Management and Prevention of Capsule Contraction with the Accommodating Crystalens

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Management and Prevention of Capsule Contraction
with the Accommodating Crystalens

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

Consultant to Bausch Lomb
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Capsular Contraction Syndrome (CCS) -James
Davison, JCRS 1993

• Complication of continuous curvilinear
  capsulorhexis NOT due to IOL
• Exaggerated reduction in equatorial capsule bag
  diameter following ECCE
• Proliferation metaplasia of residual lens
  epithelial cells (LECs)
• Weakened zonules may contribute

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Lens Vault

• Symmetric
• Posterior
• Neutral
• Anterior

• Asymmetric

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Lens Vault

• Fibrosis behind the vaulted plate(s)
• PC striae behind the vaulted plate(s), radiating
  towards optic
• Gradual shift in refraction
• New non-keratometric cylinder
• - asymmetric vault

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(No Transcript)
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Anterior Capsule YAG forPosterior-Vault
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Posterior Capsule YAG forAnterior-Vault
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Posterior Capsule YAG forAnterior-Vault
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• 2 cases of asymmetric crystalens vaulting
• with capsulorhexis contraction
• with capsulorhexis retraction
• Prevention of capsule contraction, vaulting and
  refractive shifts

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Asymmetric Crystalens vaulting with
capsulorhexis contraction
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Asymmetric Crystalens vaulting with
capsulorhexis retraction

• 48yo female, PE/crystalens 5.0 OU, March 08
• 1st eye (OS) excessive posterior vaulting
  (1.00)
• Anterior cap Yag anterior vaulting (-1.50)
• 2nd eye (OD) asymmetric vaulting (-1.50)

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Primary gaze
Up gaze
Down gaze
Left gaze
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Gonioscopy
Superior
Inferior
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Asymmetric Crystalens vaulting with
capsulorhexis retraction
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1 week postop Primary gaze MR Plano 20/15
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Right gaze
Left gaze
Right Down gaze
Down gaze
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Stability of Capsulorhexis Size and Refraction
following Crystalens AT50/52SE Implantation
with Anterior Capsule Lens Epithelial Cell
Removal

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

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Study Design

• 100 eyes with crystalens AT50/52SE
• Anterior capsulotomy 6.0 x 6.5-7.0 mm
• Removal of anterior capsule LECs
• Ultrasonic I/A with Free-flow fluidics
  (gravity)(Surgical Design)
• Shepard Capsule Polishers (Momentum Medical)
• Slit lamp photos at 1-3 wks and 4-6 mos
• Manifest refraction at 1-3 wks and 4-6 mos
• No YAG laser treatments prior to 4-6 mos

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Capsulotomy gt optic hinges
AT50SE (Five-0) 6.0 x 7.0 mm
oval capsulotomy
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Capsulotomy gt optic hinges
oval capsulotomy 6.0 x 7.0 mm
AT50SE (crystalens Five-0)
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Anterior Capsule LEC removal

• free-flow fluidics (Surgical Design)

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Anterior Capsule LEC removal

• free-flow fluidics (Surgical Design)

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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
Free flow Ultrasonic I/A
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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 Five-O
8 days
4 weeks
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6 months
1 week
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OD 1 week
OS 1 week
6 months
5.5 months
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OD 1 week
OS 1 week
6 months
5.5 months
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1 week
5.5 months
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OD 1 week
OS 1 week
7 months
6.5 months
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OD 1 week
OS 1 week
5 months
4.5 months
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1 wk
OD
OS
2 mos
6 mos
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Refractive Stability
n 100
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Refractive Stability
100 Eyes (sorted by change in SE)
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Conclusions of this study

• Meticulous anterior capsule LEC removal
• Prevents contraction of anterior capsulotomy
• Stable postop refractions with crystalens

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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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Crystalens HD

• Central 1.5 mm zone is 3 microns thicker
• Approx 1.00 D blended with surrounding optic
• Negative spherical aberration in central 1.5 mm
• Increased depth of focus centrally
• Improved intermediate and near vision
• Aberration gradually shifts to positive towards
  the periphery of the lens

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Crystalens HD

• Single point of focus on optical analysis
• No decrease in contrast sensitivity (in FDA
  trial)
• No decrease in distance acuity (in FDA trial)

Blended bi-spheric monofocal accommodating lens
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Mechanism of Accommodation Fincham, British
Journal of Ophthal 1936
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Crystalens HD
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Crystalens HD
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Crystalens HDSinger Eye Center outcomes
(Surgivision Datalink online outcomes database)
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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
• Anti-inflammatory drops x 2 months

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Thank you for your attention
Singer Eye Center Randolph, Vermont,
USA www.SingerEye.com