1 / 23

SELECTION of PATIENTS PIOLs

SELECTION of PATIENTS PIOLs. António Marinho, MD PhD Departamento de Cirurgia Refractiva Hospital Arrábida PORTO PORTUGAL. WHY PHAKIC IOLs?. Phakic IOL ’ s are ideal for high ametropias because: High predictability even in very high ametropias Stability of refraction

sydney
Télécharger la présentation

SELECTION of PATIENTS PIOLs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SELECTION of PATIENTSPIOLs António Marinho, MD PhD Departamento de Cirurgia Refractiva Hospital Arrábida PORTO PORTUGAL

  2. WHY PHAKIC IOLs? Phakic IOL’s are ideal for high ametropias because: • High predictability even in very high ametropias • Stability of refraction • Preserve accomodation • No loss (usually gains) of lines of BSCVA

  3. WHEN PHAKIC IOLs? • Mínimal Age • 18 years • exceptions • anisometropia • Stable refraction in the last 18 months • Above 50 years • low ametropia • LASIK • high ametropia • CLE • Myopia • - Subjective Refraction • under - 7D : LASIK • above -7D: Phakic IOL • Main Factor : Pachymetry • Hyperopia • - Cycloplegic Refraction • under + 3D : LASIK • above + 4D: Phakic IOL • Main factor: Keratometry

  4. INCLUSION CRITERIAGeneral • Stable refraction • No intraocular diseases (diabetes without retinopathy and well controlled glaucoma are relative contraindications,but any history of UVEITIS is absolute contraindication) • Ectatic disorders of the cornea are NOT contraindications

  5. INCLUSION CRITERIASpecific • Anterior chamber anatomy (AC depth and AC size) • Endothelium profile • Iris shape Pupil Size • Perfect Surgery

  6. Anterior chamber depth • AC depth (central) • > 2.80mm (endothelium to natural lens) • Higher IOL power may need deeper AC (see Ophtec tables) • Importance of critical distance

  7. How to measure the AC depth ? • US biometer (not precise) • Orbscan • Scheimpflug (Pentacam) • OCT (Visante,SL-OCT)

  8. How to evaluate the AC ? • US Biometer (not precise) • Orbscan • OCT (Visante,SL-OCT)

  9. AC DEPTH (OCT)

  10. Implantation simulation

  11. Anterior chamber size • Angle to angle distance (AC phakic IOLs) • Sulcus to sulcus distance (ICL) • Not important for iris-fixated IOLs (“one size fits all)

  12. How to measure AC Size ? • White to white (caliper,Orbscan,IOL master)---- not reliable • OCT (good to angle, but not to sulcus to sulcus)

  13. AC SIZE (OCT)

  14. Iris shape • Avoid convex iris • Most important in Hyperopia (clearance) • Possibility of posterior synechia

  15. Preop ACD too small <2,8mm Iris = convex

  16. Posterior Synechia

  17. Pupil Size • Mesopic pupil <6.0mm • Artisan 5mm Mesopic Pupil <7.0mm • Artisan 6mm Artiflex/Acrysof/ICL • Glare and halos

  18. Endothelium Profile • Endothelial cell count: • 21 to 25 years 2800 cells/mm • 26 to 30 years 2650 cells/mm • 31 to 35 years 2400 cells/mm • 36 to 45 years 2200 cells/mm • > 45 years 2000 cells/mm • Endothelial cell shape (avoid high polymagatism)

  19. Endothelium Profile

  20. Endothelial Cell Count • Before Surgery (inclusion criteria) • 3 months after (shows surgical trauma) • Yearly afterwards (if important decrease EXPLANT)

  21. Perfect Surgery • Atraumatic Surgery • Use cohesive viscoelastic • Center the IOL with the pupil (recheck at the end) – Artisan/Artiflex • Take all the visco out • Attention to post-op medication

  22. WHICH PIOL? • Angle- supported ? • Posterior chamber ? • Iris- supported ?

  23. PIOLs Which ?Acrysof,Artisan,Artiflex,ICLPRL

More Related