51 V
4000 Experience with single piece AcrySof
Akahoshi T
Tokyo
For a successful clear corneal cataract surgery, use of a folda-
ble IOL is mandatory. Ten years ago, the only choice of the folda-
ble IOL in Japan was silicone lens, however, due to the high in-
cidence of the after cataract and post operative inflammation ob-
served especially in the cases with uveitis and diabetic retinopa-
thy, we have stopped using silicone IOLs. For these seven years,
our first choice IOL has been acrylic. I will introduce my recent
cataract surgery and seven years experience with over 20,000
AcrySof implantation, especially focused on the recent 4,000 ex-
perience with a single piece AcrySof. Under the topical anesthesia
with Benoxinate (0.4 % oxibuprocaine), cataract was removed
through a temporal clear corneal incision by the ultrahigh vacu-
um phacoemulsification with Legacy. Every nucleus was mecha-
nically divided by the Phaco Prechop technique prior to the pha-
coemulsification. All the wound was self sealed without suturing.
Nowadays, three types of the AcrySof are used. The first choice is
a single piece AcrySof SA30AL with a 5.5 mm optic. For myopic
patients, whose IOL power is out of the range of SA30AL, 6.0 mm
optic three piece AcrySof MA60MA is used. For some special ca-
ses, the second choice three piece AcrySof with a 6.5 mm optic,
MA50BM is used. Those cases include strong against the rule
astigmatism larger than 1.5 D, cases with any vitreoretinal lesions
such as diabetic retinopathy or retinal hemorrhage which will
require subsequent laser photocoagulation or vitreoretinal surge-
ries, cases with unexpected rupture of the posterior capsule du-
ring the surgery, cases with weak ciliary zonules such as sublu-
xated lens by ocular trauma, pseudoexfoliation syndrome or reti-
nitis pigmentosa, and aphakic cases which require secondary IOL
implantation into the sulcus. AcrySof SA30AL was implanted with
a Monarch II injector system through a 3.0 or 3.2 mm clear cor-
neal incision. For implanting this lens with a forceps by a single
action, it was necessary to fold it between 3 and 9 o'clock position
and 4.0 mm larger incision was required. To implant the lens
through a smallest incision with a forceps, the lens should be fold
between 12 and 6 o'clock, which required two step implantation.
With a Monarch II injector system, the lens can be implanted
through a smallest incision by a single action. With a newly de-
veloped non screw type injector handpiece named Royale, im-
plantation has become much easier and faster. We have recently
developed a quite new injector system named Forceptor. With
this brand new implantation device, the lens can be implanted
without forceps nor injector. The time required for loading and
implanting the lens has been reduced to less than half of the
conventional method. The decentration of the lens observed after
tight implantation with a forceps was 2.4 % in the initial 4,000
cases of the three piece AcrySof, while 0 % in the initial 4,000
single piece AcrySof implanted with any of the four implantation
devices. Before we start to use the single piece AcrySof, MA60BM
or MA30BA had been used as a first choice until November, 2000.
5,782 MA60BM were implanted from August 1994 to March 2000
and 11,272 MA30BA from June 1996 to November 2000. Up to
December 2001, 739 MA50BM, 50 MA60MA and 4,382 SA30AL
have been implanted. With any types of the AcrySof, the post
operative inflammation was negligible and the laser flaremetry
data showed less than 10 PC on the next day of the surgery. 80 %
of the cases without any retinal lesions attained 20/20 corrected
vision on the next day and 93 % one week later. The incidence of
after cataract is extremely low in any AcrySof. The final YAG caps-
ulotomy rate was 1.59 % for 88 months' follow up period, which is
the lowest rate among any other IOLs we have ever experienced.
In 80.0 % of the YAG treated cases, the anterior capsulorhexis was
found to be eccentric to the optic and the anterior capsule did not
cover the optical edge uniformly. Concentric capsulorhexis slight-
ly smaller than the optic size which covered the optical edge
uniformly, resulted the lowest YAG capsulotomy rate of 8.9 %.
The size and position of the capsulorhexis seem to be one of the
important factors to reduce the after cataract formation. AcrySof
has achieved excellent clinical results in short and long term ob-
servations, which can be concluded to be the most suitable IOL
for the clear corneal cataract surgery at this moment.
Zurück
Zur Tagungsübersicht DGII 2002