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The IOL= The IOL-VIP System

The IOL= The IOL-VIP System. Dominic McHugh Royal Society of Medicine 2010. ARMD. Leading cause of blindness (“SVL”) in the Western World 2.7 million in the UK have some loss. 54% increase in >75s over the next 25 yrs. ARMD Quality of Life. With ARMD Without ARMD Home Care 23% 5%

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The IOL= The IOL-VIP System

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  1. The IOL=The IOL-VIP System Dominic McHugh Royal Society of Medicine 2010

  2. ARMD • Leading cause of blindness (“SVL”) in the Western World • 2.7 million in the UK have some loss. • 54% increase in >75s over the next 25 yrs.

  3. ARMD Quality of Life With ARMDWithout ARMD Home Care 23% 5% Falls16% 8.3% Falls With Fractures3.5% 1.5% Healthcare Costs €12,579 €1,300 (£8,521) (£885)

  4. LVA Possibilities

  5. Difficulty maintaining coaxial alignment Monovision VF 20° 11 mm incision Surgical Rehabilitation for ARMD • Hanita Ben-Sira implant • Galileiantelescope 2x • IOL+spectacle • Intraocular Miniature Telescope • Galileiantelescope 2.2- 3.5x intra (Lipshitz)

  6. IOL-VIP SystemBCC IOL in the capsular bag = telescope ocular BCX IOL in AC= telescope objective

  7. IOL-VIP SystemPC IOL AC IOL-66D +55D

  8. IOL CHARACTERISTICS ANTERIOR CHAMBER IOL (BCX) Optic Material PMMA with UV filter Diameter 5.0 Thickness 1.5mm Haptics Loop shape Z Material PMMA-1P Angle 10° IOL power+55.00 D PC IOL (BCC) Optic Material PMMA with UV filter Diameter 5.0 Thickness 1.5mm Haptics Loop shape C Material PMMA-1P Angle 7° IOL power -66.00 D

  9. Bilateral stable macular degeneration/macular hole • VA 6/18-6/60 • Adequate endothelial cell count • Adequate AC depth • Good peripheral field • Predicted benefit by IOL-VIP simulator Inclusion criteria for IOL-VIP surgery

  10. Active exudative macular degeneration • Glaucoma • PAS • Cornea guttata • Endothelial cell count < 1600 cell/mm2 • Shallow anterior chamber with depth < 3 mm • Corneal diameter < 11 mm no visual acuity improvement using the IOL-Vip simulator Exclusion criteria for IOL-VIP Surgery

  11. IOL-VIP Proposed mechanism of action Prismatic deviation of Image to PRL. Image magnificiation ~1.3

  12. Image shift to PRL (MP) Pre-op Post-op RE preop BCVA : 0.25 postop BCVA: 0.5 LE preop BCVA : 0.3 postop BCVA: 0.7 (Fasciani et al, 2008)

  13. IOL-VIP Simulator Prism

  14. IOL-VIPPreoperative assessment Best VA without and with simulator prism, rotated to achieve PRL

  15. IOL-VIP System Optimal simulator orientation determines relative IOL position 12 12 9 9 3 3 6 6 Right Eye Left Eye 12 12 3 9 3 9 6 6

  16. IOL-VIP System Optimal simulator orientation determines relative IOL position 12 12 9 9 3 3 6 6 3 9 Right Eye Left Eye 1-2 1-2 8-7 8-7 12 1-2 1-2 8-7 8-7 6

  17. IOL-VIPSurgeryPhakic/Pseudophakic eyes Corneal tunnel (superior/temporal depending on IOL orientation Large (6-7 mm) CCC Phacoemulsification if phakic Enlarge corneal incision to 7 mm PC IOL: bag if phakic, sulcus if pseudophakic PI+miochol A/C IOL Corneal sutures

  18. IOL-VIPSurgery

  19. IOL-VIP Visual Outcome Mean improvement (logMar) 1.28 preopvs0.7 postop 0.05 preopvs 0.2 postop (n=40 eyes; mean f/u 20 months, range 7-35) Orzalesi et al 2007

  20. IOL-VIPPostoperative findings • Low surgical complication rate • Endothelial cell loss 7% • PCO 18% • High hyperopia in emmetropes; better if myopic • Recent availability of “bespoke” implants

  21. IOL-VIPConclusions Advantages Improves reading/distance vision in suitable cases (6/18-6/60 pre op; small-moderate central scotoma) Patients comment favourably on scotoma shifting away from centre Disadvantages Careful selection required: pathology; psychology; costs Lengthy (6 week) postoperative rehabilitation training Suture removal Refractive error : hyperopia and astigmatism (reduced with new implants

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