AcriClip may prevent rotation of Toric IOL in the eye

The device, a PMMA ring with a notch, is injected through the haptic eyelet in the lens.

Issue: July 15, 2002

ByMichela Cimberle

A looped PMMA ring injected through the hole of the plate acts as a clip.

Additional implantation of an open-loop PMMA ring through one hole of the plate haptic.

The loop is threaded through the hole in the plate haptic until the notch captures it and holds the lens in place.

ROME – Postoperative rotation of toric plate IOLs can be effectively prevented by using a special notched ring that clips into the hole of the haptic and holds the lens in its exact position, according to a surgeon speaking here.

“The device is also extremely safe and easy to implant,” said Tobias Neuhann, MD, here at Rome 2002. Dr. Neuhann, the developer of the device, has been using it for over a year.

“Results are almost unbelievable; we have had no case of rotation or decentration in more than 100 patients,” he said.

Blocking IOL movements

Dr. Neuhann believes toric IOLs are a good solution for correcting astigmatism in cataract patients.

“They’re not popular with most doctors. The main reason is that in 10% to 20% of cases the lens rotates under capsular shrinkage in the early postoperative period. A toric lens that is not in the right position is undoubtedly a failure. Cases of luxation after Nd:Yag laser treatment have also been reported,” he said.

Dr. Neuhann said he has been using the STAAR toric IOL for 10 years. He implants an average of six lenses of this kind per week on a total of about 100 cataract patients, he said.

“I always believed it was a matter of finding the right means of stabilizing the lens. First we tried to control rotation by implanting a capsular tension ring [CTR] that was injected through the hole of the lens loop. It worked quite well because there was no more axis rotation, capsule contraction was controlled by the ring and we had no cases of lens luxation. However, in about 6% of our cases the ring produced a decentration of the IOL after about a year, due to the new incalculable size of the bag,” he said.

Complete stability

The AcriClip (AcriTec) offered the solution, combining the advantages of a CTR with a design that was conceived specifically for securing the IOL haptic to the desired position without creating additional problems.

The device is an open PMMA ring with an inward notch on one side. Once the lens is inserted in the eye, the ring is injected through one of the plate holes with a special injector (Geuder).

“The loop goes through the hole of the lens until the notch captures it and holds it in place. The lens is 100% stable on its axis and the ring represents a constant resistance against capsular bag shrinkage, distributing its irregular tensions around the circumference and along the equator. The AcriClip therefore keeps the lens in the exact position in which it was placed intraoperatively,” Dr. Neuhann said.

Sulcus fixation

The lens was stable after 1 year in all the eyes he has implanted. There have been no intraoperative or postoperative complications due to the ring, he said. Dr. Neuhann also credits the IOL clip for allowing him to implant six lenses in the sulcus.

“Sometimes the capsular bag breaks during implantation of the lens. Normally, you would have to explant the lens and put in a different one, knowing that this is a very expensive lens and also that there are no other toric IOLs available for sulcus fixation anyway,” he said.

“Now, instead, I leave the lens in place and inject the ring in the ciliary sulcus through the lens. The ring holds it in the ciliary sulcus because it’s a kind of haptic, effectively preventing the IOL from dropping into the vitreous cavity,” he said.

Dr. Neuhann believes toric IOLs will gain in popularity due to the AcriClip.

“They are far more accurate than relaxing incisions, and the IOL clip guarantees perfect long-term results with a fast, simple and safe implantation technique and no complications,” he said.

For Your Information:

Tobias Neuhann, MD, can be reached at Augenklinik am Marienplatz, Marienplatz 18/19, 80331 München, Germany; +(49) 89 2308890; fax +(49) 89 23088910; e-mail: sekretariat@a-a-m.de; Web site: www.a-a-m.de.

AcriTec, manufacturer of the AcriClip, can be reached at Lindenstrasse 22/24 D-16548, Glienicke bei Berlin, Germany; +(49) 33056 610-0; fax: +(49) 33056 610-10; e-mail: acrisales@acritec.de; Web site: www.AcriTec.de.

STAAR Surgical, manufacturer of the AA-4203TF and AA-4203TL toric IOLs, can be reached at 1911 Walker Ave., Monrovia, CA 91016; (626) 303-7902; fax: (626) 358-9187; Web site: www.staar.com.