Femtosecond Laser Surgery in Ophthalmology by Dick H. B. Gerste Ronald D. Schulz Tim

Author:Dick, H. B.,Gerste, Ronald D.,Schulz, Tim
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2018-01-19T16:00:00+00:00

Icolens

The Icolens system (Neoptics AG, Huenenberg, Switzerland) comprises a microlens with a positive refractive power, a femtosecond laser (Femto LDV, Ziemer Ophthalmic Systems AG) with a pocket-cutting algorithm, a preloaded deployment device, and purpose-designed positioning instruments. The 3.0-mm Icolens has a bifocal design with a central zone for distance and a peripheral positive refractive zone for near. The central zone has a diameter of 1.8 mm, an edge thickness of 15 μm, and a 0.15-mm central hole to facilitate nutrient flow. It is manufactured using a copolymer of 2-hydroxyethyl methacrylate and methyl methacrylate, both of which have hydrogel properties. The material has a refractive index of 1.460 in hydrated conditions. The treatment range is currently available from 1.5 to 3.0 D (for Presbyopia) and from –1.0 to +1.5 D (for Ametropia).

Baily et al 12 reported in a recent publication the 12-month results after monocular implantation of this refractive optics inlay in emmetropic patients. The Femto LDV femtosecond laser was used for pocket creation (temporal pocket incision; diameter: 3.6 mm; depth: 290 μm). After pocket creation, the preloaded device was inserted into the corneal pocket until the hole located on the leaves was centric to the pupil. The mean UNVA in the surgical eye (n = 52) improved from 0.78 logMAR preoperatively to 0.44 logMAR postoperatively, with patients having a mean gain of 3.48 lines of UNVA. The UDVA in the surgical eye significantly worsened from 0.05 logMAR preoperatively to 0.22 logMAR postoperatively (mean loss of 1.67 lines), but binocularly, UDVA could be maintained (mean gain: 0.48 lines). Also a mean loss of CDVA postoperatively was evident (–1.78 lines). There was no significant change in corneal topography or endothelial cell count. On the satisfaction survey (n = 40), 90% of patients reported being satisfied with the overall procedure in general. In all cases in which the inlays were explanted (11/52), the reason was poor refractive outcomes rather than adverse events (7/11: inadequate centration; 3/11: ambiguous ocular dominance; 1/11: unrealistic patient expectations). Explantation was uneventful, with no adverse events or complications occurring and all patients returning to the baseline refraction.

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