The FluidVision lens Source: Accommodating IOLs seem to be closing in on that goal. Hopefully, this is the future; presbyopic cataract surgery has always been both the holy grail and nemesis for cataract surgeons, said John Sheppard, MD, professor of ophthalmology, microbiology and molecular biology, and clinical director, Thomas R. While available data showed that the lens definitely worked for the first year, it is at 24 months when we would expect to see true capsular fibrosis, he added.
From the time FluidVision was under investigation, experts were in awe of this novel devices capability of harnessing the eyes natural environment to work for it. The question that remains regarding the IOLs long-term performance is: What would happen once the capsular bag fibroses? Implantation of FluidVision provides 3 to 4 D of accommodation together with excellent distance, intermediate, and near vision; most importantly, all of these remained stable throughout the 2-year follow- up period, Dr.
At months of follow-up, the monocular logMAR visual acuities for distance, intermediate, and near were 0. An accommodating lenswhen it worksis marvelous for patients and for doctors, Dr. The vexing problem, Dr. Sheppard noted, is consistency of the effective lens position ELP. The accommodating lens has a changing relationship with the capsular fornix as well as the ciliary body as the capsule undergoes normal fibrotic changes; if those parameters can be controlled, most patients with accommodating lenses do well, he said.
Capsular bag opacification In a short-term rabbit study, Floyd and colleagues1 conducted a 6-week follow-up to assess the biocompatibility and capsular bag opacification of FluidVision. According to the groups findings, capsular bag opacification with FluidVision is remarkably low overall compared with that of a commercially available single-piece hydrophobic acrylic IOLs. At 6 weeks, the mean posterior capsule opacification PCO clinical score was 0. Miyake-Apple posterior view showed a mean central PCO score of 00 in the study group and 3.
Histopathology showed no signs of toxicity in any eye, they reported. Based on these results, the team concluded that FluidVision retained an expanded capsular bag secondary to the large haptic elements size, which seems to prevent capsular bag opacification. Further, Kohl and colleagues2 evaluated the long-term uveal and capsular biocompatibility of FluidVision compared to a hydrophobic acrylic control IOL using rabbit eyes as well.
At the gross examination at 6 months, central PCO was 0. These results have a similar trend as the short-term study. The accommodating IOL [FluidVision] maintained an expanded capsular bag secondary to the large size of the haptic elements without significant contact with the anterior capsule; this appeared to prevent overall capsular bag opacification and to retain uveal and capsular biocompatibility, Dr.
Kohl and colleagues concluded. Both the short-term and long-term opacification studies in rabbit eyes were conducted at the Moran Eye Center, University of Utah, Salt Lake City, and the results supported the premise of the in-human clinical studies that commenced later on. If the fluid-filled intraocular lens truly fills the capsular bag in a predictable, sustainable fashion, then this lens design may become a viable solution to these problemsat least in some patient subsets, Dr.
It appears that this type of lens solves the major issues of accommodating and multifocal IOLs, he concluded. Floyd AM, et al. Capsular bag opacification with a new accommodating intraocular lens. J Cataract Refract Surg. Kohl JC, et al. Long-term uveal and capsular biocompatibility of a new accommodating intraocular lens.
Nichamin has financial interests with PowerVision. Sheppard has no financial interest related to his comments.