Eyeworld

EW REFRACTIVE 132 March 2018 © 2018 Novartis 1/18 US-RES-17-E-3227 References 1. Alcon Data on File (Jul 2016). 2. AcrySof ® IQ ReSTOR ® +2.5 D Multifocal Toric IOL Di- rections for Use. 3. Vega F, Alba-Bueno F, Millán MS, Varon C, Gil MA, Buil JA. Halo and through-focus performance of four diffractive multifocal intraocular lenses. Invest Ophthal- mol Vis Sci. 2015;56(6):3967-3975 (study conducted with corneal model eye with 0.28µ spherical aberration). 4. Wirtitsch MG, Findl O, Menapace R, et al. Effect of haptic design on change in axial lens position after cataract surgery. J Cataract Refract Surg. 2004;30(1):45- 51 5. Visser N, Bauer NJ, Nuijts RM. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cata- ract Refract Surg. 2013;39(4):624-637. 6. Potvin R, Kramer BA, Hardten DR, Berdahl JP. Toric intraocular lens orientation and residual refractive astigmatism: an analysis. Clin Ophthalmol. 2016;10;1829-1836. AcrySof ® IQ ReSTOR ® Family of Multifocal IOLs Important Product Infor- mation CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physi- cian. INDICATIONS: The AcrySof ® IQ ReSTOR ® Posterior Chamber Intraocular Multifocal IOLs include AcrySof ® IQ ReSTOR ® and AcrySof ® ReSTOR ® Toric and are intended for pri- mary implantation for the visual correction of aphakia secondary to removal of a catarac- tous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. In addition, the AcrySof ® IQ ReSTOR ® Toric IOL is intended to correct pre-existing astigmatism. The lenses are intended to be placed in the capsular bag. 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 for each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. The ReSTOR ® Toric IOL 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 patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. A reduction in contrast sensitivity may occur in low light conditions. Visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary; some patients may need glasses when reading small print or looking at small objects. Posterior capsule opacification (PCO), when present, may develop earlier into clinically significant PCO with multifocal 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 ReSTOR ® IOLs. Do not resterilize; do not store over 45° C; use only sterile irrigating solu- tions such as BSS ® or BSS PLUS ® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions. Managing continued from page 130 gradually loosen the IOL capsule complex and lead to dislocation," Dr. Kristianslund said. "The disloca- tion surgery resulted in a moderate IOP decrease, which seemed to be more pronounced with IOL ex- change." Surgically induced astigmatism As the focus of a separate analy- sis that involved the same study population, 4 Dr. Kristianslund and his team compared astigmatism and refractive outcomes in the two groups, demonstrating that surgi- cally induced astigmatism (SIA) was modest in both operation groups, with a slightly increased tenden- cy in the IOL exchange group, as expected. Placement of the scleral tunnel at approximately 90 degrees may have caused a flattening in this meridian, resulting in a tendency for inducing against-the-rule astigma- tism. The analysis used Scheimpflug topography to measure the cornea and vector analysis to determine astigmatism. At 6 months of follow up, SIA in the IOL repositioning group was 0.24 D @ 8 degrees, and it was 0.65 D @ 171 degrees in the IOL exchange group. The mean SIA magnitude was 0.60 ± 0.50 D for IOL repositioning and 1.12 ± 0.85 for IOL exchange (P<.001). In the IOL repositioning group, the mean pre-dislocation SE was –0.9 ± 1.5 D compared to the 6-month postoperative value of –1.6 ± 1.6 D. The prediction error was –0.7 ± 1.0 D, with the SE within ±1 D in 57% of patients. In the IOL exchange group, the target refraction was calculated using preoperative biometry mea- surements. In this group, the target SE was –0.8 ± 0.9 D compared to the postoperative SE of –0.5 ± 1.0 D. The prediction error was +0.3 ± 0.9 D, with the SE within ±1 D in 83% of patients. Dr. Kristianslund suggested an optimized A constant of 117.3 (applied: 116.9). "Both methods had an ac- ceptable surgically induced astig- matism, but it tended to be more pronounced for eyes that had undergone IOL exchange, as we ex- pected," Dr. Kristianslund said. "The IOL repositioning group achieved a more myopic refraction than they had before the dislocation, as was shown by a number of overcorrec- tions among the patients. In the IOL exchange group, patients achieved refraction closer to the attempted. Other aspects of the two methods should be taken into account, like differences in surgical complica- tions, in the choice of operation method." EW References 1. Pueringer SL, et al. Risk of late intraoc- ular lens dislocation after cataract surgery, 1980–2009: a population-based study. Am J Ophthalmol. 2011;152:618–623. 2. Kristianslund O, et al. Late in-the-bag intra- ocular lens dislocation: a randomized clinical trial comparing lens repositioning and lens ex- change. Ophthalmology. 2017;124:151–159. 3. Kristianslund O, et al. Glaucoma and intraocular pressure in patients operated for late in-the-bag intraocular lens dislocation: a randomized clinical trial. Am J Ophthalmol. 2017;176:219–227. 4. Kristianslund O, et al. Astigmatism and refractive outcome after late in-the-bag intra- ocular lens dislocation surgery: a random- ized clinical trial. Invest Ophthalmol Vis Sci. 2017;58:4747–4753. Editors' note: Dr. Kristianslund has no financial interests related to his comments. Contact information Kristianslund: olav.kristianslund@medisin.uio.no Top five pearls in surgical management of subluxated IOLs and IOL suture fixation Yassine Daoud, MD, discusses five ways to maximize outcomes when dealing with subluxated IOLs and IOL suture fixation. EWReplay.org " Other aspects of the two methods should be taken into account, like differences in surgical complications, in the choice of operation method. " —Olav Kristianslund, MD

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