Eyeworld

EW REFRACTIVE 82 March 2019 Presentation spotlight by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer New evidence suggests unilateral and bilateral small aperture lenses provide excellent vision, high patient satisfaction T he 36th Congress of the Eu- ropean Society of Cataract and Refractive Surgeons (ESCRS) featured a wealth of newly published studies that were of great practical interest to refractive surgeons. One such presentation came from Burkhard Dick, MD, professor of ophthal- mology and chairman, University Eye Clinic, Bochum, Germany, who discussed his experience with the IC-8 small aperture intraocular lens (AcuFocus, Irvine, California). "The pinhole effect is some- thing we are all familiar with and use in our daily practice. There are several small aperture options avail- able, however, my experience with the IC-8 IOL showed excellent visual acuity outcomes, with reliable ex- tended depth of focus in all implant- ed eyes, without light being split to different foci," Dr. Dick said. "The lens compensated for deviations from the target refraction, doing away with the need for specific and highly elaborate IOL calculation formulas and intraoperative orienta- tion or aberrometry systems. It was forgiving with residual astigmatism of up to 1.5 D. High quality distance vision was slightly decreased but without changing binocular contrast sensitivity. In my experience, there was a low number of symptoms that related to photic phenomena with a high rate of patient satisfaction." The IC-8 IOL is a single piece, hydrophobic, 6-mm optic IOL with a 1.36 mm central aperture, a total diameter of 3.23 mm, and a thin mask of PVDF and carbon nanopar- ticles that is implanted into the cap- sular bag, allowing the placement of the mask to be far closer to the nodal point. The current recommen- dation is unilateral implantation in one eye, with the fellow eye receiv- ing a monofocal IOL. Multicenter European study Dr. Dick presented the 6-month results of an investigation 1 that was conducted at 12 European sites involving 108 patients with bilateral cataracts who received the IC-8 IOL in one eye, with a refractive target of –0.75 D, and an aspheric, colorless, monofocal IOL in the fellow eye with a plano target. Setting a target of 0.75 D of myopia broadened the range of functional near vision by an additional diopter without loss of distance vision, according to the study results. The study eyes were corrected to plano, achieving 2.25 D of contin- uous functional range of vision. Six months after implantation, monoc- ular uncorrected visual acuity was 0.87 logMAR for far, 0.83 logMAR for intermediate, and 0.66 logMAR for near, while binocular uncorrect- ed vision was 1.15 logMAR for far, 0.91 logMAR for intermediate, and 0.69 logMAR for near. According to the study, binocu- lar contrast vision was equivalent in both the IC-8 eyes and the monofo- cal IOL eyes. Deviation from target refraction was practically a non-issue in IC-8 eyes. "In terms of deviation from target refraction in sphere and cylinder, the IC-8 was forgiving up to 1.0 D of spherical error," Dr. Dick said. "For corneal astigmatism, I would say that the patient will toler- ate up to 1.5 D of deviation. Beyond 1.5 D, we see a small decrease in visual acuity, which is more academ- ic than clinical. We saw no change in visual acuity for far, intermediate, and near vision with up to 1.5 D off target, which is not the case in an eye implanted with a monofocal IOL." IC-8: Therapeutic uses "The most important and appeal- ing approach is the therapeutic use of the device," Dr. Dick said. "This option allows us to block out scars, corneal irregularities, and aberrat- ed corneas. It is being successfully used for post-RK cases, for which I would not recommend a multifocal or EDOF lens. This is also true for the increasing number of patients who have undergone keratorefrac- tive procedures. In these eyes, we have to expect a greater deviation from target refraction, and therefore, the IC-8 IOL is my standard lens of choice. I have great outcomes in keratoconus eyes and eyes with iris abnormalities after perforating eye injury as well." Surgeon shares experience with small aperture lenses Sulcus implantation of the XtraFocus 93L (disc diameter 6 mm, pinhole diameter 1.3 mm, total diameter 14 mm) IC-8 IOL photographed after implantation (in regredient light) Source (all): Burkhard Dick, MD For highly aberrated eyes, the XtraFocus 93L implant provides a total mask and stable sulcus implantation

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