LiOs FáQuicos 2007
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Transcript of LiOs FáQuicos 2007
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LIOs Fáquicos
Dr. Rodrigo Donoso R.
Clínica Oftalmológica PasteurUniv. de Chile – Hospital del Salvador
Santiago - Chile
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Phakic IOL Indications
Miopías muy altas.
HM > 4.0 D sin presbicia.
Riesgo de Ectasia.
Corneas muy delgadas, planas o curvas.
Nistagmus, Cirugía previa, KC or KCF.
Ojo seco o problemas de superficie.
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Alta Miopía: % DR en “RLE” Follow-up % RD
Jimenez Alfaro 12,0 0,0
Colin J 12,0 0,0
Lee KH 15,0 0,0
Kaluzny JJ 19,4 2,6
Lyle WA 20,0 0,0
Wang J 23,5 0,0
Guell JL 24,0 0,0
Barraquer C 30,7 7,3
Kubaloglu A 40,2 3,5
Pucci V 42,9 4,0
Arne JL 44,0 5,6
Colin J 48,0 2,0
Gabric N 48,0 1,4
Fernadez-Vega L 57,4 2,1
Colin J 84,0 8,1
Rodriguez A 216,0 30,0
RD in CLE for High Myopia
R2 = 0,9299
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
0 50 100 150 200 250
Follow-up
% R
D % RD
Polinómica (% RD)
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Ventajas de LIOs Fáquicos:
Preservan acomodación.
Rápida rehabilitación visual postoperatoria.
Estabilidad.
Bióptica o Tórica.
Reversibilidad.
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Ventajas de LIOs Fáquicos:
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Ventajas de LIOs Fáquicos:
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Exclusion Criteria: FDA
History of/or clinical signs of iritis/uveitis in either eye.
Diabetic retinopathy in either eye or Insulin-dependent diabetes.
Glaucoma in either eye or ocular hypertension.
Blind in the fellow eye.
Pigmentary S., Pseudoexfoliation with or without glaucoma and narrow angles.
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Resultados: PIO
PIO pre y postop. p > 0,05
024
68
101214
161820
PRL ICL
PIO pre
PIO post
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Resultados: AV postop.
PRL ICL p
BCVA pre 0.52 0,64
UCVA post 0,4 0,5 0,037
BCVA post 0,7 0,8 0,056
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92.45% y 94.8% ≥ AVcc Preop.!
0,00
0,20
0,40
0,60
0,80
1,00
1,20
1,40
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Avcc
AVcc
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Índice de Seguridad: 1.34 y 1.33
1,34
0,80
1,33
0,83
0,00
0,20
0,40
0,60
0,80
1,00
1,20
1,40
1,60
Seguridad Eficacia
PRL
ICL
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Resultados FDA : AV
UCVA BCVA
ICL % Artisan % ICL % Artisan %
20/20 59,3 44,3 96,4 95
20/40 94,7 92 100 100
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Resultados: EE +/- 1.0 D 61.2 % vs 81.5 %
Corrección Miópica ICL
R2 = 0,9816
0
5
10
15
20
25
30
0,00 5,00 10,00 15,00 20,00 25,00 30,00
EE Corregido
EE
De
se
ad
o
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United States FDA Clinical Trial of the Implantable Collamer Lens (ICL) for Moderate to High Myopia. Three-Year Follow-up ICL in Treatment of Myopia (ITM) Study Group* (566 eyes)
% Predictability for preop. UCVA 20/20 and postop. SE ± 0.5D
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EE (D) ICL % Artisan %
+/- 0,5 68,3 71,7
+/- 1,0 89,5 94,7
Resultados FDA :
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Complicación: Fijación Iris- Ángulo
Endotelial cells loss, 2.2% x year.
Acute or chronic Iritis
C. Macular Edema.
Iris atrophy
Pupillary Distortion
Glaucoma.
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Complicaciones: Cámara Posterior (4% Subluxación, PRL)
Glaucoma x cierre angular.
S. Urrets-Zavalia
Gl. Dispersión Pigmentaria
“Clinically significant A. Sbc opacities” (0.4% FDA)
Uveítis Cronica y EMC.
Luxación LIO: 4% PRL!
Donoso R: Correction of high myopia with the PRL phakic intraocular lens. J Cataract Refract Surg 2006; 32:1296–1300, 2006
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PRL x ICL
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Conclusiones FDA:“The Visian ICL™ and ARTISAN Phakic IOL met or exceeded the target effectiveness criteria for refractive
stability, uncorrected visual acuity, best corrected visual acuity and refractive predictability.”
endothelial cell loss continues at the rate of 1.8% (***CA > 3.1 mm.) and 2.2% per year respectively.
+/- 37% of patients are expected to lose 50% of their corneal endothelial cells within 25 years of implantation !?
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Pérdida Endotelial **
Baratz K.: Endothelial Cell Loss: How real is the danger? Mayo Clinic. American Academy of Ophthalmology Congress 2006
ICL
Artisan
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Buena Técnica Quirúrgica
Artisan
Buen Centramiento.
Correcta fijación iris.
Minimo trauma iridiano.
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Artisan
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Buena Técnica Quirúrgica
ICL
Evitar toque cristalineano.
Asegurar Iridotomía permeable.
Remover SVE.
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Implante Artiflex
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Implante Artiflex
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Cual es el LIO Fáquico más Adecuado?
ICL -3.0 to -20.0+3.0 to +17.0
Artiflex -2.0 to -14.5
Artisan -1.0 to -23.5+1.0 to +12.0
Toric Artisan Cyl - 2 to -7.5D
Toric ICL Cyl - 1.0 to - 4.0 D
?
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En Resumen: LIOs Fáquicos
Beneficios >> Riesgos
La mejor opción para indicación.
ICL & Artisan son seguros, predecibles, estables y reversibles.
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MUCHAS GRACIAS!MUCHAS GRACIAS!