flexivue Microlens), exact positioning and centration is essential to achieve the best refractive results. Decentration of the small-aperture inlays can reduce image quality.

None of the published studies on these corneal inlays reported on serious or sight-threatening complications. Only a few cases of epithelial ingrowth and complaints of glare, halo, dry eye, or night vision problems were named.

Only a few small-aperture intracorneal inlays were explanted due to various complications like dissatisfaction with visual outcomes; visual problems including glare, halo, and night vision problems; flap problems; or refractive shift.

Removal of the device is usually easily done, and problems after explantation are resolved. Yilmaz et al. reported in their long-term follow-up study that patients returned to within ±1 D of their preoperative refraction after inlay removal. Furthermore, Alió et al. presented their data evaluating the safety of corneal inlay removal of the various types of KAMRA inlays. According to the results of this study, removal of the KAMRA inlay is safe, and this results in a good recovery of corneal topography and corneal aberrometry. One of the biggest advantages of corneal inlays versus other means of presbyopic surgery, therefore, is the fact that they are additive and do not remove tissue.

Comparing the three commercially available inlays is difficult, because there is only little data on the Flexivue Microlens and the Raindrop inlay compared to the comparatively large long-term studies on the KAMRA inlay.

Accordingly, we would like to demonstrate a retrospective consecutive cohort study conducted at the Homburg Refractive Center of the Saarland University Hospitals (UKS), that compares the monocular (non-dominant eye) visual outcomes between KAMRA corneal inlay (Acufocus, Inc., Irvine, CA) implantation in pseudophakic patients, extended-depth-of-focus lens (EDOF-IOL) TECNIS Symfony intraocular lens (Abbott Medical Optics, Santa Ana, California, USA) and diffractive multifocal intraocular lens (MF-IOL) Acrysof IQ ReSTOR +3.0 D (Alcon Laboratories, Forth Worth, Texas, USA).