Phakic posterior chamber IOLs 1.Cells involved in crystalline lens and capsular bag opacification...
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![Page 1: Phakic posterior chamber IOLs 1.Cells involved in crystalline lens and capsular bag opacification 2.Evolution of designs of PPCIOLs 3.Relevant aspects.](https://reader035.fdocuments.in/reader035/viewer/2022081504/56649f0c5503460f94c20611/html5/thumbnails/1.jpg)
Phakic posterior chamber IOLs
1. Cells involved in crystalline lens and capsular bag opacification2. Evolution of designs of PPCIOLs3. Relevant aspects of fixation and sizing4. Sizing issue: New studies5. Surgical implantation6. Relationship between cataract and myopia7. Cataractogenesis
• Specimens analyzed in our Center• Mechanisms• Review of the literature• Classification of cataracts after phakic IOL implantation?
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White-to-white + 0.5 mm(myopic eyes)
White-to-white – 0.5 mm(hyperopic eyes)
Third generation:Staar ICL
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White-to-white?
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Pop M, Payette Y, Mansour M. Predicting sulcus size using ocular Pop M, Payette Y, Mansour M. Predicting sulcus size using ocular measurements. measurements. J Cataract Refract SurgJ Cataract Refract Surg 2001; 27:1033-1038. 2001; 27:1033-1038.
-43 eyes of 24 patients (34 ± 6 years)
-Spherical equivalent: -25.50 to –8.75, and +4.00 to +7.50
-Measurements: white-to-white with surgical calipers; sulcus diameter with composites of UBM photographs (50 MHz)
-Traditional estimation of sulcus size through limbal measurement is inadequate: limbus size alone cannot predict sulcus size
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Werner L, Apple DJ, et al. Correlation between different measurements within the eye with relevance for phakic intraocular lens implantation.J Cataract Refract Surg 2002(in preparation)
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Table I. Measurements (in mm) obtained from the first 10 eyes used in this study.
Eye # Age Gender Anterior-posterior White-to-white Anterior chamber diameter Angle-to-angle Sulcus-to-sulcus
(years) length (6-12 o'clock)* (6-12 o'clock) plastic sizer (6-12 o'clock, after fixation)* (6-12 o'clock, after fixation)*
1 59 M 24.04 11 11.75 12.5 12.75
2 59 M 24.14 11 12 12 11.75
3 62 M 23.79 10.75 11.5 11.5 11.25
4 62 M 23.92 10.75 10.75 11 11
5 54 M 24.63 11 12.5 12 11.75
6 54 M 24.45 11.5 11.5 12 11.5
7 72 F 24.31 11 11.5 11.75 11.25
8 72 F 24.46 11 11.5 11.75 12
9 70 F 23.36 10.5 11.5 11.5 11.25
10 70 F 23.29 11 11.5 12 11.5
M ± SD** 63.4 ± 7.1 - 24.03 ± 0.45 10.95 ± 0.25 11.72 ± 0.46 11.80 ± 0.40 11.60 ± 0.50
* = The measurements were performed with a surgical caliper (steps of 0.25 mm).** = Mean ± standard deviation.
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Table II. Measurements (in mm) obtained from the last 12 eyes used in this study.
Eye # Age Gender Anterior-posterior White-to-white (3-9 o'clock) Anterior chamber diameter Angle-to-angle with calipers Sulcus-to-sulcus with calipers
(years) length with calipers* (3-9 o'clock) plastic sizer (3-9 o'clock, after fixation)* (3-9 o'clock, after fixation)*
11 60 M 26.15 11.50/11.52 12 11.50/11.46 11.00/11.12
12 60 M 26.59 11.50/11.41 11.5 11.50/11.60 11.25/11.25
13 74 F 23.52 11.25/11.35 12.5 11.75/11.92 11.50/11.33
14 74 F 23.74 11.50/11.51 12.25 11.75/11.92 11.25/11.06
15 69 M 23.89 12.25/12.06 11.5 11.75/11.70 11.25/10.79
16 69 M 23.93 12.00/12.08 11.5 11.75/11.66 11.25/11.18
17 67 M 26.16 12.25/12.24 12.5 12.25/12.31 11.75/11.71
18 67 M 26.01 12.50/12.44 12.75 12.00/12.19 11.50/11.72
19 56 M 26.63 11.75/12.01 12.5 11.75/11.97 11.25/11.45
20 56 M 26.27 11.75/12.02 12.5 11.75/12.16 12.25/11.96
21 63 F 25.04 11.25/11.04 11.5 11.75/11.80 11.25/10.95
22 63 F 24.23 11.75/11.43 12 11.75/11.90 11.25/11.34
M ± SD** 64.8 ± 6.1 - 25.18 ± 1.23 11.77 ± 0.40/11.75 ± 0.43 12.08 ± 0.48 11.77 ± 0.19/11.88 ± 0.25 11.39 ± 0.32/11.32 ± 0.34
* = The first measurement was performed with a surgical caliper (steps of 0.25 mm); the second measurement was performed with a digital caliper.** = Mean ± standard deviation.
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White to White vs Angle to Angle(6-12 O'clock)
White to White 6-12 O'clock (mm)
10.4 10.6 10.8 11.0 11.2 11.4 11.6
Ang
le to
Ang
le 6
-12
O'c
lock
(m
m)
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
No correlation:White-to-white andangle-to-angle(vertical meridian)N = 10 eyes
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No correlation:White-to-white andsulcus-to-sulcus(vertical meridian)N = 10 eyes
White to White vs Sulcus to Sulcus(6-12 O'clock)
White to White 6-12 O'clock (mm)
10.4 10.6 10.8 11.0 11.2 11.4 11.6
Sul
cus
to S
ulcu
s 6-
12 O
'clo
ck (
mm
)
9
10
11
12
13
14
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No correlation:White-to-white andangle-to-angle(horizontal meridian)N = 12 eyes
White to White vs Angle to Angle3-9 O'clock, Caliper #2
White to White 3-9 O'clock (mm)Caliper # 2
10.8 11.0 11.2 11.4 11.6 11.8 12.0 12.2 12.4 12.6
Ang
le to
Ang
le 3
-9 O
'clo
ck (
mm
)C
alip
er #
2
11.0
11.2
11.4
11.6
11.8
12.0
12.2
12.4
12.6
12.8
13.0
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No correlation:White-to-white andsulcus-to-sulcus(horizontal meridian)N = 12 eyes
White to White vs Sulcus to Sulcus3-9 O'clock, Caliper #2
White to White 3-9 O'clock (mm)Caliper #2
10.8 11.0 11.2 11.4 11.6 11.8 12.0 12.2 12.4 12.6
Sul
cus
to S
ulcu
s 3-
9 O
'clo
ck (
mm
)C
alip
er #
2
10.0
10.5
11.0
11.5
12.0
12.5
13.0
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Anterior segment B-scan with ahigh-frequency digital ultrasound system:
““ARTEMIS”ARTEMIS”
Developed at the Cornell University byJ. Coleman, R. Silverman, and D.Z. Reinstein
Manufactured by UltralinkG. Wilserman and S. Phillips
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Werner L, et al. Evaluation of a new ultrasound system for refractive surgeryEvaluation of a new ultrasound system for refractive surgery.Poster presented at the XX Congress of the ESCRS, Nice, France,September 2002
•15 cadaver eyes (9 phakic and 6 pseudophakic)
1 2 3
4
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Phakic cadaver eye(horizontal meridian)