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Current IOL models leave no 'moving space' for pseudoaccomodation
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STOCKHOLM, Sweden — High frequency ultrasound technology provides accurate, dynamic views of how IOLs fit in and interact with ocular structures, and shows where and how most of the problems of currently available IOL models originate.
"We are at a turning point, where we cannot any longer follow the usual pathways," Philippe Sourdille, MD, said here at the meeting of the European Society of Cataract and Refractive Surgeons. "IOL technology must evolve on the basis of what we have been able to see through these advanced viewing systems."
Although we know that capsular bag diameter varies considerably between patients, we still produce IOLs with the same diameter, Dr. Sourdille said.
Ultrasound anterior segment analysis of 26 patients followed for 10 months showed excellent central PCO prevention, but some adherence of the anterior capsule to the IOL optic, leading to a not perfectly transparent, partially fibrotic system.
Inappropriately-sized IOLs deform the anatomy of the capsular bag/zonule/ciliary body system, causing IOL-related complications and preventing a potential restoration of accommodative movement, he added.
"The excellent studies carried out in Rome with the HiScan Optikon 2000 system by Marina Modesti, MD, demonstrated that accommodation movements disappear with age, but partially reappear after cataract surgery," he said. "With the currently available IOL models, we don't exploit this possibility."
Most conventional IOLs are in fact too large, he said. They stretch the capsular bag, and settle in a backward position which certainly does not encourage pseudoaccommodation.
"A properly-sized IOL should always leave a 'moving space' between the ciliary ring and the capsular bag's equator. If the implanted bag is behind the ciliary ring, there is no space, and therefore no movement is possible," Dr. Sourdille said.