Posters

XtraFocus Pinhole IOL: a novel approach for anterior segment reconstruction addressing irregular astigmatism and irregular pupils

Poster Details

First Author: P.Agarwal UAE

Co Author(s):    S. Navon                    

Abstract Details

Purpose:

Patients with irregular astigmatism and irregular pupil present with highly compromised vision needing anterior segment reconstruction.  We describe the sulcus implantation of xtra focus pinhole IOL (Morchers GMBH) in 3 patients who had previous cataract surgeries  presenting with irregular dilated pupils and large refractive errors associated with irregular astigmatism.                         Visual performance was assessed at 1 month 3 months and 6 months after the surgery.  Postoperative outcomes were very encouraging with good uncorrected distance, intermediate and near visual acuities. . This technique presents a novel approach to tackle irregular pupil as well as irregular astigmatism with a single step surgery.

Setting:

Cleveland Clinic Abu Dhabi

Methods:

. Under topical anaesthesia  2.4 mm temporal clear corneal incision was fashioned.  Anterior chamber was filled with ophthalmic visco surgical device Provisc and the xtra focus pinhole IOL was implanted in the ciliary sulcus .  Uncorrected distance visual acuity, uncorrected intermediate visual acuity, and uncorrected near visual acuities were assessed using the Snellen’s vision chart.  Subjective vision was assessed using a Likert scale response system in a brief questionnaire that related the visual disturbances and visual satisfaction.  The entire patients underwent preoperative ultrasound biomicroscopy ensuring an adequate anterior chamber depth of 3.5 mm and pre-existing intraocular lens in the bag.

Results:

case  1: uncorrected visual acuity improved to 20/30 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity improved to J3 .The glare and photophobia resolved completely.  Subjectively the patient was satisfied with the visual outcome. case  2:  Postoperatively 1 week left eye uncorrected visual acuity was 20/70.  Intermediate uncorrected visual acuity was 20/40 and uncorrected near visual acuity was J8. case 3 Postoperatively 1 week left eye uncorrected distance visual acuity improved to 20/25 uncorrected intermediate visual acuity improved to 20/30 and uncorrected near visual acuity improved to J3.

Conclusions:

In conclusion Xtrafocus pinhole device uses a novel approach to tackle a complex anterior segment pathology presenting with irregular astigmatism with concurrent iris defects with a simultaneous single step surgical approach using xtra focus pinhole IOL. Pupilloplasty and artificial iris processes can only tackle irregular pupils, without addressing irregular corneal astigmatism. Topo guided Laser vision correction which is use to correct irregular corneal astigmatism is limited by the availability and cost combined with unpredictable surface healing in an elderly patient. Xtra focus pinhole IOL can be used as novel approach to tackle both the pathologies simultaneously

Financial Disclosure:

None