To bag or not to bag

Transcription

1 Binkhorst Medal AwardLecture 2011 To bag or not to bag Marie-José Tassignon Antwerp University Hospital Financial disclosure: BIL is licensed to Morcher Germany

2 Tribute to my mentors

3 Cataract surgery and after cataract PhD thesis V De Groot, 2005 University of Antwerp

4 Nd:YAG laser to treat PCO Before Nd -YAG laser capsulotomy After Nd -Yag Laser capsulotomy PCO not only reduces visual acuity but also quality of the image even after YAG laser - increased straylight Alleviating debillitating photophobia.by increased straylight, T VandenBerg, J Cat Refr Surg, 2011, 37, increased HO aberrations Optical aberrations in pseudophakic after YAG laser capsulotomy, F Casprini, J Cat Refr Surg, 2008, 24,

5 Changes in HO aberrations after YAG laser capsulotomy Influence of Nd:YAG laser on higher order aberrations after hydrophobic/hydrophylic IOL implantation, J Rozema, MJ Tassignon, J Cat Refr Surg, 2009, 35,

6 Quality of image before YAG laser capsulotomy

7 Quality of image after YAG laser capsulotomy

8 The bag-in-the-lens: aiming at preventing PCO US patent: 6,027,531 - PCT : licensed to Morcher, Germany

9 A:lens-in-the-bag B:bag-in-the-lens same biomaterial, same company

10 Survival Rate Kaplan - Meier survival curves 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 LIB BIL Months Cumulative Nd:YAG laser rates after BIL or LIB. I Leysen, Tassignon MJ,, J Cat Refr Surg, 2006, 32,

11 BIL following ISO standard :2006 Total number of eyes included : 807 December December eyes follow-up of / months (12-84 months) Including: - uveitis, diabetes, glaucoma, IOL exchange, eyes of children VAR rate: 0%!! Tassignon et al; in press in J Cat Refr Surg, 2011

12 Zero PCO after BIL was also found in vitro Lens epithelial cells in an in vitro capsular bag model, K De Keyzer, MJ Tassignon, et al; J Cat Refr Surg, 2008, 34, Capsular bag without IOL Capsular bag with BIL Capsular bag with LIB

13 Postmortem BIL: pathological analysis BIL: first pathological analysis, L Werner, MJ Tassignon, et al; J Cat Refr Surg, 2008, 34, Clinical and histopahological evaluation after BIL implantation, L Werner, MJ Tassignon, et al; Ophthalmology, 2010, 117, 55-62

14 Cornea Iris Anterior capsule IOL IOL Posterior capsule Metaplastic LECs and fibrosis BIL 3 years follow-up OD

15 The optical balance

16 Centration along the visual axis using Purkinje reflexes 1 and 4 of the light of the microscope P4 P1 temporal position of the surgeon will correct for the angle alpha

17 Sizing and centration of the anterior capsulorhexis using alignment of Purkinje reflexes 1 and 4 P 4 P1 Calliper ring for the purpose of sizing and centration of the BIL: US and PCT patent pending

18 Bag-in-the-Lens Centration Intraocular lens centration and visual outcome after BIL, K Verbruggen Tassignon MJ,et al, J Cat Refr Surg, 2007,

19 capsule is present but poor zonular support

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21 Lasooing the BIL to the sclera

22 Bean Shape rings in BIL lens groove

23 Changes in rotation after implantation of the BIL, J Rozema, MJ Tassignon, J Cat Refr Surg, 2009, 35, eyes VAR: 0% toric correction spherical aberrations

24 One sided toric IOL: more power when facing the cornea Anterior chamber side Vitreous side 0.55 mm A A 1 H(q 2 ) H (q 2 ) B H(q 1 ) H (q 1 ) A 1 C H(q 1 ) H (q 1 ) A 1 Surgically induced astigmatism after BIL, L Gobin, MJ Tassignon, et al; J Cat Refr Surg, 2011, 37,

25 Toric BIL IOL: clinical results Clinical results after sherotoric BIL implantation, MJ Tassignon et al, J Cat Refr Surg, 2011, in press

26 Add on IOL for pseudo accommodation This technique requires an iridectomy to avoid pigment deposits on the anterior face of the add on IOL

27 Add on IOLs and ocular alignment only when visual axis = pupillary axis

28 Accommodation ring and BIL Biomaterial having the same Young's modulus than the capsular bag liquid IOL patent discontinued

29 Refractive correction over time: option Removable, replaceable custumized optic Patent pending

30 BIL exchange is easy and predictable

31 Acknowledgement Department of ophthalmology of Antwerp University Hospital and research fellows: L Gobin, J Rozema, F Van de Velde International and National BIL users in particular: Ch Billotte, C Eckhart,T Neuhann, A Vasavada, B Lorenz,. International and National Friends