Optimizing outcomes with accommodating IOLs

All presbyopia-correcting IOLs have pros and cons, and because they have different performance characteristics that can meet the vision needs of a range of patients, Steven G. Safran, MD, said that he uses all the available technologies.

Dr. Safran provided pearls for achieving success and dealing with complications when implanting accommodating IOLS (Crystalens AO and Trulign Toric IOLs, Bausch + Lomb).

“The keys to success with these implants include proper patient selection, setting realistic patient expectations, hitting the refractive targets, performing meticulous surgery with a focus on avoiding lens epithelial cell-mediated capsule contraction, and intervening early to prevent or treat complications,” said Dr. Safran, private practice, Lawrenceville, NJ.

He noted that the most important complications of the accommodating IOLs are variable/unstable refractive outcomes and Z syndrome (asymmetric vault). The causative factors for these events are the same-capsular fibrosis leading to contraction and use of an IOL that is oversized for the capsular bag.

“Therefore, success with these IOLs involves avoiding capsular bag fibrosis and situations where the lens will be placed under destabilizing contraction forces by the capsular bag,” Dr. Safran said.

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