EyeWorld India December 2018 Issue

A symposium at the 2018 APACRS Annual Meet- ing, sponsored by HOYA Surgical Optics, covered a variety of topics relat- ing to IOL optics. The session was moderated by Prin Rojanapongpun, MD , Bangkok, Thailand, and Ronald Yeoh, MD , Singapore. During the session, Rupert Me- napace, MD , Vienna, Austria, spoke on “Defining and Assessing True Rotational Stability of Toric IOLs: A Comparative Clinical Study.” When discussing IOLs and rotational stabil- ity, he said there are several questions to be answered. What is the reported rotational stability of (T)IOLs in litera- ture, and how valid are the methods used to determine it? How do you cor- rectly assess true rotational stability? What is the true rotational stability of popular (T)IOLs? Prof. Menapace discussed pub- lished data and said there are differ- ent baselines and methods used to determine position and stability of the lens. The earliest reference in time in publications is 1 hour after surgery, with the patient already sitting up- right. Other reference points are 1–2 days postop, 1 week, and even longer, or simply the intended axis, which implies errors in primary positioning. Prof. Menapace discussed studies on rotational stability, noting the Vienna IOL Study Group rotational study project. He highlighted the materials and methods: the monofo- cal IOL model implanted (to enhance recruitment, neutralize visual impact in case of misalignment/rotation), haptic junctions and emmisaria used as reference points, primary IOL axis orientation randomized, and meridio- nal IOL position measured at the end of surgery and several postop times. Prof. Menapace also spoke about certain surgical precautions met to minimize secondary rotation like using only cohesive OVD for IOL implantation and thorough OVD aspi- ration at the conclusion of surgery, 3 minutes of waiting time to allow full Innovations in IOLs Supplement to EyeWorld Asia-Pacific Winter 2019 APACRS unfolding of haptics in the bag and the chamber then slowly flattened and carefully reinflated to leave the eye normotonic. The Vivinex ™ IOL from HOYA was compared to several different IOLs, and he noted its excep- tional performance. It was the most stable IOL his team has yet tested and did not produce outliers associated with other market leading designs. In a set of 103 cases, 100% of all Vivinex ™ IOLs had less than or equal to 5 degrees of rotation as measured from the end of surgery to 6 months. Prof. Menapace said that the most frequent and significant rotations of toric IOLs occur during the first week; from 1 week to 1 month, the incidence and amount significantly decrease; and after 1 month, signifi- cant rotation no longer occurs. Prof. Menapace noted that what counts is the positional change starting from the end of surgery, and not from 1 hour or 1 day, or even later, as well as considering the outliers and not only means, medians, and standard deviations. Hiroko Bissen-Miyajima, MD , PhD , Tokyo, Japan, shared her experi- ence in a presentation titled “Clinical Outcome of New Vivinex ™ Toric IOL.” Prof. Bissen-Miyajima highlighted the important qualities of the preload- ed Vivinex ™ IOL , such as the small incision required and the long-term stability in terms of glistening and PCO performance of the hydrophobic acrylic platform. Prof. Bissen-Miyajima discussed her clinical investigations of the Vivinex ™ Toric IOL, specifically results from preop to 3 months postop. In targeting emmetropia, Prof. Bissen- Miyajima said spherical equivalent results were good. When considering UCDVA, all eyes achieved 20/25 or better and were stable from 1 day to 3 months postop. Astigmatism decreased from preop and spectacle usage was minimal at distance (95% not using spectacles and 5% some- times using spectacles). Patient satisfaction was good, with 40% of e news magazine of the Asia-Paci c Association of Cataract & Refractive Surgeons Johnny Wu, MD, Rupert Menapace, MD, Susana Marcos, PhD, Hiroko Bissen-Miyajima, MD, PhD, Prin Rojanapongpun, MD, and Ronald Yeoh, MD Glistenings are reduced in eyes with Vivinex ™ , and there is a new approach to reduce PCO with Vivinex ™ . The IOL surface is modi ed to increase the adhesion to the posterior capsule. Sponsored by HOYA Surgical Optics