James P Gills MD St Lukes Cataract amp Laser Institute Tarpon Springs FL Financial Disclosure Dr Gills is a stockholder In Lenstec Allergan Alcon and Abbott Medical Purpose ID: 589383
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Cataract Surgery Using Biaspheric IOLs in Patients With Corneal Irregularities
James P. Gills, MDSt. Luke’s Cataract & Laser InstituteTarpon Springs FL
Financial Disclosure: Dr. Gills is a stockholder In Lenstec, Allergan, Alcon and Abbott Medical.Slide2
Purpose
To present case reports of patients with pre-existing corneal irregularities who underwent routine cataract surgery with an aberration free, biaspheric IOL between May and October 2010.Slide3
What is Paraxial Focus?Why is it important to the biaspheric lens design?
The strategy of the lens design is to reduce spherical aberrations by controlling the paraxial ray of light so that it intersects at the paraxial focal point instead of in front or behind it.Slide4
Case 1: Keratoconus
Surgical Status
Uncomplicated surgery on 7/19/2010
9.0 D Softec HD IOL
2mm CRI @ 7:30 in 8 mm optical zone (1/2 the usual correction)
Presentation1-2+ cortical spoke cataract
Keratoconus OS
Diabetic with no evidence of BDR
Manifest Refraction:
-4.50 -5.25 x 140
→
20/40
Pachymetry: 492 µm
Cell Count: 1761 cells/m
2
Axial Length: 28.39 mm
2 Month Postoperative Outcome
(9/22/10)UCVA: 20/20 J10Ref: Plano → 20/20Imp: Less astigmatism correction required; patient’s awareness of glare was minimizedSlide5
Case 2: Hexagonal Keratotomy
Surgical History1993 Hexagonal Keratotomy OD
Surgical Status
Uncomplicated surgery
on
5/25/2010
14.0 D Softec HD IOL
Presentation
2+ nuclear cataract
Pachymetry: 607µm
Axial Length: 23.56 mm
Manifest refraction:
- 2.25 - 2.00 x 130
→
20/30
3 Month Postoperative Outcome
(8/25/10)
UCVA: 20/25 J1
Ref: - 0.25 - 0.75 x 150 → 20/25Imp: Less astigmatism correction required; patient’s awareness of glare was minimizedSlide6
Case 3: LASIK
Surgical HistoryBilateral LASIK
Surgical Status
Uncomplicated surgery
11.5 D Softec HD IOL
Presentation
Cataract OD
Axial Length:
OD: 27.88 mm
Manifest Refraction:
OD: -10.25 – 0.25 x 10
5 Month Postoperative Outcome
UCVA: 20/40 J8
Ref: 0.50 – 0.50 x 35
→ 20/30
Imp: Patient’s awareness of glare was minimized
despite extremely irregular corneaSlide7
Case 4: ABMD
Presentation
Bilateral cataract
ABMD with Corneal Scarring
Amblyopia OSNormal macula
Pachymetry:
OS: 546 µm
Biometry:
OS: 21.98 mm
Manifest Refraction:
OS: +3.25 – 0.75 x 105
Slide 1 of 2Slide8
Case 4: ABMD Continued
Surgical Status
Planned monovision:
-2.0 D Target with 30.0 D Softec HD IOL OSUncomplicated surgery
LRIs: OS: 7 mm @ 4:45 OS: 5 mm @ 10:30 and 4:30 enhancement
Postoperative Outcome
3 Month Postoperative OS
UCVA: 20/200 J1+
Ref: -2.50 – 0.75 x 10
→ 20/25
Imp: Patient’s awareness of glare was minimal; improved quality of vision post-operatively despite corneal irregularitiesSlide9
Case 5: Radial Keratotomy
Surgical History
Radial Keratotomy in 1990’s 24 cut OD / 20 cut OS
Cataract Removal OD
ReSTOR +4 with piggyback lens
Presentation
(6/15/10)
Pseudophakic OD / Cataract OS
Anterior surface pigment piggyback (OD)
Cobblestone OS
Cell Count:
1618 cells/m
2
OD / 2625 cells/m
2
OS
Pachymetry:
478 µm OD / 673 µm OS
Biometry: 25.57 mm OD / 24.90 mm OSManifest Refraction: OD: +1.75 – 0.75 x 135 OS: +0.50 – 1.25 x 150
Slide 1 of 2
(Performed elsewhere)Slide10
Case 5: Radial Keratotomy
Surgical Status
OD (7/16/10)
Exchanged both IOLs -1.25 D Target with 21.0 D Softec HD IOL Scleral incision 6 mm @ 9:00 9-0 nylon suture at 2:30
OS (6/25/10)
-2.00 D Target with 28.0 D Softec HD IOL
Scleral incision 2.75 mm @ 2:30
Postoperative Outcomes
5 Month Postoperative OD
UCVA: 20/40 J10
Ref: +1.50 – 1.50 x 30
→ 20/25
5 Month Postoperative OS
UCVA: 20/100 J1+
Ref: -3.00 – 1.00 x 165
→ 20/25
OD
OS
Imp: Biaspheric IOLs improved paraxial focus by reducing spherical aberrations resulting in marked improvement in VASlide11
Conclusion
As demonstrated, the aberration free, biaspheric IOL is preferred for patients with corneal irregularities.
Compared with conventional spherical IOL cases, those presented here require approximately half as much astigmatic correction and reported little or
no
glare. This phenomena may be attributed to the aberration free, biaspheric optic of the reported IOL.
The paraxial focus that is associated with this IOL appears to primarily use the central cornea.
This paraxial focus appears to reduce spherical and optical aberrations, thus improving pseudophakic vision.