The IOL= The IOL-VIP System
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The IOL= The IOL-VIP System Dominic McHugh Royal Society of Medicine 2010
description
The IOL= The IOL-VIP System. Dominic McHugh Royal Society of Medicine 2010. ARMD. Leading cause of blindness (“SVL”) in the Western World 2.7 million in the UK have some loss. 54% increase in >75s over the next 25 yrs. ARMD Quality of Life. With ARMD Without ARMD Home Care 23%5% - PowerPoint PPT Presentation
Transcript of The IOL= The IOL-VIP System
The IOL=
The IOL-VIP System
Dominic McHughRoyal Society of Medicine
2010
ARMDLeading cause of blindness (“SVL”) in the
Western World2.7 million in the UK have some loss.54% increase in >75s over the next 25
yrs.
ARMD Quality of Life
With ARMD Without ARMD
Home Care 23% 5%Falls 16% 8.3%Falls With Fractures 3.5% 1.5%Healthcare Costs €12,579€1,300(£8,521) (£885)
LVA Possibilities
• Intraocular Miniature Telescope Galileian telescope 2.2- 3.5x intra (Lipshitz) •
• Hanita Ben-Sira implant Galileian telescope 2x IOL+spectacle
Surgical Rehabilitation for ARMD
Difficulty maintaining coaxial alignment
MonovisionVF 20° 11 mm incision
IOL-VIP SystemBCC IOL in the capsular bag = telescope ocular
BCX IOL in AC= telescope objective
IOL-VIP System
PC IOL AC IOL-66D +55D
IOL CHARACTERISTICSANTERIOR CHAMBER IOL
(BCX) Optic
Material PMMA with UV filter
Diameter 5.0Thickness 1.5mm
Haptics Loop shape Z Material PMMA-1PAngle 10° IOL power +55.00 D
PC IOL (BCC)
Optic Material PMMA with UV
filterDiameter 5.0Thickness 1.5mm
Haptics
Loop shape C Material PMMA-1P Angle 7°
IOL power -66.00 D
Inclusion criteria for IOL-VIP surgery
•Bilateral stable macular degeneration/macular hole
•VA 6/18-6/60
•Good peripheral field
•Adequate AC depth
•Adequate endothelial cell count
•Predicted benefit by IOL-VIP simulator
Exclusion criteria for IOL-VIP Surgery•Active exudative macular degeneration •Glaucoma
•Cornea guttata
•PAS
•Endothelial cell count < 1600 cell/mm2
•Shallow anterior chamber with depth < 3 mm
•Corneal diameter < 11 mm
no visual acuity improvement using the IOL-Vip simulator
IOL-VIPProposed
mechanism of action
Prismatic deviation of Image to PRL.Image magnificiation~1.3
Image shift to PRL (MP)
Post-op
Pre-op
RE preop BCVA : 0.25postop BCVA: 0.5
LE preop BCVA : 0.3 postop BCVA: 0.7
(Fasciani et al, 2008)
IOL-VIP Simulator Prism
IOL-VIPPreoperative assessment
Best VA without and with simulator prism, rotated to achieve PRL
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Left EyeRight Eye
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9 3
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9 3
IOL-VIP SystemOptimal simulator orientation
determines relative IOL position
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Left EyeRight Eye
9 3
1-2
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1-2
8-7
IOL-VIP SystemOptimal simulator orientation
determines relative IOL position
IOL-VIP Surgery
Phakic/Pseudophakic eyes• Corneal tunnel (superior/temporal depending on IOL orientation•Large (6-7 mm) CCC•Phacoemulsification if phakic•Enlarge corneal incision to 7 mm•PC IOL: bag if phakic, sulcus if pseudophakic•PI+miochol•A/C IOL•Corneal sutures
IOL-VIP Surgery
IOL-VIPVisual Outcome
Orzalesi et al 2007
IOL-VIPPostoperative findings
•Low surgical complication rate•Endothelial cell loss 7%•PCO 18%•High hyperopia in emmetropes; better if myopic•Recent availability of “bespoke” implants
IOL-VIPConclusions
Advantages• Improves reading/distance vision in suitable cases (6/18-6/60 pre op; small-moderate central scotoma)•Patients comment favourably on scotoma shifting away from centre
Disadvantages•Careful selection required: pathology; psychology; costs•Lengthy (6 week) postoperative rehabilitation training•Suture removal•Refractive error : hyperopia and astigmatism (reduced with new implants
