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  • Pearls For Implantable Phakic Contact Lens (Care Group India) by DR Suresh K Pandey DR Vidushi Sharma, SuVi Eye Institute Kota India

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    Dr Suresh K Pandey
    2K Ansichten66 Seiten
    For most patients seeking correction of their refractive error, LASIK is a safe and effective method of correcting nearsightedness, farsightedness and astigmatism.In fact, LASIK surgery is still the most common procedure to help those wishing to eliminate their dependence on eyeglasses and contact lenses. However, some patients are not good candidates for LASIK because they are extremely nearsighted, have thin corneas, or have other conditions that might predispose them to complications with LASIK. In these patients, the Implantable Phakic Contact Lens (IPCL Care Group India) might be the best option for correcting their vision. How do I know if I am a suitable IPCL candidate? Candidates for the IPCL are above 18 years of age, suffer from myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism (Cylindrical power) and want to experience superior vision correction. Candidate with refractive error who are unsuitable for laser refractive surgery. Prospective person should consult his/her ophthalmologist (eye surgeon) for more information, including an assessment of their candidacy. Women who are pregnant or nursing should wait to have the ICL implanted. Lastly, those without a large enough anterior chamber depth or endothelial cell density may not be a good IPCL candidate. ?????? No blood! No pain! No hospitalisation! Almost all levels of power can be treated. Excellent quality of vision. Easily removed or replaced ( 5 - 10 minutes) Cosmetically good as it’s INVISIBLE!! Fast recovery. How does the IPCL work? ???? Similar to a contact lens Designed to remain inside the eye Doesn’t get dirty and needs no maintenance unlike a contact lens Once -a- year visit to hospital recommended for examination How does the IPCL differ from other refractive procedures? ????? Does not cut or remove tissue from the cornea Cornea retains it natural shape Safer for higher degrees of myopia, hyperopia, astigmatism and thin corneas. Less glare issues on patients with large pupils. Very stable overtime, no regression What to expect on the procedure? ??? Procedure should take 10-15 minutes per eye Laser Iridotomies done prior to surgery Dilating and anesthetic drops The IPCL Procedure : ?????? The implant surgery is quick and painless, lasting only about 10-15 minutes. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid speculum will be placed between your eyelids to keep you from blinking during the procedure. The recovery time is short and the results of the surgery are almost immediate. Most patients resume normal activities within a week. Potential IPCL risks include : Over correction : This complication occurs if the prescriptive power of the implanted IPCL is too strong. In most cases it can be corrected with corrective eyewear or with an IPCL replacement. Undercorrection : The opposite of overcorrection, undercorrection is the result of an implantable contact lens with too weak of a prescription. Correction methods are similar to those of overcorrection. Infection : During most surgeries, there is a potential risk of an infection. Increased intraocular pressure : Pressure may build in the eye after an IPCL procedure. The sooner a surgeon is alerted to this, the greater the chance of avoiding serious damage. This is detected during your follow up visits with us or in case you face acute blurring of vision or headaches, you must visit the eye clinic. IPCL may rarely need to be repositioned. Damage to crystalline lens : because implantable contact lenses are implanted into the eye, there is a potential that the eye’s natural lens may be damaged during the procedure. If the damage is severe, the crystalline lens may need to be replaced with an intraocular lens. Cataract development : Over 50 pe

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    Pearls for Implantable Phakic Contact Lens (Care Group India) by Dr Suresh k Pandey Dr Vidushi Sharma, SuVi Eye Institute Kota India

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    For most patients seeking correction of their refractive error, LASIK is a safe and effective method of correcting nearsightedness, farsightedness and astigmatism.In fact, LASIK surgery is still the most common procedure to help those wishing to eliminate their dependence on eyeglasses and contact lenses. However, some patients are not good candidates for LASIK because they are extremely nearsighted, have thin corneas, or have other conditions that might predispose them to complications with LASIK. In these patients, the Implantable Phakic Contact Lens (IPCL Care Group India) might be the best option for correcting their vision. How do I know if I am a suitable IPCL candidate? Candidates for the IPCL are above 18 years of age, suffer from myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism (Cylindrical power) and want to experience superior vision correction. Candidate with refractive error who are unsuitable for laser refractive surgery. Prospective person should consult his/her ophthalmologist (eye surgeon) for more information, including an assessment of their candidacy. Women who are pregnant or nursing should wait to have the ICL implanted. Lastly, those without a large enough anterior chamber depth or endothelial cell density may not be a good IPCL candidate. ?????? No blood! No pain! No hospitalisation! Almost all levels of power can be treated. Excellent quality of vision. Easily removed or replaced ( 5 - 10 minutes) Cosmetically good as it’s INVISIBLE!! Fast recovery. How does the IPCL work? ???? Similar to a contact lens Designed to remain inside the eye Doesn’t get dirty and needs no maintenance unlike a contact lens Once -a- year visit to hospital recommended for examination How does the IPCL differ from other refractive procedures? ????? Does not cut or remove tissue from the cornea Cornea retains it natural shape Safer for higher degrees of myopia, hyperopia, astigmatism and thin corneas. Less glare issues on patients with large pupils. Very stable overtime, no regression What to expect on the procedure? ??? Procedure should take 10-15 minutes per eye Laser Iridotomies done prior to surgery Dilating and anesthetic drops The IPCL Procedure : ?????? The implant surgery is quick and painless, lasting only about 10-15 minutes. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid speculum will be placed between your eyelids to keep you from blinking during the procedure. The recovery time is short and the results of the surgery are almost immediate. Most patients resume normal activities within a week. Potential IPCL risks include : Over correction : This complication occurs if the prescriptive power of the implanted IPCL is too strong. In most cases it can be corrected with corrective eyewear or with an IPCL replacement. Undercorrection : The opposite of overcorrection, undercorrection is the result of an implantable contact lens with too weak of a prescription. Correction methods are similar to those of overcorrection. Infection : During most surgeries, there is a potential risk of an infection. Increased intraocular pressure : Pressure may build in the eye after an IPCL procedure. The sooner a surgeon is alerted to this, the greater the chance of avoiding serious damage. This is detected during your follow up visits with us or in case you face acute blurring of vision or headaches, you must visit the eye clinic. IPCL may rarely need to be repositioned. Damage to crystalline lens : because implantable contact lenses are implanted into the eye, there is a potential that the eye’s natural lens may be damaged during the procedure. If the damage is severe, the crystalline lens may need to be replaced with an intraocular lens. Cataract development : Over 50 pe

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    Pearls For Implantable Phakic Contact Lens (Care Group India) by DR Suresh K Pandey DR Vidushi Sharma, SuVi Eye Institute Kota India

    Hochgeladen von

    Dr Suresh K Pandey
    For most patients seeking correction of their refractive error, LASIK is a safe and effective method of correcting nearsightedness, farsightedness and astigmatism.In fact, LASIK surgery is still the most common procedure to help those wishing to eliminate their dependence on eyeglasses and contact lenses. However, some patients are not good candidates for LASIK because they are extremely nearsighted, have thin corneas, or have other conditions that might predispose them to complications with LASIK. In these patients, the Implantable Phakic Contact Lens (IPCL Care Group India) might be the best option for correcting their vision. How do I know if I am a suitable IPCL candidate? Candidates for the IPCL are above 18 years of age, suffer from myopia (nearsightedness), hyperopia (farsightedness) and/or astigmatism (Cylindrical power) and want to experience superior vision correction. Candidate with refractive error who are unsuitable for laser refractive surgery. Prospective person should consult his/her ophthalmologist (eye surgeon) for more information, including an assessment of their candidacy. Women who are pregnant or nursing should wait to have the ICL implanted. Lastly, those without a large enough anterior chamber depth or endothelial cell density may not be a good IPCL candidate. ?????? No blood! No pain! No hospitalisation! Almost all levels of power can be treated. Excellent quality of vision. Easily removed or replaced ( 5 - 10 minutes) Cosmetically good as it’s INVISIBLE!! Fast recovery. How does the IPCL work? ???? Similar to a contact lens Designed to remain inside the eye Doesn’t get dirty and needs no maintenance unlike a contact lens Once -a- year visit to hospital recommended for examination How does the IPCL differ from other refractive procedures? ????? Does not cut or remove tissue from the cornea Cornea retains it natural shape Safer for higher degrees of myopia, hyperopia, astigmatism and thin corneas. Less glare issues on patients with large pupils. Very stable overtime, no regression What to expect on the procedure? ??? Procedure should take 10-15 minutes per eye Laser Iridotomies done prior to surgery Dilating and anesthetic drops The IPCL Procedure : ?????? The implant surgery is quick and painless, lasting only about 10-15 minutes. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid speculum will be placed between your eyelids to keep you from blinking during the procedure. The recovery time is short and the results of the surgery are almost immediate. Most patients resume normal activities within a week. Potential IPCL risks include : Over correction : This complication occurs if the prescriptive power of the implanted IPCL is too strong. In most cases it can be corrected with corrective eyewear or with an IPCL replacement. Undercorrection : The opposite of overcorrection, undercorrection is the result of an implantable contact lens with too weak of a prescription. Correction methods are similar to those of overcorrection. Infection : During most surgeries, there is a potential risk of an infection. Increased intraocular pressure : Pressure may build in the eye after an IPCL procedure. The sooner a surgeon is alerted to this, the greater the chance of avoiding serious damage. This is detected during your follow up visits with us or in case you face acute blurring of vision or headaches, you must visit the eye clinic. IPCL may rarely need to be repositioned. Damage to crystalline lens : because implantable contact lenses are implanted into the eye, there is a potential that the eye’s natural lens may be damaged during the procedure. If the damage is severe, the crystalline lens may need to be replaced with an intraocular lens. Cataract development : Over 50 pe

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    Dr Vidushi Sharma

    MD (AIIMS), FRCS (UK)

    Dr Suresh K Pandey
    MS (PGIMER), ASF (USA)

    SUVI EYE INSTITUTE KOTA, RAJ, INDIA Phone +91 9351412449 E-mail:suvieye@gmail.com Website: www.suvieye.com

    Spectrum of Refractive Surgeries


    REFRACTIVE SURGERIES CORNEA BASED LENTICULAR BASED

    COMBINED(BIOPTICS)

    -R.K. -PRK -LASIK -EPILASIK -LASEK -Conductive Keratoplasty -Corneal Inlays and rings

    -Clear Lens extraction for myopia -Phakic IOL (IPCL) - Prelex Clear Lens Extraction with use of Multifocal IOLs

    Combination of the two

    HISTORY OF PHAKIC IOLs


    Pioneers of Phakic IOL Choyce, Strampelli,

    Barraquer conducted first ever trials using AC refractive lenses to correct high myopia in 1950s. But due to unacceptable complications such as loss of corneal endothelial cells, iris atrophy, PAS , these especially the angle supported lenses were phased out of the market.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    HISTORY OF PHAKIC IOL


    First model made by Fyodorov in 1980s

    in Russia of a collar button configuration. First implant in Europe in 1993. Concept of soft phakic lens.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota India

    Types of Phakic IOLs

    1.

    An intra-ocular lens is placed inside the eye in front of the patients natural lens. These are available in three types
    Anterior chamber angle fixated IOL Nuvita (Bausch & Lomb), Kelman duet, I care (corneal), Vivarte (Ciba vision) Iris supported phakic IOL Verisyse/ Artisan (AMO/Ophtec) Plate lens that fits between the iris & the crystalline lens Starr implantable contact lens (ICL), PRL (Ciba), and recently launched IPCL (Care Group India)
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    2. 3.

    Advantage of Posterior Chamber Phakic IOL (IPCL)


    Behind the iris
    Far from the endothelium (ECD) Excellent cosmesis (invisible to the eye) Close to the Nodal points of the eye Gain in retinal size image Greater effective Optical Zone (at the corneal plane)

    Sulcus located
    Stable location (allows for Toric design with same platform) Easy removable /exchangable

    No fixations into tissues (iris)


    Does not alter shape/remove tissue (corneal based procedures)

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    What Is IPCL?
    IPCL is single piece posterior chamber phakic IOL, which can be inserted into the eye through sub 2.8mm incision. The lens is customized according to shape and size of each eye Widest power correction range from +10D to -25D with cylinder up to 8D Made from a Hybrid Acrylic material to ensure long term performance. 100% vegetarian Lens no porcine collamer inside

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL

    Indications for IPCL


    Age above 18 years Stable refraction for one year Patients not suitable for LASIK/LASEK due to high

    powers or thin corneas AC depth 2.80 mm Endothelial count >2000cells/cumm No other ocular pathology

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL: An Option where LASIK is not Feasible


    LASIK IS NOT INDICATED

    WHEN
    CCT such that minimum safe

    bed thickness is not left(250270).Post op Corneal thickness should not be <410. Postop Cornea not too flat or steep.<36D or>49D(Poor Optics).

    Contraindications of IPCL
    Myopia other than axial myopia Corneal dystrophy/ Endothelial cell count

    <2000cells/cu mm Anterior chamber depth less than 2.8 mm History of uveitis Presence of anterior/posterior synechiae Glaucoma or IOP higher than 20 mmHg Evidence of nuclear sclerosis or developing cataract Personal or family history of retinal detachment Diabetes mellitus
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Pre-op assessment for IPCL


    Refraction Objective & subjective acceptance at

    12mm vertex distance Anterior chamber depth (ACD) from corneal endothelium Anterior & posterior segment examinations K-reading & Topography Intra-ocular pressure White to white measurement Specular microscopy (if possible)

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    INDICATIONS FOR IPCL


    Indication in

    Myopia
    Myopia of -3 to -25 Dioptres

    Astigmtism up to 6 Dioptres Thin Corneas Hyperopia Presbyopia (Multifocal IPCL)

    Measurement of white to white diameter (Clear Cornea to Clear Cornea)


    Using Orbscan, UBM or digital calipers
    Add 0.5 mm to horizontal WW measurement for IPCL

    overall length IPCL too short lens vault less, exposes to risk of Anterior capsular cataract IPCL too long lens vault exceeds angle crowding closed angle glaucoma

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    White-To-White Measurement Using Calipers

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    White-To-White with calipers


    Measurements of the White-to-white distance using a

    caliper has been proven to be a simple but reliable method.


    Please watch the following points:

    Make sure that the caliper is well calibrated. Pre-treat the eye with anaesthetic drops Take the measurement under the microscope with the patient in the supine position Read the caliper measure on a ruler
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Pearls: White-To-White
    Use Orbscan to validate caliper measurement:

    Automated & Manual: Eye Metrics Tool If you use the IOL-Master or similar make sure you validate the outputs: some reports of IOL-Masters overestimation of the wtw Be careful with pterygium, pigmented area around the cornea etc. Evaluate discrepancies between measuring devices and between eyes: both eyes should have about the same wtw

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL and Sizing


    Ideal sized IPCL will provide a vault (central distance

    between anterior surface of the crystalline lens and posterior surface of the IPCL) within a range of 0.250 to 0.750 mm ( CT to 1 & CT) . An undersized IPCL (less than 0.125 mm vault) may increase the risk of anterior subcapsular opacification.
    An oversized IPCL (more than 1 mm vault) may push the iris forward and close the angles which could lead to IOP rise and Iris malfunction.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL and Sizing: Vault

    If the IPCL is properly sized (WtW & ACD are critical) a separation will exist between the post surface of the IPCL and the ant suface of the human lens. We use the term - Vault to refer to this space

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL inside the Eye

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Vault

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Vault

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL IMPLANTATION PRE-OPERTIVE PREPARTION

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Peripheral Iridotomies (YAG PIs)


    One to two weeks pre-op perform PIs Provides an outlet for aqueous flow

    11:00

    1:30

    around the lens

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Peripheral Iridotomies (PIs)


    The PIs must be large & patent: at least 0.8 to 1 mm in diameter Location: 10.30 oclock and 1.30 oclock, or (90 ) apart in the superior iris Inadequate PIs can cause early post-op complications (IOP rise, pup block)

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dilatation- Immediate Pre-Op


    Minimum 8 mm dilation. Avoid Cyclopentolate. Pre-treat: Tropicamide, Phenlyephrine and NSAID

    Borderline size

    Well dilated pupil

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Topical Anesthesia- Immediate PreOperative


    Topical Anesthetic
    per routine

    IV/PO Sedation
    as necessary

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Immediate Pre-Operative
    Cataract prep and drape Normal sterile technique

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    The IPCL Injection System (Care Group India)


    The IPCL is injected through the

    injectors The IPCL cartridge requires a 2.8mm incision

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Loading the IPCL


    The IPCL is marked to ensure proper Orientation in the eye as it unfolds

    Hole on Left Side (Leading Haptic)

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Loading the IPCL Observe the IPCL for proper orientation in the cartridge
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Surgical Technique

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL PREPARATION
    Step 1. Open the Cartridge and Injector fill the Cartrige

    with HPMC Step II. Open the IPCL Container Step II. Gently Hold the IPCL with McPherson Forceps near haptics Step III: Check the Orientation of IPCL (Hole at Left Side, 2 holes superiorly) Step IV: Place the IPCL in the Cartridge Step V: Put the Cartridge in injector
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Surgical Technique of IPCL


    - Two Paracentesis

    - Viscoelastic injection
    - Temporal, clear corneal incision - Injection of IPCL

    - Injection of viscoelastic on top of IPCL


    - Positioning of IPCL behind iris - Irrigation (and aspiration) of viscoelastic - (Constriction of pupil) - 2-4 hours post-op check

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Surgical Technique


    Remember that you have always removed the crystalline lens Now you are preserving the

    crystalline lens... Nothing more than a series of steps you are already comfortable with Execution of each step is more critical

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Paracentesis for IPCL


    degrees away from the main incision
    Remember that is difficult to make a

    Carefully make two paracentesis 90

    paracentesis after the main incision

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Inject Viscoelastic (2% HPMC)


    Inject 2% HPMC type viscoelastic

    Maintain visible chains


    Do not overfill

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Clear Corneal Incision


    Slow, controlled entry Use knife that you are

    comfortable with

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Injection
    Leading Left Landmark (LLL)

    Place cartridge just inside

    incision

    Inject slowly until the leading

    left landmark is visible

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Injection
    Do not fully inject the IPCL until you

    visualize the landmarks


    You still have control as long as the IPCL

    remains in the cartridge

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Injection (How to Identify Upside Down position?


    What if this IPCL unfolded with the landmark on the Right? Upside down IPCL

    WAIT, WAIT, WAIT

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Manipulating the Haptics


    - Put viscoelastic on top of the lens to give yourself more room - Manipulate in the periphery via the paracentesis - Do the distal haptics first while the pupil is maximum dilated - Avoid going across the central lens - Manipulate on the body of the IPCL, avoid the optic

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Viscoelastic removal
    Thoroughly

    remove viscoelastic with BSS on a cannula or use your I/A instruments


    Slight incisional

    pressure while irrigating

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Constrict Pupil with Pilocarpine


    Make sure

    footplates are behind Iris

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    If you prefer, you can leave the

    pupil dilated to allow aqueous and possibly remaining viscoelastic to pass in front of the IPCL.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    2 hour post-op exam


    IOP check
    use caution if IOP > 24 mmHg or 10 mmHg higher than pre-op

    IOP Elevation - Retained Viscoelastic burp and recheck - Non-patent Iridotomies back to the Yag laser Check PIs
    ACD should look deep

    Check IPCL vault


    low vault is common at 2 and 24 hour check

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Post-op Medication
    Follow your normal cataract routine Antibiotic 3-4x / day for one week Steroids or NSAID 3-4x / day for 2 weeks (taper if steroids) Systemic Acetazolamide for 3 days
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    IPCL Loading

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    VIDEO OF IPCL
    http://www.youtube.com/watch?v=GmyMkyA9ZCE

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    VIDEO OF TORIC IPCL


    http://www.youtube.com/watch?v=GPLyfuPwfbg

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    VIDEO OF TORIC IPCL


    http://www.youtube.com/watch?v=rltHvJ3pnbs

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Toric IPCL Marking on Slit lamp

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Note the Marking on Cornea

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Axis Marking during Surgery (0-180 Degree)

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dr Vidushi & Dr Suresh Pandey Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Final Alignment of Toric IPCL

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    RECENT ADVANCES IN IPCL SIZING


    With the advancements in anterior segment imaging ,

    ultrasonic biomicroscopy , Optical coherence tomography and Scheimpflug imging ,valuable information is now provided about anterior segment anatomy for phakic Intraocular lenses(IPCL) for correction of moderate to high refractive errors.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Advantages of IPCL
    The procedure is reversible unlike LASIK
    The quality of vision is usually better It creates a small corneal incision so astigmatism is

    minimum Corneal tissue is not removed ,hence adequate tear layer Reduction of risk of optical distortions an higher order aberrations

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Complications of IPCL
    IPCL decentration
    Pupillary block Pigment dispersion

    Subcapsular cataract
    Potentially endophthalmitis

    Dr Vidushi & Dr Suresh Pandey

    Advantages of phakic IOLs over laser corrective procedures


    A higher range of refractive errors can be corrected Reversible: Phakic IOL implantation is a potentially

    reversible procedure Safe: No structural changes are induced. Hence it is safe in any eye with high error & also thin corneas. Better quality of vision: Quality of vision (contrast sensitivity) is better than the laser refractive procedures in eyes with higher refractive errors and no induced higher order aberrations. There is also a considerable improvement in BVCA with these lenses because of the magnification effect. Highly skilled procedure: Prevents misuse of the procedure.
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Bioptics

    Bioptics is a combination of phakic IOL and LASIK. Bioptics is done for the correction of the residual spherocylindrical power when a spherical implant is used.

    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    RK: Started in 1978, peaked in 1994. PRK: Started in 1984, peaked in 2006. LASIK: Started in 1989, Has LASIK peaked?? LASIK Procedure losing share in major markets. IPCL: IPCLs implant gaining popularity world wide.
    Dr Vidushi & Dr Suresh Pandey SuVi Eye Institute, Kota ,India

    Dr Vidushi Sharma
    MD (AIIMS), FRCS (UK)

    Dr Suresh K Pandey
    MS (PGIMER), ASF (USA)

    SUVI EYE INSTITUTE KOTA, RAJ, INDIA Phone +91 9351412449 E-mail:suvieye@gmail.com Website: www.suvieye.com

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