EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78716
March 2012 EW CORNEA 73 he said. "This IOL is nice as it has a 13.5-mm haptic length and a smooth anterior surface." However, Dr. Oetting prefers an IOL with an acrylic optic such as the Alcon MA50, stressing the impor- tance of lens material here. "I feel that these cases with a sulcus IOL are at greater risk for future pars plana vitrectomy for either retained mate- rial or retinal detachment," he said. "A silicone optic can cloud with an air fluid exchange during vitrectomy and become opaque if silicone oil is needed for a complex retinal detach- ment." However, he is aware that this IOL has its drawbacks for sulcus placement. "The disadvantage of the MA50 is that it has a square anterior edge, which could catch the iris, and the haptic length is only 13.0 mm," he said. Like Dr. Packer, Lisa B. Arbisser, M.D., adjunct associate professor, John A. Moran Eye Center, Univer- sity of Utah, Salt Lake City, thinks that the best currently available op- tion is the STAAR AQ series lens due to its longer-than-average 13.55-mm length, stiff haptics, round edge, and optic dimensions. She acknowl- edged, however, that the acrylic material that the lens is made of may be problematic. "Acrylic may not be the optimal thing to put in the sulcus since it's sticky and it's closer to vital tissues such as the pig- mented epithelium of the iris," she said. Despite this, she feels strongly that a square-edged lens should not be put in the sulcus. "There's the po- tential for having pigment disper- sion from the pigmented epithelium due to touch, and certainly there's no value to a square edge, which only increases dysphotopsia," she said. "The only advantage to having a square edge is to prevent PCO when it's in the bag." Instead of being advantageous, Dr. Arbisser stressed that particularly with an anterior square edge, there is far more potential for rubbing on the pigmented epithelium and causing pigment epithelial glaucoma. True sulcus lens Dr. Arbisser thinks that the Sulcoflex lens (Rayner, East Sussex, England), which is currently not approved in the U.S., is desperately needed in the U.S. "As I understand it, that's the best truly sulcus-designed lens around," she said. "It's what we need for piggyback, and it's what we need for a backup lens. The STAAR [lens] is the best that we have, but that silicone material is not particu- larly biocompatible." She pointed out that despite it currently being the best available lens, there are a host of drawbacks. "It's an old product," Dr. Arbisser said. Also, unless these are optic- captured or secured with a suture, Dr. Arbisser stressed that they are not truly healthy sulcus lenses. Dr. Arbisser believes that indus- try has let practitioners down in this respect. "It's just not worth it for Alcon, Abbott Medical Optics [Santa Ana, Calif.], and Bausch + Lomb [Rochester, N.Y.] to develop a true sulcus lens because they wouldn't get their money back," Dr. Arbisser said. As a result, practitioners are forced to make due with expensive consignments of three-piece lenses really meant for the bag. By contrast, the hydrophilic acrylic Sulcoflex is specifically made for the sulcus. Dr. Packer agreed that the lens, with its 6.5-mm optic, 14- mm length, and 10 degrees of angu- lation, is potentially very attractive here. "It has a very gentle curvature on the front surface," he said. "So it's really made to go behind the iris with due respect for the biocompati- bility issues that you'd have in a sul- cus lens." However, even this is not perfect, since it currently only comes in powers from –5 to +5 D, some- thing that Dr. Packer acknowledged could be easily rectified. He pointed out that the toric version of the lens might have even wider applicability due to the number of people with residual astigmatism after cataract surgery. However, he does not see the Sulcoflex becoming available any time soon. "I think that it's a great product, but it's a daunting prospect to think about getting FDA approval for that," he said. "It's a whole new category of devices, so we don't even know what kind of effectiveness measure they would require or safety measures. I don't know when or if we'll ever see that in the U.S." In the meantime, practitioners will have to do their best with consignments of bag lenses that they can MacGyver in place. EW Editors' note: The doctors mentioned have no financial interests related to this article. Contact information Arbisser: 563-323-2020, drlisa@arbisser.com Oetting: 319-384-9958, thomas-oetting@uiowa.edu Packer: 541-687-2110, mpacker@finemd.com ™ That's all youneed! One-size-fits-all punctum plug eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. FCI-Ophthalmics.com 800.932.4202 Visit PlugintoFCI.com for promotional pricing