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Safety and Efficacy of Toric ICL

Safety and Efficacy of Toric ICL. April 2008 ASCRS. John Chang Jr. MD Director of Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium & Hospital. Toric Implantation Collamer Lens (TICL) is now in phase III of the U.S. FDA study. TICL. From 04/2004 to 04/2007 No. of patients: 27

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Safety and Efficacy of Toric ICL

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  1. Safety and Efficacy of Toric ICL April 2008 ASCRS John Chang Jr. MD Director of Guy Hugh Chan Refractive Surgery Centre Hong Kong Sanatorium & Hospital

  2. Toric Implantation Collamer Lens (TICL) is now in phase III of the U.S. FDA study

  3. TICL • From 04/2004 to 04/2007 • No. of patients: 27 • No. of eyes: 42 • Bilateral TICL: 15 • Age range: 23 to 44 yrs • Mean age: 32.1 ± 6.7 yrs • Mean FU: 6 months Lens power range (Visian TICL) • Sphere ranges from -3D to -23D • Cylinder ranges from +1DC to +6DC • Customized axis • Can correct up to -18DS/-0.75DC or -14DS/-5.0DC

  4. TICL - Results

  5. TICL - Results PostOp Rx at 12M

  6. TICL - Stability

  7. TICL - Results – 12M

  8. TICL - Safety – 12M No eye lost any vision

  9. TICL - Complications • 1 eye (2.9%) transient IOP rise at 1 month • Steroid induced • 1 lens rotated 15o clockwise • Patient with RE preop Rx -18.75/+3.50 x100 • Implanted with TICL -23.0/+3.50/099 • After surgery the lens rotated clockwise by 15o • Residual Rx -2.00/+2.50x120 (20/20), UCVA 20/80 • Lens dialed 6M after surgery • UCVA 20/25; MRx -0.50/+1.00 x 65 (20/20)

  10. TICL - Surgical Technique • Same as Non Toric • Laser PI 1week prior to lens implantation • Temporal 3.0 - 3.2mm self sealing incision • Lens injected via foldable injector into AC • Lens dialed into sulcus • Surgery done under topical anesthesia • Toric lens supplied correct Power for Sphere and Cylinder but axis can be different by up to 22o • During surgery the axis of the lens to be positioned is marked. • Temporal incision is made to match that axis • Need to dial lens into position (surgical planner software supplied)

  11. TICL - Advantages & Disadvantages Advantages • Technically not difficult (Avg surgery time 25 mins) • No / Minimal night vision problems • Short learning curve – easier than Phaco • Lens is removable Disadvantages • Sizing can be difficult, Orbscan not always reliable • Sizing even more important than non-toric ICL • Glaucoma? Pigment dispersion? • Expensive • 2 Procedures: Laser P.I. First (uncomfortable), then lens implantation

  12. TICL - Conclusion • Toric ICL results very encouraging (100% 20/20 UCVA) • Transient IOP rise 2° to steroid use • Accuracy as good / better than LASIK for high myopia • Much better immediate and long term stability than LASIK. • No cataract with TICL

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