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Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD

ASCRS 2008, Chicago. Assessment of a triple procedure in patients with ICL-induced cataracts ~ICL TM removal, phacoemulsification and 　　　 intraocular lens implantation. Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD. Kitasato Univ. School of Medicine,JAPAN.

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Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD

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  1. ASCRS 2008, Chicago Assessment of a triple procedure in patients with ICL-induced cataracts~ICLTM removal, phacoemulsification and　　　 intraocular lens implantation Daisuke Aizawa,MD Kazutaka Kamiya,MD Tetsuya Ikeda,MD Kimiya Shimizu,MD Kitasato Univ. School of Medicine,JAPAN

  2. ICLTM implantation has advantages over LASIK in high myopic correction. Kitasato University School of Medicine Introduction （ Aizawa et.al. APSCRS 2007） • On the other hand, cataracts are among the complications of this procedure. • We assessed the triple procedure of ICL removal, PEA and IOL implantation.

  3. Kitasato University School of Medicine Objects & Methods • 10 eyes of 8 patients(6 eyes of male,4 eyes of female) • IOL MasterTM was used for axial length measurement. （SRK-T） • Operation ・Topical anesthesia ・ICL extraction via 3 mm temporal corneal incision ・PEA+IOL through the same incision

  4. Kitasato University School of Medicine Results 1 Visual acuity * 1.05 1.10 0.81 0.73 Visual acuity 0.68 0.73 0.31 * • Safety index= 1.51 • Efficacy index = 0.93 BSCVA UCVA 0.02 * P＜0.001 （Wilcoxon signed rank test） Before ICL After ICL Cataract After ICL removal implantation implantation formation and IOL implantation

  5. Kitasato University School of Medicine Results 2,3 Predictability, Manifest refraction (SE) Predictability Manifest refraction (SE) 0 6 overcorrection 5 -1.6 -2.0 -2.9 4 Achieved (D) Achieved (D) 3 Manifest refraction (D) 2 -15.1 1 undercorrection 0 0 1 2 3 4 5 6 -25 Attempted (D) Attempted (D) Before ICL After ICL Cataract After ICL removal implantation implantation formation and IOL implantation < ±0.5D： 80% < ±1.0D： 90%

  6. Kitasato University School of Medicine Results 4,5 IOP, Endothelial cell density Endothelial cell density IOP 3000 20 2555 2526 2296 IOP (mmHg) Corneal endothelial cell density (cells/㎜2） 13.2 13.5 12.9 * N.S. Cell loss 9.1% * P＜0.01 　　（Wilcoxon signed rank test） （Wilcoxon signed rank test） 0 0 Before ICL Cataract After ICL removal implantation formation and IOL implantation Before ICL Cataract After ICL removal implantation formation and IOL implantation

  7. Kitasato University School of Medicine Results 6 Vaulting (ICL to lens)

  8. Nuclear cataract (7 eyes) → common in high myopia ・Age at ICL removal (present study): 51.1 ± 4.2 y.o. 　　・Age at cat. operation in high myopia: 56.8 ± 10.0 y.o. 　　・Average age at cat. operation: 63.4 ± 8.9 y.o. high myopia occur cat. earlier • Anterior subcapsular cat. (3 eyes) → suspected ICL-induced 　　・after crystalline lens exposure to ICL 　　・as a nutritional disturbance as changes in the dynamic state of aqueous humor Kitasato University School of Medicine Assessment 1 Cataract type （Shimizu JSCRS 2007） （Trinidade F et al. J Cataract Refract Surg. 1998） （K.Fujisawa et al ; Graefes Arch Clin Exp Ophthalmol. 2006 ）

  9. 　・version II: anterior-subcapsular (3 eyes / 9 patients) nuclear (6 eyes / 9 patients) 　・version IV:nuclear (1 eye / 1 patient) Version IV lenses have higher vaulting. We consider that is the reason why ASC is unlikely. Kitasato University School of Medicine Assessment 2 Lens Version & Cataract Type Ver.Ⅲ Ver.Ⅳ Ver.Ⅱ Optical zone larger Vaulting: +0.17mm

  10. Kitasato University School of Medicine Assessment 3 Predictability (error < ±1.0D) Predictability of cataract surgery (%) 90.5% 90% * IOL master, (SRK-T) 60-80% ** IOL master, (SRK-T, Double-K method) (Iida et. al.JSCRS 2006) high myopic eye ICL Implanted eye LASIK eye *** IOL master, (SRK-T) (Shimizu et.al. JSCRS 2007) * ** *** Predictability of IOL power calculation in ICL implanted eyes is almost equal to that in unoperated high myopic eyes without any specific calculation method.

  11. Kitasato University School of Medicine Assessment 4 Changes in accommodation • Cataract occurs earlier in high myopia. • Pseudo-accommodation is greater in IOL eyes in high myopia. • In high myopic eyes in patients in their 50s,breadth of accommodation and pseudo-accommodation after cataract surgery and implantation with ICLs are approximately the same. Accommodation and Pseudo-accommodation ICL implanted eyes high myopic eyes regular eyes Accommodation and Pseudo-accommodation (D) （Shimizu, JSCRS 2007） 20’s 30’s 40’s 50’s

  12. Cataracts occurred frequently in elderly persons and in cases of old type ICL implantations. Even if cataracts are formed, Kitasato University School of Medicine Conclusions the ICL can be removed easily, IOL power can be calculated enough predictably, no decrease in area of distinct vision, and good visual performance is maintained.

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