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Iva Dekaris

Iva Dekaris

University Eye Hospital ‘Svjetlost’, Croatia

Title: Refractive lens exchange with implantation of premium intraocular lenses

Biography

Biography: Iva Dekaris

Abstract

Introduction: “Premium" intraocular lenses have advanced features beyond those found in basic mono-focal intraocular lenses (IOLs). Multifocal IOLs (m-IOLs), for example, are presbyopia-correcting lenses enabling almost spectacle-free life after conventional cataract surgery, or in case of refractive lens exchange (RLE). Currently, there is a whole spectrum of mIOLs on the market out of which bifocal IOLs correct only distance and near vision, while trifocal and extended range of vision IOLs provide also good intermediate vision. With invention of toric mIOLs, full visual correction may be obtained even in patients with pre-existing astigmatism. Our results with the implantation of different types of premium IOLs are presented.rnrnSubjects & Methods: In a period 2005-2015, at our Hospital over 3000 eyes had RLE with m-IOL implantation (Restor +4, Restor +3, Tecnis ZM900&ZMA00&ZMB00, Re-Zoom, Acry-Lisa & ATLISA 809MP, Tecnis Symfony and Trifocal ED). In last two years mostly trifocal and Symphony lenses were used, with the results presented in this study. Trifocal IOL: Ninety five patients (204 eyes) underwent bilateral trifocal IOL implantation (ATLISA tri839MP, Zeiss, Germany) after RLE. Patients were presbyopes; 95 hypermetropes and 7 myopes, aged 46 to 68 years. Twenty 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (ATLISA tri-toric 939MP, Zeiss, Germany). Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 patients, 84 eyes). Follow up was at least 6 months, up to three years. Symfony IOL: Forty six patients (92 eyes) were followed after RLE with bilateral implantation of the Tecnis Symfony IOL. Emmetropia was targeted in dominant eye, and mild myopia of up to -0.50 D in non-dominant eye. UDVA, UIVA at 66 cm, UNVA, spectacle independence, patient satisfaction and visual disturbances were measured. Follow up was at least 3 months. Results: Trifocal IOL: All patients achieved monocular UDVA better than 0.1 log-MAR, (76.9% of eyes 0.0 log-MAR). Monocular UIVA better than 0.2 log-MAR was achieved in 96.1% of patients. All patients could read J2 and better; 72.1% of patients could read J1. UDVA at 10% contrast level was 0.0 log-MAR in 62.5% of patients. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. Spherical equivalent was equal or less than 0.5 D in 97% of trifocal eyes; and within the range of +1.00 to -1.00 D of astigmatism in all trifocal toric eyes. Symfony IOL: Binocular UDVA of 0.02 log-MAR or better was achieved in 95% of patients. Mean binocular UIVA at 66 cm was 0.01 log-MAR and UNVA at patient’s preferred distance was 0.01 log-MAR (J1-J2). Night driving visual disturbances was reported in 6 out of 46 patients (13%), only 2% of patients reported halos.rnrnConclusions: Refractive lens exchange with implantation of trifocal or Symfony IOL enables good vision at all distances and almost completes spectacle independence. It is an excellent choice for younger, active presbyopes in need of good intermediate vision. Meticulous preoperative counseling is of outmost importance to choose proper mIOL for each patient.rn