safety and efficacy of toric icl in asian eyes aao beijing 052007 16052007 1

1
Safety and Efficacy of Toric ICL
April 2008 ASCRS
John Chang Jr. MD Director of Guy Hugh Chan
Refractive Surgery Centre Hong Kong Sanatorium
Hospital
2
Toric Implantation Collamer Lens (TICL) is now in
phase III of the U.S. FDA study
3
TICL

• Lens power range (Visian TICL)
• Sphere ranges from -3D to -23D
• Cylinder ranges from 1DC to 6DC
• Customized axis
• Can correct up to -18DS/-0.75DC or -14DS/-5.0DC

• From 04/2004 to 04/2007
• No. of patients 27
• No. of eyes 42
• Bilateral TICL 15
• Age range 23 to 44 yrs
• Mean age 32.1 6.7 yrs
• Mean FU 6 months

4
TICL - Results
5
TICL - Results
PostOp Rx at 12M
6
TICL - Stability
7
TICL - Results 12M
8
TICL - Safety 12M
No eye lost any vision
9
TICL - Complications

• 1 eye (2.9) transient IOP rise at 1 month
• Steroid induced
• 1 lens rotated 15o clockwise
• Patient with RE preop Rx -18.75/3.50 x100
• Implanted with TICL -23.0/3.50/099
• After surgery the lens rotated clockwise by 15o
• Residual Rx -2.00/2.50x120 (20/20), UCVA 20/80
• Lens dialed 6M after surgery
• UCVA 20/25 MRx -0.50/1.00 x 65 (20/20)

10
TICL - Surgical Technique

• Same as Non Toric
• Laser PI 1week prior to lens implantation
• Temporal 3.0 - 3.2mm self sealing incision
• Lens injected via foldable injector into AC
• Lens dialed into sulcus
• Surgery done under topical anesthesia
• Toric lens supplied correct Power for Sphere and
  Cylinder but axis can be different by up to 22o
• During surgery the axis of the lens to be
  positioned is marked.
• Temporal incision is made to match that axis
• Need to dial lens into position (surgical planner
  software supplied)

11
TICL - Advantages Disadvantages

• Advantages
• Technically not difficult (Avg surgery time 25
  mins)
• No / Minimal night vision problems
• Short learning curve easier than Phaco
• Lens is removable
• Disadvantages
• Sizing can be difficult, Orbscan not always
  reliable
• Sizing even more important than non-toric ICL
• Glaucoma? Pigment dispersion?
• Expensive
• 2 Procedures Laser P.I. First (uncomfortable),
  then lens implantation

12
TICL - Conclusion

• Toric ICL results very encouraging (100 20/20
  UCVA)
• Transient IOP rise 2 to steroid use
• Accuracy as good / better than LASIK for high
  myopia
• Much better immediate and long term stability
  than LASIK.
• No cataract with TICL