1 / 21

The IOL= The IOL-VIP System

The IOL= The IOL-VIP System. Dominic McHugh Royal Society of Medicine 2010. ARMD. Leading cause of blindness (“SVL”) in the Western World 2.7 million in the UK have some loss. 54% increase in >75s over the next 25 yrs. ARMD Quality of Life. With ARMD Without ARMD Home Care 23% 5%

may
Télécharger la présentation

The IOL= The IOL-VIP System

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. The IOL=The IOL-VIP System Dominic McHugh Royal Society of Medicine 2010

  2. ARMD • Leading cause of blindness (“SVL”) in the Western World • 2.7 million in the UK have some loss. • 54% increase in >75s over the next 25 yrs.

  3. ARMD Quality of Life With ARMDWithout ARMD Home Care 23% 5% Falls16% 8.3% Falls With Fractures3.5% 1.5% Healthcare Costs €12,579 €1,300 (£8,521) (£885)

  4. LVA Possibilities

  5. Difficulty maintaining coaxial alignment Monovision VF 20° 11 mm incision Surgical Rehabilitation for ARMD • Hanita Ben-Sira implant • Galileiantelescope 2x • IOL+spectacle • Intraocular Miniature Telescope • Galileiantelescope 2.2- 3.5x intra (Lipshitz)

  6. IOL-VIP SystemBCC IOL in the capsular bag = telescope ocular BCX IOL in AC= telescope objective

  7. IOL-VIP SystemPC IOL AC IOL-66D +55D

  8. IOL CHARACTERISTICS ANTERIOR CHAMBER IOL (BCX) Optic Material PMMA with UV filter Diameter 5.0 Thickness 1.5mm Haptics Loop shape Z Material PMMA-1P Angle 10° IOL power+55.00 D PC IOL (BCC) Optic Material PMMA with UV filter Diameter 5.0 Thickness 1.5mm Haptics Loop shape C Material PMMA-1P Angle 7° IOL power -66.00 D

  9. Bilateral stable macular degeneration/macular hole • VA 6/18-6/60 • Adequate endothelial cell count • Adequate AC depth • Good peripheral field • Predicted benefit by IOL-VIP simulator Inclusion criteria for IOL-VIP surgery

  10. Active exudative macular degeneration • Glaucoma • PAS • Cornea guttata • Endothelial cell count < 1600 cell/mm2 • Shallow anterior chamber with depth < 3 mm • Corneal diameter < 11 mm no visual acuity improvement using the IOL-Vip simulator Exclusion criteria for IOL-VIP Surgery

  11. IOL-VIP Proposed mechanism of action Prismatic deviation of Image to PRL. Image magnificiation ~1.3

  12. Image shift to PRL (MP) Pre-op Post-op RE preop BCVA : 0.25 postop BCVA: 0.5 LE preop BCVA : 0.3 postop BCVA: 0.7 (Fasciani et al, 2008)

  13. IOL-VIP Simulator Prism

  14. IOL-VIPPreoperative assessment Best VA without and with simulator prism, rotated to achieve PRL

  15. IOL-VIP System Optimal simulator orientation determines relative IOL position 12 12 9 9 3 3 6 6 Right Eye Left Eye 12 12 3 9 3 9 6 6

  16. IOL-VIP System Optimal simulator orientation determines relative IOL position 12 12 9 9 3 3 6 6 3 9 Right Eye Left Eye 1-2 1-2 8-7 8-7 12 1-2 1-2 8-7 8-7 6

  17. IOL-VIPSurgeryPhakic/Pseudophakic eyes Corneal tunnel (superior/temporal depending on IOL orientation Large (6-7 mm) CCC Phacoemulsification if phakic Enlarge corneal incision to 7 mm PC IOL: bag if phakic, sulcus if pseudophakic PI+miochol A/C IOL Corneal sutures

  18. IOL-VIPSurgery

  19. IOL-VIP Visual Outcome Mean improvement (logMar) 1.28 preopvs0.7 postop 0.05 preopvs 0.2 postop (n=40 eyes; mean f/u 20 months, range 7-35) Orzalesi et al 2007

  20. IOL-VIPPostoperative findings • Low surgical complication rate • Endothelial cell loss 7% • PCO 18% • High hyperopia in emmetropes; better if myopic • Recent availability of “bespoke” implants

  21. IOL-VIPConclusions Advantages Improves reading/distance vision in suitable cases (6/18-6/60 pre op; small-moderate central scotoma) Patients comment favourably on scotoma shifting away from centre Disadvantages Careful selection required: pathology; psychology; costs Lengthy (6 week) postoperative rehabilitation training Suture removal Refractive error : hyperopia and astigmatism (reduced with new implants

More Related