Intraokularlinse Acri. Lyc 59 RET® mit unveränderter Brechkraft bei Silikonöltamponade

Abstract

Silicone oil tamponade is used in vitreous surgery for different ophthalmic diseases, such as diabetic retinopathy and proliferative vitreoretinopathy. An unwanted side effect of silicone oil in pseudophakic eyes is the hyperopic shift of refraction of about 6 D. Refraction differences like this between both eyes destroy binocular vision due to aniseikonia. The intraocular lens (IOL) Acri. Lye 59 RET ® was specifically designed to solve this refractive problem in silicone oil filled eyes. Based on the concave posterior lens surface with the centre of curvature in the fovea, all light rays go perpendicularly and without deflection through the posterior lens surface. Refraction does not change regardless of the substance and its refractive index in the vitreous cavity. Perfect optical quality requires close contact between the IOL and the vitreous substitute: After standard in-the-bag IOL implantation and central excision of the posterior capsule, the IOL optic is buttoned into the posterior capsular opening. Though diabetics presumably benefit most from this IOL, they are not suitable for this prospective study because of the high variability of their disease. Therefore patients with idiopathic macular holes were selected, as in these cases surgery can be performed according to a fixed time scheme. A total of 41 affected eyes underwent cataract surgery, vitrectomy, IOL implantation with buttonhole technique and silicon oil filling. About 11 weeks later silicone oil was removed. Follow-ups were performed eight weeks after the first and six weeks after the second surgery. In this study Acri. Lyc 59 RET ® met the expectation of unchanged refraction with different endotamponades. The change of refraction after silicone oil removal of 0.22 D was not clinically relevant. However, the postoperative refraction missed the intended value by 1.83 D in silicone oil and 1.61 D in water. This was due to an inadequate deep anterior chamber in the geometric-optical calculation. The postoperative refraction data were used to derive the appropriate anterior chamber depth and A-constant for a more accurate IOL-calculation. Micropsia due to silicone oil tamponade was detected, but less than expected and not of clinical relevance. Acri. Lye 59 RET ® is the first IOL solving the problem of refractive shift due to silicone oil tamponade. Therefore, the main indication for this IOL is cataract in patients with diabetic retinopathy or more generally eye diseases that eventually will need silicone oil.