Accommodating Crystalens: tips for successful implantation

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Accommodating Crystalens tips for successful
implantation

• Jack A. Singer, MD
• Singer Eye Center
• Randolph, Vermont, USA

Consultant to Bausch Lomb Surgical Design
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Crystalens
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12.0 mm tip to tip length 4.00 - 16.75D11.5 mm
tip to tip length 17.00 - 33.00D
17.00 27.00D in 0.25 DIOPTER steps
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Crystalens Accommodative Lens
Increased Pressure
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Accommodative Arching

• Wavefront analysis
• Transient hot spots in natural crystalline lens
  and in crystalens IOL during accommodation
• Transient myopic astigmatism
• Multi-factorial mechanism of accommodation
• Position shifts of the crystalens optic
• Axial movement
• Flexing
• Arching
• Tilt

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Crystalens Accommodative Arching
Kevin Waltz, MD
Distance refractive map Near
refractive map 0.186 rms total error
0.464 rms total errror



-0.690.36X078 -2.370.92x008
S/P IOL Rotation by 90
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Steven Dell, MD Retinal Wave Front Power Map
2002
Power Change 2.5 to 3.0 D
Tracy Technologies
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Crystalens Refractive Targetcrystalens Five-O

• Accommodative blended vision
• plano to -0.25 in dominant eye
• -0.50 to -0.75 in non-dominant eye
• Skew towards myopia in myopes
• Skew towards plano in low hyperopes

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Crystalens Refractive TargetCrystalens HD

• Accommodative blended vision not needed!
• Plano in dominant eye
• -0.25 in non-dominant eye

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Capsulotomy gt optic hinges
AT50SE AT52SE (crystalens Five-O) HD500 HD520
(Crystalens HD)
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Capsulotomy gt optic hinges
6.0 mm horizontal x 7.0 mm vertical for
Crystalens horizontal
Temporal incision
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Enlargement of Anterior Capsulorhexis
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10 Days post-op
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Crystalens Five-O
8 days
4 weeks
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Crystalens Five-O
OD 1 week
OS 4 weeks
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Anterior Capsule LEC removal

• Ultrasonic I/A, curved, 0.2 mm port
• 5 to 15 ultrasound / Free-flow fluidics

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Anterior Capsule LEC removal

• Titanium curettes for sub-incisional area
• Shepard polishers (Momentum Medical,MomentumMedIn
  c_at_verizon.net)

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Anterior Capsule LEC removal

• Ultrasonic I/A, curved, 0.2 mm port
• 5 to 15 ultrasound / Free-flow (gravity)
• Shepherd polishers (Momentum Medical)

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Crystalens Injection
STAAR Surgical MSI-T Titanium injector AQ-FP
cartridge / 2.5 mm incision
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Crystalens Trailing Haptic Tuck
Push, depress, and guide end of loop into bag
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Keep Crystalens vaulted posteriorly

• PAH Pre Aspiration Hydration
• Aspirate viscoelastic ant post to IOL
• Inject BSS (26g) while withdrawing I/A tip

If Crystalens vaults anteriorly...

• Re-hydrate all incisions
• Rock rotate IOL while injecting BSS (26g)
  through side port

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Crystalens Rock Rotate
Uday Devgan, MD
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Crystalens fixation

• Intraocular carbachol (diluted 51 w/BSS)
• Capsular fibrosis around the polyimide loops
• Stable IOL fixation with posterior vault
• Cycloplegia
• Atropine 1 qD x 2 days
• Atropine 0.4 mg intraocular
• Cyclogyl 2 bid x 7 days

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YAG Laser Treatment
Posterior Capsulotomy
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YAG Laser Treatment
Posterior Capsulotomy
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YAG Laser Treatment
Anterior Capsulotomy
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Distance
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Intermediate
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
Uncorrected Near
J1
J1
J2
J3
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crystalens Sept 1, 2007 to Sept 30, 2008
Outcomes at the last postoperative visit
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A lens than can do this Consistently
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Anatomical diagram of accommodative
arching Date 1936
Wavefront mapping of accommodative
arching Date 2006
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Fincham, Mechanism of Accommodation
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(No Transcript)
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HD 5.0 Under 30X Magnification
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(No Transcript)
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AT-45, Five-O and HD-100 Monocular Uncorrected
Near VAwithin 0.50 D of intended target
refraction4-6 months postoperativen60
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AT-45, Five-O and HD-100 Monocular
Distance-Corrected Near VAwithin 0.50 D of
intended target refraction 4-6 months
postoperativen60
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Depth of Field Comparison
Crystalens HD
AT-45
Wave Front Error
P-V 0.72 RMS 0.57
P-V 0.51 RMS 0.36
Bench Test
Data from Ed Sarver
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Log Contrast Sensitivity Mesopic Illumination (3
cd/m2) Without Glare
Log contrastsensitivity
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Log Contrast Sensitivity Mesopic Illumination (3
cd/m2) With Glare (3 Lux)
Log contrastsensitivity
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One Point of FocusSimulated Images
Accommodating
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Blended bi-spheric monofocal accommodating lens
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Monocular Uncorrected Distance Acuity
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Monocular Uncorrected Intermediate Acuity
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Monocular Uncorrected Near Acuity
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Presby-IOL Quality of Vision
Resolution of the human eye is between 6 20
cycles/mm
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Crystalens tips

• Mini-monovision for crystalens Five-O
• Not for Crystalens HD
• Rhexis gt optic hinges (6 x 7 mm)
• Meticulous LEC removal
• Keep IOL vaulted posterior
• Watertight incision
• Carbachol (diluted 51 w/BSS) or Cycloplegia
• Capsule closure w/in 2 weeks
• Ant cap Yag if not closing
• Anti-inflammatory drops x 2 months

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Exceed Patient Expectations
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Thank you for your attention
Singer Eye Center Randolph, Vermont,
USA www.singereye.com/pages/videos.php