Dominic McHugh
Royal Society of Medicine
2010

 Leading cause of blindness (“SVL”) in the Western
World
 2.7 million in the UK have some loss.
 54% increase in >75s over the next 25 yrs.

With ARMD Without ARMD
Home Care 23%
Falls 16%
5%
8.3%
Falls With Fractures 3.5% 1.5%
Healthcare Costs €12,579 €1,300
(£8,521) (£885)

• Hanita Ben-Sira implant
Galileian telescope 2x
IOL+spectacle
• Intraocular Miniature Telescope
Galileian telescope 2.2- 3.5x intra (Lipshitz)
•
Difficulty maintaining coaxial alignment
Monovision
VF 20°
11 mm incision

IOL-VIP System
BCC IOL in the capsular bag = telescope ocular
BCX IOL in AC= telescope objective

PC IOL AC IOL
-66D +55D

ANTERIOR CHAMBER IOL (BCX) PC IOL (BCC)
Optic
Optic
Material
Diameter
Thickness
PMMA with UV filter
5.0
1.5mm
Material
Diameter
Thickness
PMMA with UV filter
5.0
1.5mm
Haptics
Haptics
Loop shape
Material
Angle
Z
PMMA-1P
10°
Loop shape
Material
Angle
C
PMMA-1P
7°
IOL power
IOL power +55.00 D
-66.00 D

Inclusion criteria for IOL-VIP surgery
• Bilateral stable macular degeneration/macular hole
• VA 6/18-6/60
• Adequate endothelial cell count
• Adequate AC depth
• Good peripheral field
• Predicted benefit by IOL-VIP simulator

Exclusion criteria for IOL-VIP Surgery
• Active exudative macular degeneration
• Glaucoma
• PAS
• Cornea guttata
• Endothelial cell count < 1600 cell/mm2
• Shallow anterior chamber with depth < 3 mm
• Corneal diameter < 11 mm

IOL-VIP
Proposed mechanism of action
Prismatic deviation of
Image to PRL.
Image magnificiation
~1.3

Pre-op
Post-op
RE preop BCVA : 0.25
postop BCVA: 0.5
(Fasciani et al, 2008)
LE preop BCVA : 0.3
postop BCVA: 0.7

Best VA without and with simulator prism, rotated to achieve PRL

IOL-VIP System
Optimal simulator orientation determines relative IOL position
Right Eye Left Eye
12 12
9 3 9 3
12
9
6
6
3
12 6
9
6
3

9
9
8-7
IOL-VIP System
Optimal simulator orientation determines relative IOL position
Right Eye
Left Eye
12 12
1-2
1-2
3 9 3
8-7
6
1-2
6
1-2
12
3
8-7 8-7
6

• Corneal tunnel (superior/temporal depending on
IOL orientation
• Large (6-7 mm) CCC
• Phacoemulsification if phakic
• Enlarge corneal incision to 7 mm
• PC IOL: bag if phakic, sulcus if pseudophakic
• PI+miochol
• A/C IOL
• Corneal sutures

Surgery

IOL-VIP
Visual Outcome
Orzalesi et al
2007

• Low surgical complication rate
• Endothelial cell loss 7%
• PCO 18%
• High hyperopia in emmetropes; better if myopic
• Recent availability of “bespoke” implants

Advantages
• Improves reading/distance vision in suitable cases (6/18-
6/60 pre op; small-moderate central scotoma)
• Patients comment favourably on scotoma shifting away from centre
Disadvantages
• Careful selection required: pathology; psychology; costs
• Lengthy (6 week) postoperative rehabilitation training
• Suture removal
• Refractive error : hyperopia and astigmatism (reduced with new implants