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Expanding refractive options with the Crystalens
Surgeon presents cases in which formerly ineligible patients benefit from the accommodative IOL.
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As the eyeonics Crystalens becomes more popular, there are patients requesting the lens who do not appear to be candidates for the new accommodative IOL. The relatively uncharted territory of bioptics and primary piggybacks, however, may offer these patients the advantage of seamless vision with the Crystalens.
The following cases represent possible options for patients who could have been considered unacceptable for the implants due to Crystalens power limitations. The IOL is currently manufactured in steps of 0.25 D from +10 D to +33 D.
Case one
A 57-year-old hyperope presented desiring Crystalens surgery. The preoperative refraction was +9.75 +0.50 × 26 with 20/20 VA on the right, and +10.5-D sphere, 20/30 VA and mild amblyopia on the left.
Biometry revealed that the patient would have required a Crystalens of +35 D for the right eye and +37 D for the left.
The patient’s right eye underwent an uncomplicated lens exchange with implantation of a +33-D Crystalens, the maximum power available, in accordance with recommended technique. The power was supplemented with a STAAR AQ5010 +4-D lens in the ciliary sulcus, taking care to keep both haptics and optics of the STAAR lens clear of the anterior capsule opening (Figures 1 and 2).
Images: Brown DC |
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The eye was pressurized, and both lenses remained in good position. A small, superficial safety suture of 10-0 nylon was placed in the temporal clear corneal incision to avoid depressurization and hypotony.
On a separate occasion, the left eye was implanted with a +3-D STAAR AQ5010 lens in the ciliary sulcus.
Both eyes were maintained on cycloplegics as recommended by eyeonics, ie, Cyclogyl 1% (cyclopentolate HCl, Alcon) four times a day for 10 days postoperatively.
On day 1 the right eye was +0.50 +0.50 × 20 with 20/30 distance, and the left eye was +0.50 sphere with 20/30 distance.
At 2-month follow-up, vision in the right eye was 20/20 without correction and J3 without correction at 14 inches; the left eye was 20/40 at distance without correction and J4 at near.
Slit-lamp examination showed normal anterior segments, iris details and pupil size. The patient is glare-free and enjoys excellent distance and near vision without correction.
Case two
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The patient is a 51-year-old high myope who is contact lens intolerant and will not undergo laser vision correction.
The preoperative refraction was –8.25 +1.00 × 108 with 20/20 VA in the right eye and –7.00 –0.75 × 75 with 20/20 VA in the left eye.
Biometry revealed the Crystalens power would need to be +6 D for the right eye and +9 D for the left.
The left eye underwent a +10-D Crystalens implantation, supplemented by a –1-D AQ5010 STAAR lens in the ciliary sulcus.
On a separate occasion, the right eye was implanted with a +10-D Crystalens, with a primary sulcus implantation of a –4-D AQ5010 STAAR lens.
Both procedures were uncomplicated.
Follow-up examination revealed 20/20 uncorrected visual acuity and J3 uncorrected vision at near.
Slit-lamp examination on each postoperative course showed the sulcus-placed lenses to be virtually invisible. The Crystalens is well-positioned with a posterior vault (Figure 3).
Case three
The patient is a 60-year-old man with bilateral keratoconus. He has been wearing contact lenses for many years but has become intolerant of the contacts.
The left eye had undergone a corneal transplant 40 years prior, which resulted in a clear graft but with high myopia and a large cylinder.
The preoperative refraction was –5.00 +0.75 × 150 in the right eye and –8.50 +4.75 × 25 in the left (Figure 4).
The patient underwent clear lens replacement with a +12-D Crystalens in the right eye. The left eye underwent uncomplicated Crystalens implantation, using a +14-D lens with a planned overcorrection (Figure 5).
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On postop day 1, the right eye was 20/25 +2 without correction and the left eye was 20/400 without correction.
The left eye was monitored for stability, and after 2 months residual refraction was –4.50 +5.00 × 25 with 20/20 acuity.
PRK with mitomycin C was performed on the left eye with a resultant –0.25 +0.25 × 160 with 20/20 acuity.
The patient is now 20/20 at distance without correction in each eye and J2 at near without correction. He states “he has never seen better in his life.”
For Your Information:
- David C. Brown, MD, FACS, ABES, can be reached at Eye Centers of Florida, 4101 Evans Ave., Fort Myers, FL 33901; 239-939-3456; fax: 239-939-1575; e-mail: david.brown@ecof.com. Dr. Brown has a financial interest in Ultralink, LLC, developer of the Artemis II.
- eyeonics inc. can be reached at 6 Journey, Suite 270, Aliso Viejo, CA 92656; 949-916-9352; fax: 949-916-9359; e-mail: contact@eyeonics.com; Web site: www.eyeonics.com.
- STAAR Surgical can be reached at 1911 Walker Ave., Monrovia, CA 91016; 626-303-7902; fax: 626-358-9187; Web site: www.staar.com.