ascrs/escrs survey on foldable iols requiring explantation or secondary intervention 2005 update
DESCRIPTION
ASCRS/ESCRS Survey on Foldable IOLs Requiring Explantation or Secondary Intervention 2005 Update. Nick Mamalis, MD Professor of Ophthalmology. John A. Moran Eye Center University of Utah, Salt Lake City. Co-Authors Brian Haugen, MD Jonathan Haymore, MD Natalya Romaniv, MD - PowerPoint PPT PresentationTRANSCRIPT
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ASCRS/ESCRS Survey on Foldable IOLs RequiringExplantation or Secondary Intervention
2005 Update
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Nick Mamalis, MDProfessor of Ophthalmology
John A. Moran Eye CenterUniversity of Utah, Salt Lake City
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Co-Authors
Brian Haugen, MDJonathan Haymore, MDNatalya Romaniv, MD
Ophthalmic Research Fellows
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Materials and MethodsMaterials and Methods
• 8th annual survey of ASCRS/ESCRS 8th annual survey of ASCRS/ESCRS membersmembers
• Foldable IOL Foldable IOL complications/explantations - 2005complications/explantations - 2005
• Intermountain Ocular Research Intermountain Ocular Research Center - University of UtahCenter - University of Utah
• Cataract Clinical CommitteeCataract Clinical Committee
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Materials and MethodsMaterials and Methods
• Signs and symptoms/complaintsSigns and symptoms/complaints
• Pre-op visual acuityPre-op visual acuity
• Complications requiring IOL Complications requiring IOL removal/exchange/secondary removal/exchange/secondary interventionintervention
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Materials and MethodsMaterials and MethodsFoldable IOL DesignsFoldable IOL Designs
• One-piece, plate-type lensesOne-piece, plate-type lenses
• One-piece lenses with hapticsOne-piece lenses with haptics
• Three-piece lensesThree-piece lenses
• Multifocal lensesMultifocal lenses
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Materials and MethodsMaterials and MethodsFoldable IOL MaterialsFoldable IOL Materials
• SiliconeSilicone
• Acrylic (hydrophobic)Acrylic (hydrophobic)
• Hydrogel (hydrophilic acrylic)Hydrogel (hydrophilic acrylic)
• CollamerCollamer
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Survey Lens Totals 2005Survey Lens Totals 2005
2% 11%
30%
9%20%
10%
18%
Multifocal,Silicone
One Piece (plate),Silicone
One Piece with Haptics,Acrylic
One Piece with Haptics,Hydrogel
Three Piece,Acrylic
Three Piece,Hydrogel
Three Piece,Silicone
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ComplicationsComplicationsThree-Piece Silicone IOLThree-Piece Silicone IOL
• Dislocation / decentration seen most Dislocation / decentration seen most commonlycommonly
0%
10%
20%
30%
40%
50%
60%
70%
80%
Three Piece,Silicone
% o
f C
om
plic
ati
on
Calcification/opacification
Damaged IOL - Cracked or torn during insertion
Dislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsOne-Piece (Plate Silicone)One-Piece (Plate Silicone)
• Dislocation / decentrationDislocation / decentration
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
One Piece (plate),Silicone
% o
f Co
mp
licat
ion
Calcification/opacification
Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsThree-Piece AcrylicThree-Piece Acrylic
• Dislocation / decentrationDislocation / decentration• Incorrect lens powerIncorrect lens power• Glare/optical aberrationsGlare/optical aberrations
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Three Piece,Acrylic
% o
f Co
mp
licat
ion
Calcification/opacification
Damaged IOL - Cracked or tornduring insertionDislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsOne-Piece with Haptics AcrylicOne-Piece with Haptics Acrylic
• Incorrect lens powerIncorrect lens power• Dislocation / decentrationDislocation / decentration
0%
5%
10%
15%
20%
25%
30%
35%
One Piece with Haptics,Acrylic
% o
f C
om
pli
ca
tio
n
Calcification/opacification
Damaged IOL - Cracked or torn duringinsertion
Dislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsThree-Piece HydrogelThree-Piece Hydrogel
• Calcification / opacificationCalcification / opacification• Damaged IOLDamaged IOL
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Three Piece,Hydrogel
% o
f Co
mp
licat
ion
Calcification/opacification
Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsOne-Piece with Haptics HydrogelOne-Piece with Haptics Hydrogel
• Calcification / opacificationCalcification / opacification
0%
10%
20%
30%
40%
50%
60%
One Piece w ith Haptics,Hydrogel
% o
f Com
plic
atio
n
Calcification/opacification
Damaged IOL - Cracked or torn duringinsertionDislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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ComplicationsComplicationsMultifocal SiliconeMultifocal Silicone
• Glare / optical aberrationsGlare / optical aberrations
• Incorrect lens powerIncorrect lens power
0%
10%
20%
30%
40%
50%
60%
Multifocal,Silicone
% o
f C
om
plic
ati
on
Calcification/opacification
Damaged IOL - Cracked or torn during insertion
Dislocation/Decentration
Glare/optical aberrations
Incorrect lens power
Infection/endophthalmitis
Operative complications
Removed during retinal surgery
Retinal problems/RD
Unknown
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Pre-operative Visual AcuityPre-operative Visual Acuity20052005
0%
10%
20%
30%
40%
50%
60%
Mult
ifoca
l,Silic
one
One P
iece (
plate)
,Silic
one
One P
iece w
ith H
aptic
s,Acr
ylic
One P
iece w
ith H
aptic
s,Hyd
roge
l
Three
Piec
e,Acr
ylic
Three
Piec
e,Hyd
roge
l
Three
Piec
e,Silic
one
% o
f V
isu
al A
cu
ity
20/20 - 20/40
20/200 - 20/400
20/50 - 20/100
Unknown
Worse than 20/400
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Post Explant Visual AcuityPost Explant Visual Acuity20052005
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Mult
ifoca
l,Silic
one
One P
iece (
plate
),Silic
one
One P
iece w
ith H
aptic
s,Acr
ylic
One P
iece w
ith H
aptic
s,Hyd
roge
l
Three
Piec
e,Acry
lic
Three
Piec
e,Hyd
roge
l
Three
Piec
e,Silic
one
% o
f V
isu
al A
cu
ity
20/20 - 20/40
20/200 - 20/400
20/50 - 20/100
Less than 20/400
Unknown
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DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications
• Dislocation/decentration overall Dislocation/decentration overall most common reason for IOL most common reason for IOL explantationexplantation
• Followed by incorrect lens powerFollowed by incorrect lens power
• Damaged IOLDamaged IOL
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DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications
• Continuing trends in complications Continuing trends in complications over eight years over eight years
• Several differences in complications Several differences in complications over this period of timeover this period of time
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Three-Piece, SiliconeThree-Piece, Silicone
0%
10%
20%
30%
40%
50%
60%
70%
80%
Damaged IOL - cr acked/ tor n
dur ing inser tion
Dislocation/ decentr ation Glar e/ optical aber r ations Incor r ect lens power
1998
1999
2000
2001
2002
2003
2004
2005
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Three-Piece, AcrylicThree-Piece, Acrylic
0%
10%
20%
30%
40%
50%
60%
70%
Dislocation/decentration Glare/optical aberrations Incorrect lens pow er
1998
1999
2000
2001
2002
2003
2004
2005
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One-Piece (Plate) SiliconeOne-Piece (Plate) Silicone
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Damaged IOL - Cracked/tornduring insertion
Dislocation/decentration Incorrect lens power
1998
1999
2000
2001
2002
2003
2004
2005
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DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications
• Calcification of hydrophilic acrylic Calcification of hydrophilic acrylic (hydrogel) IOLs the next most common (hydrogel) IOLs the next most common reason for explantationreason for explantation
• Calcification on both the lens surface as Calcification on both the lens surface as well as substance of the lenswell as substance of the lens
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DiscussionDiscussionFoldable IOL ComplicationsFoldable IOL Complications
• Glare/optical aberration continues Glare/optical aberration continues to be seen as a reason for IOL to be seen as a reason for IOL removalremoval
• Other reasons such as damaged Other reasons such as damaged IOL during insertion seen less IOL during insertion seen less frequentlyfrequently
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ConclusionsConclusionsAvoidance of Complications Using Avoidance of Complications Using Foldable IOLsFoldable IOLs
• Good surgical technique essentialGood surgical technique essential
• CCC with capsular bag fixation of the CCC with capsular bag fixation of the IOLIOL
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ConclusionsConclusionsAvoidance of Complications UsingAvoidance of Complications UsingFoldable IOLsFoldable IOLs
• Need for accurate IOL Need for accurate IOL measurementsmeasurements
• Necessity for use of new Necessity for use of new technologies for axial length technologies for axial length measurements and calculationsmeasurements and calculations
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ConclusionsConclusionsAvoidance of Complications UsingAvoidance of Complications UsingFoldable IOLsFoldable IOLs
• Ongoing vigilance regarding newer Ongoing vigilance regarding newer IOL materialsIOL materials
• Hydrophilic acrylic (hydrogel) IOLsHydrophilic acrylic (hydrogel) IOLs
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ConclusionsConclusionsASCRS/ESCRS SurveyASCRS/ESCRS Survey
• Ongoing yearly data collectionOngoing yearly data collection
• Forms available by ASCRS/ESCRS Forms available by ASCRS/ESCRS fax on demand-web sitefax on demand-web site
• Please submit survey forms on Please submit survey forms on explanted foldable IOLsexplanted foldable IOLs
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