ACRYSOF ReSTOR

IOL- A CHALLENGE IN
HIGH AMETROPIES
CORRECTION
Assoc. Prof. M.Filip, Carmen Dragne,
A. Filip, Marineta Magureanu, R.
Asandi
AmaOptimex Eye Clinic, Bucharest,
Romania

PURPOSE
To highlight the stages necessary for the
success of the Acrysof ReSTOR IOL
implantation:
Patient selection;
Keratometry;
Biometry;
Surgical technique accuracy;
Postoperative treatment.
To evaluate the functional results regarding the:
Visual acuity (VA);
Patient satisfaction

AMAOPTIMEX EYE CLINIC

Between 05.06.2006 and 22.02.2007, 84 ambulatory
refractive lens exchange (RLE) performed:
High myopia >8d 64 eyes;
High hyperopia >6d 20 eyes.
Acrysof ReSTOR iol has been implanted in:
High myopia >8d 5 eyes;
High hyperopia >6d 3 eyes.
During this period 30 Acrysof ReSTOR iol were
implantated in the clinic.

PATIENT SELECTION
All the patients were correct and complete

informed on the procedure and especially upon

connected risks; they signed an agreement before
surgery.
Compatible patients:
Very motivated to reduce their glasses
dependency, and willing to retain the ability to
see either close and distant objects without
glasses;
Bilateral implantation candidates;
PFK pc monofocal at the congener eye (the
maxim effect occurs at bilateral implantation).

PATIENT SELECTION
Patient
characteristics
consider:

to

carefully

Patients who have excessive complaints about their

prescription glasses or contact lenses;
Patients who drive at night for their occupation;
Individuals who have preexisting complaints about
nighttime glare.

MEDICAL
CONSIDERATION
PATIENT SELECTION

Age >20 years old;

Stable refraction in the last 6 months;
Patients with more than 1 diopter astigmatism;
Amblyopia;
Power requirements outside of lens range
(10-30 diopters);
Patients with previous refractive surgery;
Significant pre-existing ocular pathologies (e.g.
corneal, retinal disease).

KERATOMETRY
Discontinue contact lens wear for at least 2

weeks, until stable keratometry reading is

confirmed;
K readings are suspect, below 40 diopters
or greater than 47 diopters;
To confirm irregular astigmatism we use
corneal topography, if the suspicion
remains we give up Acrysof Restor
implantation.

BIOMETRY
Gold standard: immersion biometry;
We performed this technique at all

patients selected for RLE;

ADVANTAGES:
No direct corneal contact;
No corneal compression or tear bridge;
Gives true axial length;
Less operator dependent.

IOL POWER
CALCULATION
Target emmetropia to achieve optimal visual

performance: +0.25 +0.5d sph;

Use 118.1 A-constant for the Acrysof Restor
iol;
We use as IOL calculation the following
formula:
o Holladay formula for high myopia, axial
length >24.5mm;
o Hoffer-Q formula for high hyperopia, axial
length <22mm.

TREATMENT
Treatment before surgery:
Ciprofloxacin, topical and systemic;
Technique used: irrigation/aspiration of
transparent lens with Alcon Legacy
Series 20000 and implantation iol pc in
the bag;
treatment:
topical
Postoperative
treatment: ciprofloxacin, tropicamide,
diclophenacum, dexamethasone;
Postoperative control at 6 weeks.

CASE 1
N.A. female, 21 years old, urban area;
Reason for presenting: to give up glasses;
Ophthalmologic exam:

BCVA RE 0.8 with correction +3d sph

BCVA LE 0.3 with correction +3d sph
Refraction with cycloplegia:
RE : +6.25dsph/+0.75dcyl ax 176
LE : +7dsph/+1dcyl ax 100
Immersion biometry using SRK II formula (instead of
Hoffer-Q formula) +28.5d to target +0.32dsph
RE Acrysof Restor iol +28.5d;
Postoperative refraction RE +2dsph/+0.25dcyl ax 101;
Recommendation: Excimer after 6 months to attend
emmetropia.

CASE 2

B.S. male, 20 years old, urban area;

Reason for presenting: to give up glasses;
Ophthalmologic exam :
BCVA RE 1 wc -8.5dsph/-0.75dcyl ax 0
BCVA LE 1 wc -6.5dsph/ -1.5dcyl ax 10
Refraction with cycloplegia:
RE : -9dsph/-0.75dcyl ax 0
LE : -6.75dsph/ -1.5dcyl ax 10
Immersion biometry RE using Holladay formula
+10.5d to target +0.25dsph
RE Acrysof Restor iol +10.5d;
LE Excimer

CASE 2
6 weeks control :
Postoperative refraction:
RE +0.5dsph/-0.75dcyl ax 131;
LE 0dsph/-1.25dcyl ax 3;
VA RE 1 without correction;
VA LE 0.9 without correction;
3 months control :
Postoperative refraction:
RE 0dsph/-0.75dcyl ax 131;
LE -0.5dsph/-0.75dcyl ax 6;
VA RE 0.7 without correction;
VA LE 0.9 without correction;
Slitlamp examination RE: PFK PC Restor centered, posterior
capsula opacity++
Recommendation: RE laser yag at 6 months control.

CASE 3
B.C. female, 23 years old, urban area;
Reason for presenting: to give up glasses;
Ophthalmologic exam:

BCVA RE 0.6 wc -10dsph/-1.5dcyl ax 165

BCVA LE 0.7 wc -9dsph/ -2.5dcyl ax 10
Refraction with cycloplegia:
RE : -11.25dsph/-1.5dcyl ax 0
LE : -9.5dsph/ -2.5dcyl ax 10
Immersion biometry using Holladay formula
RE+10d to target --1.41dsph
LE +10d to target --0.25dsph
BE Acrysof Restor IOL +10d, after 6 months Excimer
for emmetropia.

CASE 3
6 weeks control :
Postoperative refraction:
RE -1.75dsph/ -1.25dcyl ax 158;
LE 0dsph/ -2dcyl ax 1;
UCVA RE 0.7;
BCVA RE 1 with correction -1.25d cyl ax 165
UCVA LE 0.7;
BCVA LE 0.9 with correction -1.25d cyl ax 0
Slitlamp examination BE: PFK PC Restor well
positioned,
Rec.: BE Excimer after 6 months,if necessary.

CASE 4
C.G. male, 33 years old, urban area;
Reason for presenting: to give up glasses;
Ophthalmologic exam:
20

BCVA RE 0.3 wc -10dsph/-1dcyl ax

BCVA LE 0.6 wc -11dsph

Refraction with cycloplegia:
RE : -10.5dsph/-1.75dcyl ax 20
LE : -10.75dsph
Immersion biometry using Holladay formula
RE+10d to target --1.41dsph
LE +11d to target +0.25dsph
BE Restor +10d; after 6 months RE Excimer
for emmetropia.

CASE 4
6 weeks control:
Postoperative refraction:
RE -1.5dsph/ -1.75dcyl ax 19;
LE +0.25dsph/ +0.5dcyl ax 176;
UCVA RE 0.2;
BCVA RE 0.4 with correction -1d sph/1.25dcyl ax 175
VA LE 0.7 without correction;
Slitlamp examination BE: PFK PC Restor well
positioned,
Recommendation: RE Excimer after 6 months.

CASE 5
G.D. male, 31years old, urban area;
Reason for presenting: to give up at glasses;
Ophthalmologic exam:

BCVA RE 0.8 wc +4dsph

BCVA LE 0.8 wc +4dsph
Refraction with cycloplegia:
RE : +6.5dsph
LE : +7.5dsph/+0.5dcyl ax 176
Immersion biometry using Hoffer-Q formula
RE+28.5d to target +0.31sph
LE +29.5d to target +0.25dsph
BE Restor

CASE 5
6 weeks control :
Postoperative refraction:
RE +0.25dsph/ +0.5dcyl ax 170;
LE +0.25dsph/ +0.25dcyl ax 40;
VA RE 0.9 without correction;
VA LE 0.9 without correction
Slitlamp examination BE: PFK PC Restor well
positioned,

RESULTS
All the patients were from urban area;
All the patients were very motivated to
reduce their dependency on glasses;
Mean age of the patients was 25,6
years old;
Visual disturbances as: night vision
problems, glare, halos did not occur
in our patients.

ACRYSOF RESTOR
PERSPECTIVE
In patients selection we exceeded the
producers indications:

Patients with more than 1 diopter astigmatism

Excimer after 6 months;

Patients with high myopia, where we expect
postoperative remaining myopiaDiscussion
about Excimer after 6 months,preoperatively;
Amblyopia;

CONCLUSIONS
Functional results:
binocular visual acuity is 1-2 Snellen lines
superior than monocular visual acuity;
Patient satisfaction level: very high, except case
1, with a remain hyperopia Excimer and case 2
with secondary cataract laser YAG;
No patient needs glasses for every day activity.
The result is an increased range of quality vision
that delivers a high level of spectacle freedom.