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Anterior Segment Intraocular Lens
Discussion improved night vision undisturbed by glare and halos. The
Refractive lens exchange can be considered the future of refractive accommodative function of the WIOL-CF is based on its aspheric
surgery. The biggest challenge in ophthalmological research is the hyperboloid optics, which can improve quality of vision and give
continuous development of new artificial IOLs that can provide greater depth of focus, providing pseudoaccommodation and
satisfactory vision at all distances. Accommodative lenses represent a eliminating spherical aberrations. In general, the WIOL-CF can be
new category that, by accomplishing lens movement, can restore considered a promising alternative solution for patients under 60 years
some degree of natural accommodation.
13,14
The biggest limitations of age who lead an active life and require good near, intermediate and
associated with the use of accommodative lenses are capsular far vision. Post-operative patient training is important in order to
fibrosis, which annuls the accommodative effect, and the high achieve the maximum degree of pseudoaccommodation and provide
incidence of posterior capsule opacification.
15
The WIOL-CF is a new- high-quality spectacle-independent near vision. n
generation accommodative lens that possesses certain qualities that
seem to overcome the drawbacks of accommodative IOL implantation.
Ioannis G Pallikaris is a Professor of Ophthalmology,
The high water content of the lens offers high biocompatibility and
Rector and a member of the Board of the Department
permeability, and its negatively charged surface allows resistance to of Materials Science and Technology at the University
protein deposits, cell attachment, opacification of the posterior
of Crete. During his time at the University of Crete, he
founded and was Director of the Vardinoyannion Eye
capsule and minimum adhesion to tissues such as capsule, iris and
Institute of Crete and the Institute of Vision and
cornea. Another important quality of the lens is its sharp-edged Optics, and has been Chairman of the Department of
continuous rim, which supports resistance to posterior capsule
Ophthalmology and Director of the Eye Clinic of the
University Hospital of Heraklion.
opacification; in addition, the continuous transition between optics
and rim, in conjunction with the low refractive index of the lens, offers
1. Javitt JC, Brenner MH, Curbow B, et al., Outcomes of Ophthalmol, 2005;16(1):33–7. 12. Küchle M, Seitz B, Langenbucher A, et al., Comparison of
cataract surgery. Improvement in visual acuity and 7. Schmitz S, Dick HB, Krummenauer F, et al., Contrast 6-month results of implantation of the 1CU
subjective visual function after surgery in the first, sensitivity and glare disability by halogen light after accommodative intraocular lens with conventional
second, and both eyes, Arch Ophthalmol, 1993;111(5): monofocal and multifocal lens implantation, Br J Ophthalmol, intraocular lenses, Ophthalmology, 2004;111(2):318–24.
686–91. 2000;84(10):1109–12. 13. Hancox J, Spalton D, Heatley C, et al., Objective
2. Kashani S, Mearza AA, Claoué C, Refractive lens exchange 8. Cumming JS, Kammann J, Experience with an measurement of intraocular lens movement and dioptric
for presbyopia, Cont Lens Anterior Eye, 2008;31(3):117–21. accommodating IOL, Cataract Refract Surg, 1996;22(8):1001. change with a focus shift accommodating intraocular
3. Olson RJ, Werner L, Mamalis N, Cionni R, New intraocular 9. Dick HB, Accommodative intraocular lenses: current lens, J Cataract Refract Surg, 2006;32(7):1098–1103.
lens technology, Am J Opthalmol, 2005;140;709–16. status, Curr Opin Ophthalmol, 2005;16(1):8–26. 14. Marchini G, Pedrotti E, Sartori P, Tosi R, Ultrasound
4. Jain S, Arora I, Azar DT, Success of monovision in 10. Dogru M, Honda R, Omoto M, et al., Early visual results biomicroscopic changes during accommodation in eyes
presbyopes: review of the literature and potential with the 1CU accommodating intraocular lens, J Cataract with accommodating intraocular lenses: pilot study and
applications to refractive surgery, Surv Ophthalmol, Refract Surg, 2005;31(5):895–902. hypothesis for the mechanism of accommodation,
1996;40(6):491–9. 11. Marchini G, Mora P, Pedrotti E, et al., Functional J Cataract Refract Surg, 2004;30(12):2476–82.
5. Versteeg FF, Multifocal IOLs for presbyopia, J Cataract Refract assessment of two different accommodative intraocular 15. Doane JF, Jackson RT, Accommodative intraocular lenses:
Surg, 2005;31(7):1266. lenses compared with a monofocal intraocular lens, considerations on use, function and design, Curr Opin
6. Bellucci R, Multifocal intraocular lenses, Curr Opin Ophthalmology, 2007;114(11):2038–43. Ophthalmol, 2007;18(4):318–24.
Editor’s Recommendation
Ultrasound Biomicroscopic Changes During Accommodation in Eyes with Accommodating Intraocular Lenses
Marchini G, et al., J Cataract Refract Surg, 2004;30:2476–82.
This study aimed to document ciliary body constriction and was a correlation between the accommodative amplitude and the
movement with the Crystalens AT-45 intraocular lens (IOL) (eyeonics) percentage variation in the ACD and scleral–ciliary process angle.
using ultrasound biomicroscopy. Patients with no pre-existing ocular Results showed that all surgical procedures were uneventful. The
conditions other than cataract who agreed to return for follow-up mean uncorrected distance acuity at one month was 0.±0.14 (SD)
were considered. Twenty eyes of 14 patients with a best corrected and remained stable at six months. Three of 20 eyes (15%) and eight
visual acuity of 5/10 or worse and a refractive error (spherical of 20 eyes (40%) had a Jaeger acuity of J1 and J3, respectively,
equivalent) of ±1.0 diopter (D) had implantation of a Crystalens AT-45 without additional power correction. During accommodation, the
accommodating IOL. Six patients had bilateral implantation. mean reduction in ACD was 0.32±0.16mm at one month and
Ultrasound biomicroscopy was performed post-operatively at one 0.33±0.25mm at six months. The mean narrowing of the scleral–
and six months. Before and during accommodation, the anterior ciliary process angle was 4.32±1.87º at one month and 4.43±1.85º at
chamber depth (ACD) was measured to assess the endothelium–IOL six months. There was a correlation between accommodative
distance and measure the scleral–ciliary process angle to determine amplitude and a decrease in the ACD (r=0.404) and a decrease in
whether there was anterior rotation of the ciliary body. The scleral–ciliary process angle (r=0.773). The authors concluded that
uncorrected distance acuity, best corrected distance acuity, aterior displacement of the Crystalens IOL and corresponding
uncorrected near acuity, distance corrected near acuity, best anterior rotation of the ciliary body occurred during near vision.
corrected near acuity and accommodative amplitude were The IOL displacement and rotation were proportional to the
determined. Analysis was performed to determine whether there accommodation capacity. n
56 EUROPEAN OPHTHALMIC REVIEW