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EW REFRACTIVE
December 2018
Contact information
Kaskaloglu: mahmut@kaskaloglu.com
atrophic iris, eccentric pupil, iris
coloboma, and atonic pupil.
Zonular issues: Success of MFIOL
surgery ultimately depends on
proper implantation and centration,
hence patients with loose zonules,
those with pseudoexfoliation, and
individuals with previous vitrecto-
mies are poor candidates.
Capsule tear: Although this can
impede MFIOL stability, Dr. Kas-
kaloglu thinks that in certain case
scenarios, a MFIOL can still be used,
such as with a capsular bag that can
be stabilized by a MFIOL with optic
capture.
Macular disease: Good macular
function is required to achieve opti-
mal results with MFIOLs, and OCT
is a must before the surgery. Eyes
with epiretinal membrane, diabetic
retinopathy, and AMD are not rec-
ommended for MFIOL, particularly
if there are drusen near the fovea.
According to Dr. Kaskaloglu, "Most
patients are younger at the time
they have a cataract or RLE opera-
tion. Ten percent may have AMD,
1–2% will have ERM within their
lifetime, and we hope that better
treatments are on the way. I will
choose not to implant a MFIOL in
eyes with diabetic retinopathy, but it
is up to the surgeon and the patient
to decide what to do."
Biometry: Optical biometry and
ultrasound should be used to exam-
ine eyes, implementing the proper
formula and optimized A-constants
to help achieve better results. Small
refractive errors matter, in both
sphere and cylinder, when consider-
ing MFIOLs, and he advised caution
in adhering to the requirements.
"Angle kappa is the angle between
the pupil and the line of sight, but it
is never zero. Avoid large angle kap-
pa. In a large practice, angle kappa
may be overlooked. Lastly, corneal
wavefront HOA RMS over 0.50 µm is
not suitable for MFIOLs, but it is not
an absolute value. Coma and spher-
ical aberrations may reduce visual
acuity," he said. EW
Editors' note: Dr. Kaskaloglu has
no financial interests related to
his comments.
