Folie 1

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ga_at_uni-hd.de www.lasik-hd.de
The CIA Customised IOL Application Individiual
approach towards presbyopic refractive lens
exchange with multifocal and monofocal IOLs
Auffarth GU, IJ Limberger, Borkenstein AFM,
Mansfeld A, Ehmer A
Dept. of Ophthalmology, University of
Heidelberg, Germany, Director Prof. Dr. H.E.
Völcker
The authors have no financial interest in the
products mentioned here
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Purpose

• To evaluate outcome of presbyopic refractive lens
  exchange with implantation of multifocal and
  monofocal IOLs
• Special reference to binocular outcome including
  amblyopic eyes

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Methods and Patients

• Interventional case series of 30 patients, aged
  between 44 and 66 years
• Uncomplicated refractive lens exchange surgery
• Amblyopic or astigmatic eyes were included
• Individualized IOL application (Multifocal, Toric
  or Monofocal IOL)
• First surgery on amblyopic eye

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Intraocular lenses used

• The patients underwent uncomplicated presbyopic
  lens exchange with implantation of either
• AMO tecnis diffractive multifocal IOL,
• AMO ReZoom,
• refractive Rayner M-Flex or
• M-Flex T(oric) or
• Alcon Restor
• Monofocal IOLs aspherical and/or toric IOLs

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Results

• Only 50-60 of patients were bilaterally suitable
  for multifocal IOL technology.
• Others required monofocal aspherical IOLs (AMO
  Tecnis ZA9003) or toric IOLs (Rayner T-Flex,
  Acrysof Toric IOL) or combination of it.

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Results

• Preoperative conditions against
• multifocal IOLs were
• Higher grade of astigmatism,
• higher grade of ametropia (MIOL
• not available in that power range)
• Patient concern about
• contrast/glare problems
• Financial problems (costs of IOL)
• were no issue.

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Case 1 Female, 54 yrs.,RLE
Normal Eye
Amblyopic Eye
OD Pre-OP-Data UCDVA 20/50 0.75 sph
20/20 IOL AMO Tecnis Multifocal ZM900
(21.5 Dpt.) OD Post-OP-Data UCDVA
20/20 UCNVA 20/20
OS Pre-OP-Data UCDVA
20/100 6.25/-4.75/175 20/30 IOL Rayner 588F
M-Flex T (22.0 Dpt./4.5
Torus) OS Post-OP-Data UCDVA
20/30 UCNVA 20/30
Binocular 20/20 Spectable free
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Case 2 Female, 59 yrs., RLE
Normal Eye
Amblyopic Eye
OD Pre-OP-Data UCDVA 20/200 5.0/-1.0/96
20/25 IOL AMO Tecnis Multifocal
ZM900 (31.0 Dpt.) OD Post-OP-Data UCDVA
20/40 UCNVA 20/30
OS Pre-OP-Data UCDVA
20/200 6.0/-3.0/175 20/25 IOL Rayner 588F
M-Flex T (28.0 Dpt./3.5
Torus) OS Post-OP-Data UCDVA
20/30 UCNVA 20/40
Binocular 20/30 Spectable free
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Case 3 Female, 54 yrs. RLE
Amblyopic Eye
Normal Eye
OD Pre-OP-Data UCDVA HM -12/-1.5/60
20/200 IOL Alcon Toric SN60T5 (12.0 Dpt./3
Torus) OD Post-OP-Data UCDVA
20/100 UCNVA n/a
OD Pre-OP-Data UCDVA HM -11/-1.5/180
20/50 IOL AMO Tecnis Multifocal
ZM900 (12.5 Dpt.) OS Post-OP-Data UCDVA
20/30 UCNVA 20/40
Binocular 20/30 Spectable free
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Results

• Combinations of following IOLs were possible

Rayner M-Flex T
AMO Tecnis MIOL
Alcon Restor
Alcon Toric
Alcon Toric
AMO Tecnis MIOL
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Conclusions

• Custommatching of different Multifocal IOLs
  with toric or blue light filter IOLs is possible
  without further complains or visual symptoms of
  the patients.
• Unilateral Multifocal IOL Implantation is
  possible if the fellow eye is completely
  corrected by a toric IOL thus enhancing the
  binocular performance.
• Refractive lens exchange in the presbyopic age
  group is a multifactorial approach consisting of
  a variety of IOL options which can be offered to
  the patient.

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G.U. Auffarth A.F.M. Borkenstein, A. Ehmer, M.P.
Holzer, S. Hara, H. Jin, I.J. Limberger, T.M.
Rabsilber, M.J. Sanchez, I.Schmack
International Vision Correction Research Centre
Certified for DIN EN ISO 90012000
Web www.lasik-hd.de