Icl Aios 2010

THE EYE FOUNDATION
COIMBATORE - TIRUPUR
Outcome of ICL
A Retrospective Analysis in 63 Eyes
Dr Chandra Shekar C S
Dr Ramamurthy D
Dr ChitraRamamurthy
Dr Shreesh Kumar
Outcome of ICL – A Retrospective Analysis in 63 Eyes
Introduction
 In depth understanding of the eye and its behavior to

refractive surgeries has led to introduction newer technologies
www.theeyefoundation.com
Introduction
 Limited corneal thickness - keratorefractive
 Growing awareness of corneal endothelial changes - anterior

chamber and iris clipped lenses
 Clear lens extraction (CLE) - loss of accommodation and

retinal detachment is of grave concern
Introduction
ICL has emerged as a favoured

procedure
 It’s more anatomical
 Preservation of accommodation
 Potentially reversible
Materials and Methods
 Period March 2007 - March 2009
 Follow up 6 weeks -1 year
Number of eyes 63
Number of patients 43
Inclusion criteria
 Limited Corneal thickness

 No previous ophthalmic surgery
 No ocular pathology
Cont’d
Clinical evaluation
 Visual acuity
 Accurate refraction
 Slit lamp evaluation
 Retinal evaluation
 Specular microscopy
 Orbscan
Lens power calculation (parameters)
 Manifest refraction
 K values
 Horizontal white-to-white measurement (calipers)
 AC Depth (endo)
 Central pachymetry
Peripheral Iridotomy
1:30
11:00
Outcome of ICL – A Retrospective analysis in 63 eyes
Surgical Procedure
Results
Results
Results
No of patients - 43 Male-Female Ratio - 3:5
M
F
Results
Results
 Total number of
eyes 63
TOR
SPH
 Spherical ICL 43
 Toric ICL 20
Results
Results
 Out of the 43 patients, except 6, the rest retained their

BCVA after the procedure.
 One patient had Retinal detachment and glaucoma.
 Five of them had residual refractive error ranging from

0.75 D sph - -6.0D sph and
astigmatism ranging from -0.75 D cyl - 1.25 D cyl
Results
Normal 48
Pigmentation 13
Ant sub cap opacification 1
Glaucoma & RD 1
Conclusion
 Our long term experience with ICL’s showed

good visual outcome
 It is an ideal procedure in the armamentarium

of refractive surgeon
A PRESENTATION FROM
THE EYE FOUNDATION

COIMBATORE - TIRUPUR
Results
SPHERICAL
Results
Total number of
TOR
eyes - 63
spherical ICL - 43 SPH

Toric ICL - 20
Results
No of patients - 43 Male-female ratio was - 3:5
SEX
M
17
F
26
References
 Staar Collamer posterior chamber phakic intraocular lens to correct myopia
and hyperopia. Rosen E, Gore C.
J Cataract Refract Surg. 1998 May;24(5):596-606
 Posterior chamber phakic intraocular lens for hyperopia of +4 to +11 diopters.

Davidorf JM, Zaldivar R, Oscherow S.
J Cataract Refract Surg. 1998 May;jun14(3)306-11
 Incidence of Lens Opacities and Clinically Significant Cataracts With the

Implantable Contact Lens: Comparison of Two Lens Designs
Donald R. Sanders, MD, PhD; John A. Vukich, MD;
Journal of Refractive Surgery Volume 18 November/December 2002 673
ICL is Very Thin
< 50
microns
m m
5. 5 m
– 0 m
4.6 . 0
12
Collagen copolymer
COLLAMER
ICL is Very Thin
Leading
Foot Plates right
< 50
microns
Alignment marks
Collagen copolymer
COLLAMER
Toric ICL – Positioning Markings

 Additional markings have been etched on the horizontal
axis to allow accurate alignment.
Conclusion
• Our short term results quite encouraging
• Long term study needed for more complete conclusion
Results
No of patients - 43
Bil 23
Ul 20
M, 17
No of eyes - 63
F, 26
Age group - 16 yrs to 48

yrs
Male-female ratio was3:5

Introduction
• In keratorefractive -corneal thickness becomes a limiting
factor,
• anterior chamber and iris clipped lenses- growing awareness

of corneal endothelial changes with,
• Clear lens extraction (CLE) risk has been used with good
results in high myopia, there is always a grave of retinal
detachment and consequent loss of accommodation must be
considered.
Results
Bilateral - 23
Unilateral - 20 UL, BL,
20 23
Results
6/18; 1
6/12; 1
6/6; 5
Results
Sl Corneal
Eye Sph Cyl Axis V/A SPM Othereye
no thickness
1 OD -18.00 -2.75 15 6/18 548 2697 Zyo
Phakic
2 OS -7.00 -1.00 180 6/6 453 3611
IOL
3 OD -15.00 -1.25 180 6/6 5 526 2733
4 OS -7.00 -1.75 20 6/6 478 3115 ZYO (TS)
5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL

6 OS -9.00 -2.00 180 6/6 525 3063 Tor ICL
7 OD -10.00 -0.50 40 6/12 497 3603 Zyo
Results
Sl Corneal
Eye Sph Cyl Axis V/A SPM Othereye
no thickness
1 OD -18.00 -2.75 15 6/18 548 2697 Zyo
Phakic
2 OS -7.00 -1.00 180 6/6 453 3611
IOL
3 OD -15.00 -1.25 180 6/6 5 526 2733
4 OS -7.00 -1.75 20 6/6 478 3115 ZYO (TS)
5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL

6 OS -9.00 -2.00 180 6/6 525 3063 Tor ICL
7 OD -10.00 -0.50 40 6/12 497 3603 Zyo
• ICL
• Myopia - 7D to 18D
• Toric ICL
• Myopia - 12D & 9D
• Astigmatism - 2.50D
Posterior Chamber Phakic IOL
COLLAMER: The Material
• Collagen copolymer: Highly biocompatible

• Hydrophilic: repels proteins
• Affinity for fibronectin
• Refractive index = 1.45
• Elastic: Gentle unfolding
• Tensile strength: Strong, Resists Tearing
• UV Chromophore (covalently bound)
• Lathe Cut: many design options!
Clinical Indications
• Mild to high Myopia, with/without astigmatism

• Mild - moderate Hyperopia
• Stable Keratoconus
• Thin Cornea
• Dry eyes
• Large mesopic pupil (>7mm)
Surgical Technique
• - Two Paracentesis
• - Viscoelastic injection (HPMC)
• - Temporal, clear corneal incision (3.2mm)
• - Injection of ICL
• - Injection of viscoelastic on top of ICL
• - Positioning of ICL behind iris
• - Irrigation (and aspiration) of viscoelastic
• - (Constriction of pupil for surgical iridectomy)
• - 2-4 hours post-op check
2 hour post-op exam

• IOP check
– use caution if IOP > 24 mmHg or 10 mmHg higher than pre-op
• IOP Elevation
• - Retained Viscoelastic – burp and recheck
• - Non-patent Iridotomies – back to the Yag laser
• Check PI’s
– ACD should look deep
• Check ICL vault
– low vault is common at 2 and 24 hour check
(real vault after 1 week)
Post-op medication
Follow the normal cataract routine
• Antibiotic 3-4x / day for one week
• Steroids/NSAID 3-4x / day for 2 weeks
Comparison of Induced
Spherical & Coma (-8D patient)
ICL
Comparison of Induced
Spherical & Coma (-8D patient)
LASIK www.theeyefoundation.com
Immediate Pre-Op
• Topical Anesthetic
– per routine
Immediate Pre-Op
• Cataract prep and drape
• Normal sterile technique
Surgical Technique
• Remember: NO TOUCH ZONE
Immediate Pre-Op
• Minimum 8mm dilation
• Pre-treat: Tropicamide, Phenylepherine and NSAID
Borderline Size Well Dilated Pupil
Immediate Pre-Op
• Topical Anesthetic
– per routine
Marking the 0°- 180° axis
Horizontal Slit
Marking the 0°- 180° axis
Horizontal Slit
Results
Bil 23
Ul 20
M, 17
No of eyes - 63
F, 26

yrs

Results
Bil 23
Ul 20
M, 17
No of eyes - 63
F, 26

yrs


Icl Aios 2010

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Icl Aios 2010

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Доступные форматы

THE EYE FOUNDATION

 In depth understanding of the eye and its behavior to

 Limited corneal thickness - keratorefractive

 Growing awareness of corneal endothelial changes - anterior

 Clear lens extraction (CLE) - loss of accommodation and

ICL has emerged as a favoured

 It’s more anatomical

Materials and Methods

 Period March 2007 - March 2009

 Follow up 6 weeks -1 year

Materials and Methods

 Limited Corneal thickness

Materials and Methods

Materials and Methods

Materials and Methods

Lens power calculation (parameters)

Materials and Methods

 Out of the 43 patients, except 6, the rest retained their

 One patient had Retinal detachment and glaucoma.

 Five of them had residual refractive error ranging from

Ant sub cap opacification 1

 Our long term experience with ICL’s showed

 It is an ideal procedure in the armamentarium

THE EYE FOUNDATION

spherical ICL - 43 SPH

 Posterior chamber phakic intraocular lens for hyperopia of +4 to +11 diopters.

 Incidence of Lens Opacities and Clinically Significant Cataracts With the

Toric ICL – Positioning Markings

• Our short term results quite encouraging

• Long term study needed for more complete conclusion

Age group - 16 yrs to 48

Male-female ratio was3:5

• anterior chamber and iris clipped lenses- growing awareness

3 OD -15.00 -1.25 180 6/6 5 526 2733

4 OS -7.00 -1.75 20 6/6 478 3115 ZYO (TS)

5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL

3 OD -15.00 -1.25 180 6/6 5 526 2733

4 OS -7.00 -1.75 20 6/6 478 3115 ZYO (TS)

5 OD -12.25 -2.50 180 6/6 525 2973 Tor ICL

Materials and Methods

Posterior Chamber Phakic IOL

COLLAMER: The Material

• Collagen copolymer: Highly biocompatible

• Mild to high Myopia, with/without astigmatism

2 hour post-op exam

Follow the normal cataract routine

• Antibiotic 3-4x / day for one week

• Steroids/NSAID 3-4x / day for 2 weeks

• Cataract prep and drape

• Normal sterile technique

• Remember: NO TOUCH ZONE

Borderline Size Well Dilated Pupil

Marking the 0°- 180° axis

Marking the 0°- 180° axis

Age group - 16 yrs to 48

Male-female ratio was3:5

Age group - 16 yrs to 48

Male-female ratio was3:5

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