New accommodating lens provides optimal quality of vision at 3 months

For best results, the capsulorrhexis should be 5.5 mm to 6 mm, and the lens should be rotated when inserted, surgeon says.

Issue: August 2009

ROME — The Crystalens HD from Bausch & Lomb performs well at 1 and 3 months, allowing a high degree of spectacle independence for far and near vision, according to a study.

The Crystalens HD is the fourth generation of the only accommodative lens. Further enhancements to the design of the implant have resulted in increased depth of focus to improve near, intermediate and distance acuity, as well as visual quality.

Made of a third-generation silicone material, Biosil, the lens is a modified plate-style implant with a larger, 5-mm optic. The loop-to-loop length is 11.5 mm, but a longer 12-mm version is available for eyes with longer axial length. The A-constant is 119, and the refractive index is 1.427.

“Compared to the previous AT-50SE, this model has better results at distance, intermediate and near,” Erik L. Mertens, MD, FEBOphth, said.

In his case series, cataract surgery was performed with the Stellaris phaco system (Bausch & Lomb).

After phacoemulsification, the 1.8-mm incisions were enlarged to 2.8 mm, and the Crystalens HD was implanted with the specifically designed injector.

Surgical tips

Dr. Mertens gave a few surgical tips for successful outcomes with this lens. The capsulorrhexis should be 5.5 mm to 6 mm, and the lens should be rotated when inserted.

“If you cannot spin, it isn’t in, as they say. Also ensure that the optic of the lens is folded posteriorly,” he said.

A watertight incision is mandatory because a loss of chamber stability after surgery would make the lens fall forward, with negative consequences on postoperative refraction.

At the end of surgery, a drop of atropine should be instilled in each eye.

Early data

Dr. Mertens presented the 1-month data at the winter meeting of the European Society of Cataract and Refractive Surgeons here. Results in 55 eyes at 1 month showed a monocular uncorrected distance vision of 20/40 or better in 78% of the eyes, 20/32 or better in 64%, 20/25 or better in 44% and 20/20 or better in 25% of the eyes. A further improvement was seen in the 29 eyes that achieved 3 months of follow-up, in which 20/40 was achieved by 72%, 20/32 by 59%, 20/25 by 52% and 20/20 by 31%.

Intermediate vision was 20/40 in 96% of the eyes, 20/32 in 93%, 20/25 in 84% and 20/20 in 76%. At 3 months, intermediate was 20/40 in 100% and 20/20 in 81%.

Near vision was optimal. At 1 month, 80% of the eyes could read J3 or better, 68% J2 or better and 44% J1 or better. At 3 months, J3 was achieved in 89% of the eyes and J1 in 74%.

“We are extremely satisfied with our results. We’ll continue to expand our case series and to monitor our patients to evaluate the performance of the lens in the long term,” Dr. Mertens said.

He recommended an accurate preoperative examination to select the suitable candidates.

“Managing expectations is also important,” he said. – by Michela Cimberle

Erik L. Mertens, MD, FEBOphth, is director of the Medipolis Eye Center in Antwerp, Belgium. He can be reached at Medipolis, Boomsesteenweg 223, B-2610 Wilrijk, Belgium; +32-3-8282949; fax: +32-3-8208891; e-mail: e.mertens@medipolis.be.

Dr. Mertens’ results are similar to the results we are seeing in the United States. I was privileged to lead the [U.S. Food and Drug Administration] study of the Crystalens HD-100 and to implant the first HD-500 lens after FDA approval was granted in July 2008.

As Dr. Mertens pointed out, with meticulous attention to detail in biometry and surgical technique, excellent results can be expected. Patients are for the most part thrilled with their vision, and they usually become enthusiastic ambassadors of this new technology and the surgeon who implanted it. I would expect that those surgeons who adopt this technology will be pleased with their decision.

– James Davies, MD
Innovision Eye Care Center, Carlsbad, U.S.A.