Surgical correction of post-DALK ametropia · stable post dalk ametropia in presence of cataract in younger patients for whom corneal refractive surgery is controindicated intraocular

Surgical correction of post-DALK ametropia

XIV SICSSO Congress

Augusto PocobelliRome, Italy

Lecce 25-27 giugno 2015

Rome, Italy

PLOS ONE January 29, 2015

The Cochrane Library 2014, Issue 7

The Cochrane Library 2014, Issue 7

IN OUR CASE SERIES WE NOTED KERATOMETRIC STABILITY IN OUR CASE SERIES WE NOTED KERATOMETRIC STABILITY

AFTER AT LEAST 1 YEAR FROM SUTURE REMOVAL

IT WAS NECESSARY TO SELECT PATIENTS

FOR POST DALK AMETROPIA CORRECTION

SURGICAL CORRECTION IN

POST DALKAMETROPIA

CATARACT CLEAR LENS

PHACOEMULSIFICATION

WITH TORIC IOL IMPLANTATION

POSTERIOR CHAMBER

PHAKIC INTRAOCULAR LENS

IMPLANTATION

J Cataract Refract Surg 2014

26 eyes were included. Mean age was 57.1 years at the time of cataract surgery

Previous keratoplasty was penetrating (84.6%) or deep anterior lamellar (15.4%)

Keratoconus (73.1%) was the major indication for keratoplasty.

The mean IOL cylinder power was 6.85 + 3.02 diopters (D).

Both mean refractive spherical equivalent and refractive astigmatism decreased

significantlysignificantly

Significant improvement in the mean uncorrected distance visual acuity (UDVA) and in

the mean corrected distance visual acuity (CDVA)

Postoperatively, the UDVA and CDVA were 20/40 or better in 61.5% of eyes and 92.3%

of eyes, respectively.

In 2014 we started a prospective study on PHACOEMULSIFICATION with

TORIC IOL implantation in patients undergone a DALK procedure

INDICATION FOR DALK WAS KERATOCONUS

seven eyes of seven patients

MEAN FOLLOW-UP TIME AFTER PHACOEMULSIFICATION WAS

TIME BETWEEN SUTURE REMOVAL AND CATARACT EXTRACTION WAS AT LEAST 1 YEAR

6,71m +2,98

ALL PATIENT HAD FIL 611 T Customized Toric iol

MEAN FINAL ASTIGMATISM WAS 4,43D + 1,10 and SPHERICAL EQUIVALENT 7,57D + 7,75

6,33±±±± 2,76 D

ALL PATIENT HAD FIL 611 T Customized Toric iol

IMPLANTATION FROM THE SAME SURGEON

FIL 611 T Customized toric IOL

• Optic Diameter 6 mm

• Total Diameter 11.80 mm

• CCI 2.4 mm

• Material: foldable acrilate with 25% H2O• Material: foldable acrilate with 25% H2O

• Real axis tecnology

0,63

3,14

4,434,43

5,43

1,43

1,00

2,00

3,00

4,00

5,00

6,00

UCVA BCVA Cil

Pre Op.

Post Op.

-7,57

-0,43

-8,00 -7,00 -6,00 -5,00 -4,00 -3,00 -2,00 -1,00 0,00

Spherical Equivalent

Post Op.

Pre Op.

MEAN REFRACTIVE SPHERICAL EQUIVALENT WAS

MEAN REFRACTIVE ASTIGMATISM WAS

-7,57D +7,75

4,43D + 1,10 1,43D + 1,59

-0,43D +0,92

PRE POST

0,00

-8,00 -7,00 -6,00 -5,00 -4,00 -3,00 -2,00 -1,00 0,00

MEAN BEST CORRECTED VISUAL ACUITY (BCVA) WAS 3,14/10 +1,35

3/50 +4/50

5,43/10 +2,37

4,43/10 +2,23/10MEAN UNCORRECTED VISUAL ACUITY (UDVA) WAS

ENDOTHELIAL CELL COUNT WAS2020±±±±235

cell/mm2

1959±±±±170

cell/mm2

ICL

� Foldable plate-design / foot-plates

� Behind the iris / sulcus located

� Made of collamer

� Many designs possible with lathe� Many designs possible with lathe

� Wide range of prescriptions

� Removable/exchangable

� Excellent optical perfomance

(material, design,position)centralFlow technology

J Cataract Refract Surg 2009

PZ

PZ N. C. , MALE, 29 YEARS OLD OD>>OS KERATOCONUS

OD DALK JUL 2102 : BCVA WAS 1/10 ECD 2250 cells/mm2

OD SUTURE REMOVAL JUN 2013 : BCVA WAS 7/10 (-11sf = -0,75cil)

OD ICL IMPLANTATION AUG 2014 : UBVA WAS 8/10 at 15 days control

PZ

PRE OP3 MONTHS6 MONTHS

9 MONTHS

9/10ECD 2125 cells/mm2

IN CONCLUSION

INTRAOCULAR TORIC IOL IMPLANTATION

IS A VIABLE TREATMENT FOR

STABLE POST DALK AMETROPIA IN PRESENCE OF CATARACT

INTRAOCULAR TORIC IOL IMPLANTATION

IS A VIABLE TREATMENT FOR

STABLE POST DALK AMETROPIA IN PRESENCE OF CATARACTSTABLE POST DALK AMETROPIA IN PRESENCE OF CATARACTSTABLE POST DALK AMETROPIA IN PRESENCE OF CATARACT

IN YOUNGER PATIENTS FOR WHOM

CORNEAL REFRACTIVE SURGERY IS CONTROINDICATED

INTRAOCULAR PHAKIC IOL IMPLANTATION

IS A SAFE AND EFFECTIVE TREATMENT

IN YOUNGER PATIENTS FOR WHOM

CORNEAL REFRACTIVE SURGERY IS CONTROINDICATED

INTRAOCULAR PHAKIC IOL IMPLANTATION

IS A SAFE AND EFFECTIVE TREATMENT

DALK REMAINS A SAFE PROCEDURE AND ALLOWS A DEFINITIVE CORRECTION OF THE

RESULTING AMETROPIA