Latest-generation accommodating IOL increasingly shows promise

Preliminary results from an ongoing study reveal enhanced intermediate and near vision correction.

BUDAPEST — As the number of patients grows and the follow-up of several surgeons increases, the accommodating Crystalens HD IOL from Bausch + Lomb continues to show promise. Compared with previous models, it is 3 µm thicker in the center of the optic, providing enhanced intermediate and near vision correction.

Mark Tomalla

A prospective, non-controlled, open-observation study is ongoing at the Clinic for Refractive and Ophthalmic Surgery in Duisburg, Germany. So far, 48 eyes have been enrolled, and 6-month results are available for 17 eyes.

“Experience shows that optimal postoperative results are achieved at 4 to 6 weeks from implantation,” Mark Tomalla, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.

“We also learned that secondary cataract is better treated early, at 8 to 10 weeks after primary surgery. This improves the mobility of the Crystalens HD and also offsets astigmatism that may have been induced,” he said.

Implanting the lens

Surgery with this lens differs in a few important ways and requires expert hands to be performed successfully.

Good IOL implantation begins with the injector, Dr. Tomalla said. The lens must be properly fixed inside the injector to ensure it cannot turn. The shooter must be placed deep in the anterior chamber and removed slowly after the injection.

“Placing the haptics is a delicate maneuver. The IOL must be rotated until it fits exactly in place. Sometimes the second haptic is difficult to fix because the hinge is extremely flexible,” he said.

The capsulorrhexis must be larger than the IOL optic (eg, 5.5 mm to 6 mm for a 5-mm IOL optic), and the anterior capsular bag must lie clearly outside the optic, according to Dr. Tomalla.

After thorough removal of viscoelastic and cortex, the IOL must be pressed back against the posterior capsule and remain in this position for 10 to 14 days while the natural fibrosis processes fuse the lens haptics with the capsule. Accommodation movements are prevented by pupil dilation with one drop of atropine immediately after surgery.

“The patient must not try to accommodate in the first 10 days and must always wear glasses for reading,” Dr. Tomalla said. “Some discomfort and increased blinding sensitivity is experienced over this period, and patients should be made aware of this prior to surgery.”

Early results

The preliminary 6-month Duisburg study results showed an uncorrected vision of 20/20 at distance in 78% of the patients, at intermediate in 86% of the patients and at near in 100% of the patients.

“None of the patients needs spectacles at distance and intermediate. Reading glasses are no longer used by 71% of the patients and occasionally by 29% of the patients. Binocularly operated patients show considerably better results than monocularly operated patients. All patients expressed subjectively high satisfaction,” Dr. Tomalla said.

No blinding sensitivity or halos were reported, and night vision was unaffected by the lens. – by Michela Cimberle

• Mark Tomalla, MD, can be reached at Clinic for Refractive and Ophthalmic Surgery, Fahrnerstrasse 133-135, 47169 Duisburg, Germany; +49-203-5081711; fax: +49-203-5081713; e-mail: mark.tomalla@ejk.de.

Dr. Tomalla’s 6-month outcomes data demonstrate clearly that, with careful intraoperative technique and postoperative management, patients with the accommodating Crystalens HD can achieve true accommodation and a high degree of spectacle independence. Our experience with this same lens in the United States has paralleled his findings regarding capsulotomy size, injector handling and the value of early YAG capsulotomy (not usually sooner than 3 months postoperatively). Surgeons newly adopting the Crystalens will do well to follow these recommendations with their own patients.

– John A. Hovanesian, MD, FACS
OSN U.S. Edition Cornea/External Disease Board Member