Multifocal phakic IOL helpful in tackling presbyopia

Brest, France-The initial results from implantation of the NewLife multifocal anterior chamber phakic IOL (GBR lens, IOLTech, LaRochelle, France) to treat presbyopia indicate that it is safe and effective. However, refinements in the design of the IOL are needed, as are longer follow-up periods, according to Beatrice Cochener, MD.

"The current approach to treating presbyopia is to work on a compromise between far and near vision. Among new options for treating presbyopia is IOL implantation," Dr. Cochener said.

"The phakic multifocal IOL should be an anterior chamber implant but the anterior chamber needs to be sufficiently deep. This IOL combines the treatment aimed at emmetropia with minimal risk of retinal detachment," said Dr. Cochener, professor and chairman, department of ophthalmology, Brest University, France.

Study of 26 eyes Dr. Cochener reported her experience with 26 eyes, eight of which were myopic and 18 hyperopic. All patients had less than 1.75 D of cylinder. The patients had been followed for up to 12 months after implantation. All patients underwent bilateral implantation with the angle-supported IOL. All patients had an anterior chamber depth greater than 3 mm and a clear crystalline lens.

The lens is implanted through a 3.2-mm incision. Before surgery, Dr. Cochener and colleagues measure the white-to-white distance to size the lens properly. The incision is later enlarged to 3.4 mm, because, as she said, a major limitation of this surgery is that forceps are needed to fold the lens to facilitate implantation in the anterior chamber.

"This technique has a learning curve," Dr. Cochener said. "First, the surgeon must learn to fold the lens properly without damaging it during folding, and then learn not to damage the endothelium, the natural lens, and the iris during implantation.

"The most important aspect during implantation is that the superior haptic is introduced into the eye without undue force," she said. The use of viscoelastic and its removal is also important, Dr. Cochener noted.

The results showed an improvement in the uncorrected distance visual acuity. At 3 months after implantation and suture removal, the eyes stabilized. Three patients underwent PRK to treat residual cylinder.

"The results are more impressive when the near visual results are considered. No patients required additional spectacle correction. All could read at the level of J3 or J4. The best results were obtained 3 months after the surgery," Dr. Cochener reported.

Seven patients lost 1 line of best-corrected distance vision, and two patients lost 2 lines.

"Considering that we are dealing with the compromise surrounding correction of presbyopia, we lose a bit of distance vision to achieve improvement in near vision," she said.

One patient lost 2 lines of near visual acuity that was related to slight decentration of the lens. Another patient lost 2 lines of near vision because of loss of pupil reactivity following the development of postoperative inflammation.

Better results for hyperopia The refractive error in terms of the spherical components was corrected better in hyperopic patients than in the myopic patients, Dr. Cochener explained, and suggested that PRK may be needed for the myopic patients.

Regarding the quality of vision after the surgery, 33% of patients reported halos and glare. The investigators found a direct correlation between the centration of the lens and the pupil.

The satisfaction rate was very high; 23 of the 26 patients indicated that they would undergo the surgery again.

Dispersion of iris pigment into the anterior chamber occurred in seven cases. There were five cases of vertical pupil ovalization that remained at 3 months after surgery; however, this change did not affect the multifocal effect of the IOL, Dr. Cochener noted.

Other causes of concern were the formation of synechiae around the superior haptic in four cases and discrete iris retraction in five cases, which may lead to questions concerning the sizing and the design of the IOL, she said. There were no intraoperative complications.