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061 Correction de la presbytie - l’enjeu de la prévention de l’opacification de la capsule postérieure
COMMUNICATIONS ORALES SYMPOSIUM EUROPÉEN possible IOL for the case. All the opportune steps must be taken to prevent posterior capsule opacification. Conclusions: Identification of dominant eye is mandatory, since 35% of the population has one clearly dominant eye, usually in charge of providing good distance vision. Following a meticulous approach, clear lens exchange with multifocal IOL implantation may prove to be a safe and reliable technique for the treatm.
060
SA-16.30
Personnalisation de l’optique d’une LIO. Customised Optics for IOLs. CLAOUE C* (Essex, Royaume-Uni), CLAOUE CH (Londres, Royaume-Uni) Introduction: The first IOL was implanted in 1949 without biometry and proved to be the first refractive surprise and the first IOL explant. Since then, IOL technology has improved with measurements and calculations for defocus (spherical error) correction, that means that the spherical refractive outcome is highly predictable. Aim: However, each eye is different, and we should now be moving towards personalised IOL optics. Aspects that need consideration are astigmatism and presbyopia correction (lower order aberrations), and then higher order aberration correction. Material and methods: The question of 0.25 dioptre increments for IOLs has become relevant with the introduction of Optical Coherence Tomography for axial length measurements. Similarly, the use of Toric and Multifocal IOLs to correct corneal toric errors and presbyopia should become widespread. Manufacturers are now offering some personalised IOLs, but most have not yet moved towards individualised optics. Discussion: In addition to lower order aberration correction, a few manufacturers have made a start in higher order aberration correction with aspheric optics. The term is being used for a variety of optical treatments and needs careful examination. Furthermore, few manufacturers have so far combined correction to offer for example an IOL with a Toric, Multifocal, and Aspheric optic. Such an IOL is a real step towards individualised optical correction. Conclusion: IOL manufacturers need to be challenged to produce more complex products.
061
SA-16.40
Correction de la presbytie - l’enjeu de la prévention de l’opacification de la capsule postérieure. Correction of Presbyopia - Challenge for Prevention of Posterior Capsule Opacification. PRIGLINGER S* (Munich, Allemagne). Introduction: Posterior capsule opacification (PCO) still remains one of the major complications in cataract surgery. Problems especially emerge with the design of accommodative and multifocal intraocular lens (IOL). For proper function these IOLs require elastic lens capsules without any tendency of after cataract formation to avoid reduced mobility of the IOL and IOL decentration. Furthermore future concepts of presbyopia correction such as injectable IOL materials also highly depend on elastic lens capsules without any capsule opacification. Material and methods: The most accepted concept of PCO prevention today is the sharp edge design of an IOL. The sharp edge independently of IOL material can inhibit PCO development. Other current investigated strategies focus on the genetic and pharmacological manipulation of lens epithelial cells (LEC) or on the removal of these cells. A new in vitro PCO model for testing new strategies and substances which could influence LEC growth will be presented. This model is based on the stabilisation of the capsular bag by a capsular tension ring (CTR). It offers excellent stabilisation of the capsule and physiological conditions in organ culture. The influence of different CTRs on PCO was evaluated. We found, that CTRs do not completely prevent PCO development in vitro, however different CTR designs show different shapes of capsule expansion and different pattern of LEC growth. Cystamine, ß-lactose and alkylphosphocholine, all antiproliferative but non toxic substrates were tested: Although none of the substances evaluated could fully prevent LEC migration in the in vitro PCO model, ß-lactose and alkylphosphocholine were highly effective in delaying LEC migration on the capsule bag when compared to untreated LEC. In a third approach the laser photolysis system of A.R.C Laser ® was adapted for capsule polishing by ablation of LEC. After cataract extraction multiple laser pulses were applied to mechanically remove LEC. The lowest efficient energy necessary for removal of LEC was evaluated in the in vitro model. Conclusion: The introduced in vitro model offers an easy and safe way to investigate the impact of innovative approaches on PCO prevention. 2S16
Vol. 30, Hors Série 2, 2007
113 e Congrès de la Société Française d'Ophtalmologie
060
SA-16.30
Personnalisation de l’optique d’une LIO. Customised Optics for IOLs. CLAOUE C* (Essex, Royaume-Uni), CLAOUE CH (Londres, Royaume-Uni) Introduction: The first IOL was implanted in 1949 without biometry and proved to be the first refractive surprise and the first IOL explant. Since then, IOL technology has improved with measurements and calculations for defocus (spherical error) correction, that means that the spherical refractive outcome is highly predictable. Aim: However, each eye is different, and we should now be moving towards personalised IOL optics. Aspects that need consideration are astigmatism and presbyopia correction (lower order aberrations), and then higher order aberration correction. Material and methods: The question of 0.25 dioptre increments for IOLs has become relevant with the introduction of Optical Coherence Tomography for axial length measurements. Similarly, the use of Toric and Multifocal IOLs to correct corneal toric errors and presbyopia should become widespread. Manufacturers are now offering some personalised IOLs, but most have not yet moved towards individualised optics. Discussion: In addition to lower order aberration correction, a few manufacturers have made a start in higher order aberration correction with aspheric optics. The term is being used for a variety of optical treatments and needs careful examination. Furthermore, few manufacturers have so far combined correction to offer for example an IOL with a Toric, Multifocal, and Aspheric optic. Such an IOL is a real step towards individualised optical correction. Conclusion: IOL manufacturers need to be challenged to produce more complex products.
061
SA-16.40
Correction de la presbytie - l’enjeu de la prévention de l’opacification de la capsule postérieure. Correction of Presbyopia - Challenge for Prevention of Posterior Capsule Opacification. PRIGLINGER S* (Munich, Allemagne). Introduction: Posterior capsule opacification (PCO) still remains one of the major complications in cataract surgery. Problems especially emerge with the design of accommodative and multifocal intraocular lens (IOL). For proper function these IOLs require elastic lens capsules without any tendency of after cataract formation to avoid reduced mobility of the IOL and IOL decentration. Furthermore future concepts of presbyopia correction such as injectable IOL materials also highly depend on elastic lens capsules without any capsule opacification. Material and methods: The most accepted concept of PCO prevention today is the sharp edge design of an IOL. The sharp edge independently of IOL material can inhibit PCO development. Other current investigated strategies focus on the genetic and pharmacological manipulation of lens epithelial cells (LEC) or on the removal of these cells. A new in vitro PCO model for testing new strategies and substances which could influence LEC growth will be presented. This model is based on the stabilisation of the capsular bag by a capsular tension ring (CTR). It offers excellent stabilisation of the capsule and physiological conditions in organ culture. The influence of different CTRs on PCO was evaluated. We found, that CTRs do not completely prevent PCO development in vitro, however different CTR designs show different shapes of capsule expansion and different pattern of LEC growth. Cystamine, ß-lactose and alkylphosphocholine, all antiproliferative but non toxic substrates were tested: Although none of the substances evaluated could fully prevent LEC migration in the in vitro PCO model, ß-lactose and alkylphosphocholine were highly effective in delaying LEC migration on the capsule bag when compared to untreated LEC. In a third approach the laser photolysis system of A.R.C Laser ® was adapted for capsule polishing by ablation of LEC. After cataract extraction multiple laser pulses were applied to mechanically remove LEC. The lowest efficient energy necessary for removal of LEC was evaluated in the in vitro model. Conclusion: The introduced in vitro model offers an easy and safe way to investigate the impact of innovative approaches on PCO prevention. 2S16
Vol. 30, Hors Série 2, 2007
113 e Congrès de la Société Française d'Ophtalmologie