Scleral fixation of foldable IOL recommended for trauma, vit/ret surgery

Size and shape of the Ultima IOL enhance stability and allow fundus visualization, surgeon says.

Issue: August 15, 2003

ByMichela Cimberle

Corneal Ultima
Specifications

One piece
Hydrophilic acrylic with 26% water contents and UV filter
Optic diameter: 6.5 mm
Total diameter: 13 mm
A-Constant: 120
Power range: +10D to +30D in 0.5 D increments

PARIS – The Ultima IOL from Corneal is designed specifically to be used in cases without sufficient capsular support, according to the surgeon who designed the lens. The name Ultima refers to its use as a last choice, when IOLs are not appropriate, said Giuseppe Migliorati, MD.

“It is the first scleral-fixation lens that is foldable and can therefore be implanted through a 4-mm incision. Conventional lenses required a large cut, which produced a higher rate of astigmatism,” he said at the meeting of the French Society of Ophthalmology. In addition, its large, symmetric Greek-cross design with four points of fixation provides excellent stability in the sulcus, Dr. Migliorati said.

Perfect stability

When Dr. Migliorati submitted his IOL design to Corneal, he had two goals in mind: small incision and stability. Once the first prototypes of the lens were produced and he implanted them in his patients, results were “beyond expectations,” he said.

“Even without sutures, this lens is absolutely stable, without any tilting. We had the opportunity to see how firmly and precisely it was positioned through the photos we took of an aniridic patient implanted with it,” he said.


The lens is flat, with a haptic angulation of 0°.
The IOL was initially inserted by a 3-6-9-12 o’clock suture.	Subsequently, a 3-9 or 2-8 o’clock suture was used.

In two cases, the suture was judged unnecessary due to the presence of a residual capsular support.

In one case, a new insertion technique was adopted with no direct suturing of the IOL, but using what was coined as “hammock sutures.” The lens was leaned on two pieces of suture put across 7 and 5 o’clock and 11 and 2 o’clock.

The lens is always well centered with or without scleral suturing.

The elasticity and compressibility of the acrylic material, together with the design of the haptics, allow this lens to be adapted to different sulcus diameters, he said.

“If there is a minimum of capsular support, the lens doesn’t need sutures. Otherwise, two sutures at 9 and 3 o’clock are usually sufficient to keep it firmly in place. An additional suture is needed at 6 o’clock when you use the lens as a support for a second, piggyback implant. What is good is that you can choose case by case whether to apply two, three, four or no sutures,” Dr. Migliorati said.

Implantation

Thanks to the suppleness of the material, implantation is fairly easy once the surgeon has become familiar with the lens.

“Initially, if there are residuals of the capsule in the eye, the large size of the IOL may be a problem, but after a few implants you get used to it because the lens is extremely manageable. My advice is to use forceps that open widely in the eye. The forceps which were normally used for silicone lenses are not suitable because they don’t have an aperture which is large enough,” said Dr. Migliorati.

During fixation maneuvers, if sutures are applied, he also recommended to keep the lens well hydrated because it tends to dry and stiffen.

“Finally, in case the lens is sutured in more than two points, two surgeons are better than one to make the maneuvers easier and faster,” he said.

Indications

Dr. Migliorati has implanted about 15 Ultima IOLs, mostly in cases of complicated ocular trauma or vitreoretinal surgery.

In case of ocular trauma, no matter how much of the posterior capsule is left, this lens has a good fit and stability and can be implanted without causing any further damage to the eye, he said.

“Some of our patients had miotic or atrophic pupils due to inflammation or glaucoma. In such cases, conventional scleral-fixation IOLs could not be inserted without causing a severe trauma to the pupil. The Ultima lens, on the contrary, passed through these small pupils without any problem,” said Dr. Migliorati.

The lens is also an effective response to the requirements of eyes undergoing vitreoretinal surgery, he said.

“In a patient with retinal detachment and subluxated crystalline lens, I performed cataract surgery, implanted the lens in the sulcus without sutures, then carried out a vitrectomy with the use of gas and silicone oil tamponade,” he said. “Thanks to its large, 6.5-mm optic, the lens allows for perfect visualization of the ocular fundus and stays in place, perfectly stable, during surgery.”

If the power of the lens needs to be adjusted, the large, flat shape of the Ultima provides support for piggyback implants, Dr. Migliorati said.

“When sutured, it is almost like an artificial capsule,” Dr. Migliorati said.

In his case series, visual results were good in all the patients who could regain some degree of vision.

For Your Information:

Giuseppe Migliorati, MD, can be reached at Via Andreuzzi 12, Udine, Italy; phone/fax: (39) 0432-511027 ; e-mail: giuseppe.migliorati@libero.it. Dr. Migliorati has a financial interest in the Ultima IOL.

Corneal, maker of the Ultima IOL, can be reached at 31 Rue des Colonnes, 75012 Paris, France; (33) 1-43-42-9393; fax: (33) 1-43-07-0190; e-mail: export@corneal.com.