Safety and Efficacy of Toric Safety and Efficacy of Toric ICLICL

John Chang Jr. MDDirector of Guy Hugh Chan Refractive Surgery Centre

Hong Kong Sanatorium & Hospital

April 2008 ASCRS

Toric Implantation Collamer Lens (TICL) is now in phase III of the U.S. FDA study

TICLTICLLens power range

(Visian TICL) Sphere ranges from -3D

to -23D Cylinder ranges from

+1DC to +6DC Customized axis Can correct up to -

18DS/-0.75DC or -14DS/-5.0DC

From 04/2004 to 04/2007

No. of patients: 27 No. of eyes: 42 Bilateral TICL: 15 Age range: 23 to 44

yrs Mean age: 32.1 ± 6.7

yrs Mean FU: 6 months

TICL - ResultsTICL - Results

PreOp PostOp at 12M

Mean Sphere -14.20 ± 2.83D -0.20 ± 0.42 D

Range -7.00 to -19.50D +0.50 to -1.0D

Mean cyl 2.64 ± 0.89D 0.60 ± 0.49D

Range 1.00 to 4.50D 0 to 2.0D

Mean MSE -12.88 ± 2.79D +0.10 ± 0.33D

Range -6.00 to -18.25D -0.50 to 1.13D

TICL - ResultsTICL - Results

Within ± 0.5D Within ± 1.0D

MRSE 95% 95%

Cylinder 57% 91%

PostOp Rx at 12M

TICL - StabilityTICL - Stability

TICL - Results – 12MTICL - Results – 12M

TICL - Safety – 12MTICL - Safety – 12M

No eye lost any vision

TICL - ComplicationsTICL - Complications 1 eye (2.9%) transient IOP rise at 1

month Steroid induced

1 lens rotated 15o clockwise Patient with RE preop Rx -18.75/+3.50 x100 Implanted with TICL -23.0/+3.50/099 After surgery the lens rotated clockwise by 15o

Residual Rx -2.00/+2.50x120 (20/20), UCVA 20/80 Lens dialed 6M after surgery UCVA 20/25; MRx -0.50/+1.00 x 65 (20/20)

TICL - Surgical TICL - Surgical TechniqueTechnique Same as Non Toric Laser PI 1week prior to lens implantation Temporal 3.0 - 3.2mm self sealing incision Lens injected via foldable injector into AC Lens dialed into sulcus Surgery done under topical anesthesia Toric lens supplied correct Power for Sphere and

Cylinder but axis can be different by up to 22o

During surgery the axis of the lens to be positioned is marked.

Temporal incision is made to match that axis Need to dial lens into position (surgical planner

software supplied)

TICL - Advantages & TICL - Advantages & DisadvantagesDisadvantages

Advantages Technically not difficult (Avg surgery time 25

mins) No / Minimal night vision problems Short learning curve – easier than Phaco Lens is removableDisadvantages Sizing can be difficult, Orbscan not always

reliable Sizing even more important than non-toric ICL Glaucoma? Pigment dispersion? Expensive 2 Procedures: Laser P.I. First (uncomfortable),

then lens implantation

TICL - ConclusionTICL - Conclusion

Toric ICL results very encouraging (100% 20/20 UCVA)

Transient IOP rise 2° to steroid use Accuracy as good / better than LASIK for high

myopia Much better immediate and long term stability

than LASIK. No cataract with TICL