EyeWorld Asia-Pacific June 2012 Issue

June 2012 28 EWAP CATARACT/IOL it’s a foldable lens so surgeons can get it through a small, clear corneal incision. Wound healing is fast and relatively little astigmatism is induced. Another advantage of the Visian ICL, according to Michael Knorz, MD , professor of ophthalmology, Heidelberg University, Manheim, Germany, is that it’s invisible to the naked eye. It sits behind the iris and does not reflect light, he said. On the downside, it requires an iridectomy (or two) and causes cataract formation in a certain number of eyes, he said. The Verisyse has the advantages of having longer-term results, it does not seem to cause cataracts, and endothelial cell loss is not a problem, Dr. Knorz said. The disadvantages are that surgery is difficult, an iridectomy is required, and the large incision induces some astigmatism, he added. According to Dr. Barsam, most surgeons are very happy with the Visian. It’s the one he uses, he said. “I prefer it because I worry about endothelial cell loss with the anterior chamber lenses, which can continue, albeit at a very low rate, with time,” Dr. Barsam said. “All the studies show that if we select patients appropriately, ones who have deep anterior chambers, significant endothelial cell loss should not be a concern. But these lenses were only FDA approved in 2004 or 2005, so we still only have 6 years of data, and I would like longer-term data to be satisfied about any kind of long-term safety issues.” Other potential side effects with the phakic lenses are inflammation and intraocular pressure changes, he said, but those are all treatable with drops. “I don’t think there are any significant problems with [the lenses] that occur beyond the first month; there are immediate post-op problems, which can be managed,” he said. According to Dr. Knorz, these phakic IOLs have long- term data and can be considered safe for long-term use. However, he cautioned, “That does not mean they work in every patient forever; in other words, an annual follow-up visit is required to check intraocular pressure and corneal endothelial cell counts.” Phakic lenses elsewhere Outside of the U.S., there are a number of other phakic lenses available. The AcrySof Cachet is a foldable acrylic angle-supported lens. Still awaiting FDA approval, this lens is easier to implant than the aforementioned phakic IOLs, Dr. Knorz said. There is no need for an iridectomy, it works with a small incision, and there is long-term data available, he said. However, one disadvantage is that there is no toric version, he added. The newest iteration of the Verisyse, the Veriflex, is a foldable lens that can go through a 3-mm incision and is clipped to the iris, Dr. Barsam said. There is also a toric version of the Visian ICL, known as the Visian TICL. Patient selection The best patients for phakic lenses are those who are highly myopic or have corneas that are too thin for LASIK or PRK to be safe, Dr. Barsam said. They are probably under the age of 40 because highly myopic patients tend to develop cataracts earlier. If patients are already presbyopic, they may be better off with a clear lens extraction if they’re unsuitable for LASIK or PRK, he said. In addition, Dr. Yoo said that patients should have an adequate anterior chamber depth and not have problems with their corneal endothelium. For Dr. Knorz, the ideal patients are those outside the range of good LASIK outcomes. “In Germany, the legal range for LASIK is –8 to +4. Outside that, a phakic IOL is recommended,” he said. “I personally use the Cachet from –6 to –17 and the Verisyse from +5 and higher in pre- presbyopia patients.” EWAP Editors’ note: Dr. Barsam has no financial interests related to this article. Dr. Knorz has financial interests with Alcon and AMO. Dr. Yoo has financial interests with AMO. Contact information Barsam: +44 79 705 50172, abarsam@hotmail.com Knorz: +49 62 138 33410, knorz@eye.de Yoo: +1-305-326-6322, syoo@med.miami.edu CALENDAR OF MEETINGS 2012-2013 DATE MEETING VENUE August 21-25 17th Congress of the Chinese Ophthalmological Society www.coschina.org Nanjing, China September 8-12 XXX Congress of the ESCRS www.escrs.org Milan, Italy November 10-13 Annual Meeting of the American Academy of Ophthalmology (AAO) www.aao.org Chicago, USA 2013 January 17-20 Joint Meeting of the 28th Congress of APAO and 71th Annual Conference of AIOS www.aios.org Hyderabad, India April 19-23 ASCRS-ASOA Symposium & Congress (ASCRS-ASOA) www.ascrs.org San Francisco, USA July 11-14 26th APACRS Annual Meeting – A Global Focus on the Anterior Segment www.apacrs.org Singapore October 5-9 XXXI Congress of the ESCRS www.escrs.org Amsterdam, Netherlands November 16-19 Annual Meeting of the American Academy of Ophthalmology (AAO) www.aao.org Chicago, USA Phakic - from page 27