Eyeworld

Contact information Name: ATARACT C PRESENTATION SPOTLIGHT 40 | EYEWORLD | OCTOBER 2019 myopes compared to the emmetropic population (phakic eyes). 9,10 Some degree of PVD is often detected with OCT and ultrasound after lens surgery in individuals without preoperative PVD – 71% after 3 months in nonmyopic eyes. 11 Pseudopha- kic eyes with an axial length of ≥25 mm were shown to be more likely to have a PVD as compared to those eyes with an axial length of <25 mm, odds ratio 4.7. 12 Higher percentages of new PVD after cataract surgery have been observed in younger patients and a trend towards higher occurrence of new PVD with increas- ing myopia was shown. 13 Addressing the influence of PVD on RD after lens surgery in myopic eyes, Dr. Ullrich and her team are collecting data from 618 patients with axial lengths longer than 25 mm from 11 ophthalmology centers in six countries, as part of the Myopic Pseudophakic Retinal Detachment ESCRS Study. The study's main outcome will be assessed after 3 years, with an extended follow-up to 5 years. The study includes funduscopy, SD-OCT, and ultrasound. Patients will be divided into two groups— complete PVD vs. partial or no PVD. The study is ongoing. "There are number of clinical pearls to keep in mind. The presence of PVD should be assessed preoperatively, possibly with OCT. Prophylactic treatment with laser is controversial, however, it could be considered for example in an RD fellow eye with lattice. RLE in myopes, which requires an extensive informed consent procedure, might best be applied in patients over 55 years of age with PVD," Dr. Ullrich said. AcrySof ® IQ PanOptix ® Family of Trifocal IOLs Important Product Information CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ PanOptix ® Trifocal IOLs include AcrySof ® IQ PanOptix ® and AcrySof ® IQ PanOptix ® Toric IOLs and are indicated for primary implantation in the capsular bag in the posterior chamber of the eye for the visual correction of aphakia in adult patients, with less than 1 diopter of pre-existing corneal astigmatism, in whom a cataractous lens has been removed. The lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. In addition, the AcrySof ® IQ PanOptix ® Toric Trifocal IOL is indicated for the reduction of residual refractive astigmatism. WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia and ensure that IOL centration is achieved. For the AcrySof ® IQ PanOptix ® Toric Trifocal IOL, the lens should not be implanted if the posterior capsule is ruptured, if the zonules are damaged or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction. If necessary, lens repositioning should occur as early as possible prior to lens encapsulation. Some visual effects may be expected due to the superposition of focused and unfocused multiple images. These may include some perceptions of halos or starbursts, as well as other visual symptoms. As with other multifocal IOLs, there is a possibility that visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. A reduction in contrast sensitivity as compared to a monofocal IOL may be experienced by some patients and may be more prevalent in low lighting conditions. Therefore, patients implanted with multifocal IOLs should exercise caution when driving at night or in poor visibility conditions. Patients should be advised that unexpected outcomes could lead to continued spectacle dependence or the need for secondary surgical intervention (e.g., intraocular lens replacement or repositioning). As with other multifocal IOLs, patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO) may significantly affect the vision of patients with multifocal IOLs sooner in its progression than patients with monofocal IOLs. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure, available from Alcon, informing them of possible risks and benefits associated with the AcrySof ® IQ PanOptix ® Trifocal IOLs. ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions. © 2019 Alcon Inc. 9/19 US-ACP-1900126 continued from page 36 References 1. Bjerrum SS, et al. Risk of pseu- dophakic retinal detachment in 202,226 patients using the fellow nonoperated eye as reference. Ophthalmology. 2013;120:2573– 2579. 2. Daien V, et al. Incidence, risk factors, and impact of age on retinal detachment after cataract surgery in France: a national population study. Ophthalmology. 2015;122:2179–85. 3. Rosen E. Risk management for rhegmatogenous retinal detach- ment following refractive lens exchange and phakic IOL implan- tation in myopic eyes. J Cataract Refract Surg. 2006;32:697–701. 4. Colin J, et al. Retinal detach- ment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology. 1999;106:2281–4. 5. Ripandelli G, et al. Cataract surgery as a risk factor for retinal detachment in very highly myopic eyes. Ophthalmology. 2003;110:2355–61. 6. Laube T, et al. Pseudophakic retinal detachment in young-aged patients. PLoS One. 2017;12(8): e0184187. 7. Tielsch JM, et al. Risk factors for retinal detachment after cata- ract surgery. A population-based case-control study. Ophthalmolo- gy. 1996;103(10):1537–45. 8. Petousis V, et al. Risk factors for retinal detachment following cataract surgery: the impact of posterior capsule rupture. Br J Ophthalmol. 2016;100:1461– 1465. 9. Yonemoto, J., et al., The age of onset of posterior vitreous de- tachment. Graefes Arch Clin Exp Ophthalmol. 1994;232(2):67–70. 10. Itakura, H., et al., Vitreous changes in high myopia observed by swept-source optical coher- ence tomography. Invest Ophthal- mol Vis Sci. 2014;55(3):1447–52. 11. Ivastinovic D, et al. Evolution of early changes at the vitreo- retinal interface after cataract surgery determined by optical coherence tomography and ul- trasonography. Am J Ophthalmol. 2012;153:705–9. 12. Hilford D, et al. Posterior vitreous detachment following cataract surgery. Eye (Lond), 2009;23(6):1388-92. 13. Hikichi T. Time course of development of posterior vitreous detachments after phacoemulsi- fication surgery. Ophthalmology. 2012;119(10):2102–7.

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