Meticulous surgery brings out the best in accommodating IOL

Accommodation capability was confirmed in a 4-year study with UBM and aberrometer technology.

Careful surgical maneuvers could best ensure success with an accommodating IOL, according to one surgeon.

The Synchrony IOL (Visiogen/Abbott Medical Optics) is a single-piece, dual-optic silicone IOL designed to mimic the natural lens. While the posterior optic is negatively powered, the anterior optic has a positive power of 32 D. The spring-like structure that connects the two optics allows their relative distance to change with the accommodation effort, thus providing distance, intermediate and near vision.

“There are a few simple rules to be followed if you want this lens to be efficient,” Eduardo Marques, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons in Istanbul, Turkey.

“First of all, when I implant accommodating lenses, I like to mark the cornea because I want my rhexis to be a constant size, which with Synchrony is around 5 mm, and I want it to be as centered and as round as possible to keep the lens inside the bag,” he said.

The second important step is to achieve a clean, transparent capsular bag. Dr. Marques not only removes the cortex, but also polishes the underside of the anterior capsule to remove the lens epithelial cells.

“This will make the capsule more transparent, and I believe that it will keep it more flexible over time,” he said.

Implantation of the lens is quite easy, according to Dr. Marques. The Synchrony comes preloaded in an injector. As long as the surgeon ensures that the injector is kept level with the capsulorrhexis, the lens unfolds and centers nearly on its own.

Finally, the viscoelastic must be thoroughly removed from the space between the optics. This can be done with either a bimanual or coaxial irrigation and aspiration technique.

Initial study

In the first 48 patients Dr. Marques implanted with the Synchrony lens, the average incision size was 3.7 mm and the average capsulorrhexis size was 5 mm.

“This is exactly what we wanted to achieve,” he said.

Mean refraction after implantation of the lens was plano ± 0.7 D, and astigmatism was 0.5 ± 0.5 D.

“We were very pleased because we are using a fairly large incision that could theoretically lead to a higher amount of astigmatism,” Dr. Marques said.

Visual acuity results were encouraging. Distance vision was as good as with the best monofocal lens, intermediate vision was sharp and clear, and distance-corrected near vision was 20/40 or better in 80% of patients.

“These results are very good for an accommodative lens,” Dr. Marques said.

The posterior capsular opacification rate is low with this lens, he said.

Further research

In a separate study, Dr. Marques confirmed that the Synchrony lens has true accommodation capabilities that are maintained over time.

“The theory is that with a 1-mm distance change, we achieve 2.5 D of accommodation. We wanted to demonstrate that this really happens inside the eye,” Dr. Marques said.

Over a period of 4 years, subjective measurements of distance-corrected near visual acuity and amplitude of accommodation were taken in five patients. Objective evidence of accommodation was evaluated using ultrasound biomicroscopy and iTrace aberrometer (Tracey Technologies).

“Patients maintained a stable capability to read at near over the entire follow-up period, and UBM showed forward axial movement of the front optic during accommodation at 1 and 4 years, with similar magnitude movements between these time points. The iTrace showed a very consistent myopic refractive change during accommodation at all time points,” Dr. Marques said.

“I believe that this lens is a very viable option for presbyopia,” he said. – by Michela Cimberle

• Eduardo Marques, MD, can be reached at Hospital da Cruz Vermelha Portuguesa, Rua Duarte Galvão 54, P-1549-008 Lisboa, Portugal; 351-217-713-566; email: em.lx@netcabo.pt.
• Disclosure: Dr. Marques is a consultant for Abbott Medical Optics.