Verisyse™ for
Correction of Aphakia
No Financial Interest !
Alois Dexl
University Eye Clinic
Paracelsus Medical University Salzburg
Chairman: Prim. Univ.-Prof. Dr. Günther Grabner
Aphakia

Aphakia = absence of natural crystalline lens

Western World: very uncommon
 Phako / ECCE with IOL-implantation
in the capsular bag

Reasons
 After complicated cataract surgery
 Post-traumatic
 Capsular
dislocation of crystalline lens
loss
 Ectopia lentis
 Marfan
syndrome, Weill-Marhesani syndrome, hyperlysinaemia,
homocystinuria, sulfite oxidase deficiency, Ehlers-Danlos syndrome
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Conservative Correction ?

Spectacles
 Reduced peripheral vision
 Ring scotoma (prismatic effect)
 „Jack in the box“
 Aniseokonia

Contact lenses
 Fitting, removal, cleaning…
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Surgical Correction

Angle supported AC-IOL
 Endothelial cell loss (1 year: 6-45%)
 Pseudophakic bullous keratopathy (PBK)
 UGH-syndrome

Scleral fixation of PC-IOL
 Choroidal haemorrhage
 Retinal detachment
 Vitreous incarceration
 Chronic inflammation
 IOL-iris contact
 IOL decentration
 Pigmentary dispersion
 High aqueous flare
 CME
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Surgical Correction

Iris-Claw aphakic IOL
 Best choice for primary or secondary implantation in aphakic eyes
 Safer then open-loop-angle supported AC-IOLs
 Surgery easier, shorter and safer then sclera sutured IOLs
 Some cases of PBK
 Endothelial cell loss – caused by surgical trauma ?
1978
Prof. Jan Worst
Model 205T
Worst Iris Claw® Lens
1986
Model 205Y or
ARTISAN™
VRSA54
VERISYSE ™
Aphakia Lens
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Verisyse® Aphakia

VRSA54 Verisyse
 Primary or secondary implantation after ICCE, ECCE and
Phaco
 Dioptric power: +2,0 D to +30,0 D
(14.5 to 24.5 in 0.5 D steps)
 Optical Diameter: 5.0 mm
 Overall Diameter: 8.5 mm
 Biconvex design
 A-constant:
 115 for AC implantation
 116.8 for retropupillary implantation (ULIB)
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Frequency
University Eye Clinic Salzburg 1996 – 2010
Aphakic Iris claw IOL
 1996 – 2005: 78
=
8 / year
 2006 – 2009: 50
=
14 / year
 2009 – 2010: 22
=
22 / year
University Eye Clinic Salzburg
Paracelsus Medical University
Total 150
alois@dexl.at
Frequency
SUBLUXATED lenses
82
 Primary surgery (Marfan´s syndrome) 25
 Posttraumatic
25
 Spontaneous IOL dislocation (PEX)
32
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Positioning of Verisyse® Aphakia

Anterior

Posterior
 Risk of endothelial cell loss decreases
 AC is deeper
 Distance from haptics to endothelium is larger
 Irido-corneal angle is wider
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Posterior approach
Advantages

Very safe for corneal endothelium

Produces less glare

Only a very small  of HOA1

„Physiological“ space for an IOL is behind the iris
1 Kaymak
C, Mester U. paper at ESCRS-Meeting, Lissabon 2005
.
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Posterior approach
Disadvantages

Extensive anterior vitrectomy required

Special intruments are useful in order to avoid IOLdrop into the vitreous cavity during implantation
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Posterior approach
Sekundo, Eur J Ophthalmol 2008
Special instruments usefull to avoid a tilting of the IOL during implantation procedure
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Posterior approach


Mohr et al. Ophthalmologe 2002
 48 aphakic cases
 2/48 reversible CME
Wolter-Roessler et al. Klin Monatsbl Augenheilkd. 2008
 48 aphakic cases, 14 Months
 2/48 reversible CME
 2/48 traumatic haptic dislocation
 1/48 retinal detachment
 1/48 pupillary block > iridectomy mandatory

Hara et al. J Refract Surg. 2011
 11 eyes retropupillary Verisyse

No complications
 21 eyes transscleral sutured IOL



5/21 ciliary choroidal body haemmorhage
1/21 CME
1/21 IOL dislocation
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
Conclusion
 VERY FEW COMPARATIVE LONG-TERM studies
 Need for a prospective, long-term (multi-center) study
Anterior chamber IOL´s
 Angle-supported
 Iris-claw
Posteriorly
enclavated
Iris-claw lens
Posterior chamber IOL´s
 Sclera-fixated
 Iris-sutured
Decision tree
for the very different clinical situations
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at
University Eye Clinic Salzburg
Paracelsus Medical University
alois@dexl.at