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Bilateral surgery enhances use of apodized diffractive IOL


Lisbon, Portugal—Bilateral simultaneous surgery to implant an IOL seems to be a safe alternative for patients, and there are numerous advantages associated with performing a bilateral procedure, according to Richard Packard, MD, FRCS. In addition, using the AcrySof ReSTOR IOL (Alcon Laboratories) in this clinical situation provides excellent visual results and high patient satisfaction.

Dr. Packard, director of Arnott Eye Associates in London, recounted his experience with bilateral simultaneous surgery using the ReSTOR IOL at the European Society of Cataract and Refractive Surgeons annual meeting.

"Why perform bilateral simultaneous surgery?" Dr. Packard asked. "Patients prefer only one hospitalization and the decreased costs associated with that. In addition, operating on both eyes consecutively at the same session is an efficient use of the operating theater when treating those patients who require bilateral surgery. There is minimal, if any, greater risk to the patient compared with surgeries performed on separate occasions. More importantly, there is quicker visual rehabilitation because cortical adaptation required by the ReSTOR IOL can begin immediately."

Good distance, near vision

Dr. Packard also likes to use the ReSTOR SA60D3 IOL because in his hands this IOL provides good distance and near vision; in addition, in the setting of bilateral simultaneous surgery it provides high patient satisfaction. The IOL has an apodized diffractive optic, a diffractive structure with a 3.6-mm optical center, and step heights that peripherally decrease 1.3 to 0.4 μm and peripherally decreasing widths. The IOL also has a +4 add at the lens plane equaling +3.2 at the spectacle plane.

"The IOL incorporates the concepts of diffraction-refraction to gain the advantages of both technologies. When light passes through the central portion of the ReSTOR optic, the diffractive steps create light waves that are focused on more than one point. It incorporates a +4 add for reading correction, which provides quality near vision," he said.

Dr. Packard has performed bilateral simultaneous surgery on 124 prospective patients (63 men, 61 women) since October 2003. These patients presented for either cataract or refractive surgeries and opted for implantation of the ReSTOR IOL. The following parameters were recorded: age, sex, reason for surgery, preoperative visual acuity with and without glasses, biometry, topography, surgical technique, and the postoperative visual acuity with and without glasses for near and distance vision. The patients were also assessed for their responses to bilateral surgery and to the visual outcome provided by the ReSTOR IOL and its ability to provide near and distance vision.

The average patient age was 58 years. The preoperative treatment range was –10.0 to +6.25 D with astigmatism up to –2.5 D. Of the 124 patients, 55 had hyperopia, 38 myopia, and 31 were within 1 D of emmetropia preoperative refraction. Forty-six patients had limbal relaxing incisions, 15 had piggybacking to extend the power range of the IOL, and 91 patients had lens removal for cataract and 33 for refractive lens exchange. No surgical complications occurred, according to Dr. Packard.

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