We have microincisions & now we have a suitable IOL

April 1, 2008

I have been so impressed with the aspheric optics and good centration of the Akreos MI60 that I use it as my first choice for implantation; including in patients with visual-critical occupations such as aviators and air traffic controllers

As one of the first British ophthalmic surgeons to use the MI60 IOL, I have developed some useful techniques that help me make the most of this new IOL. I have been using it in biaxial surgery through a 1.7 mm incision as well as in standard coaxial cataract surgery through a 2.8 mm incision, in conjunction with the Stellaris phacoemulsification unit (Bausch & Lomb). I have been so impressed by the good centration of the IOL, coupled with the small corneal incision required for surgery, that I now use it as my standard IOL, including in my aircrew cataract patients where a good result is crucial to their employment.

At first sight, I was concerned about the shape of the Akreos MI60 lens. However, I soon discovered that its four-haptic design allows it to absorb compression forces in three dimensions. When the capsular bag contracts, the haptics bend without transferring the forces to the optic to maintain IOL centration. The centration of the IOL is therefore excellent even where there has been significant capsular contraction.

So far I have implanted over 70 of these IOLs; 32 through a 1.7 to 1.8 mm incision using the wound-assist technique after biaxial microincision cataract surgery. Implantation has been straightforward in every case.

It is important to take special care to make sure that each haptic is within the capsular bag at the end of surgery, because this is essential for good IOL centration. I would also not advise implanting the lens into the ciliary sulcus if there is a posterior capsular rupture because the overall lens diameter ranges from 10.5 to 11 mm and is unlikely to be stable if implanted in such a position.