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The new Akreos MI 60 lens. Joel Pynson, MD - Director Design Engineering Bausch & Lomb, Toulouse - France London, September 9th 2006. Akreos material. Hydrophilic acrylic Made of MMA and HEMA Hydration rate : 26% First human implantation : July 1998 Excellent biocompatibility

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the new akreos mi 60 lens

The new Akreos MI 60 lens

Joel Pynson, MD - Director Design Engineering

Bausch & Lomb, Toulouse - France

London, September 9th 2006

akreos material
Akreos material
  • Hydrophilic acrylic
  • Made of MMA and HEMA
  • Hydration rate : 26%
  • First human implantation : July 1998
  • Excellent biocompatibility
  • Superior optic quality (machining versus molding)
  • Over 1.5 millions lenses implanted
akreos ao
Akreos AO
  • To improve the PCO rate with a full 360° barrier
  • To improve the visual results with an aspheric optic
  • To reduce the incision size from 3.2 mm to 2.8 mm
slide5

Spherical Aberration

Typical Spherical IOL

S.A. < 0

“Undercorrected”

Proposed Aspherical IOL

S.A. = 0

Proposed Aspherical IOL

S.A. > 0

“Overcorrected”

advantages
Advantages
  • Better optic quality whatever is the pupil diameter
  • Optic quality not modified by lens decentration
  • Suitable for any cornea, even cornea with negative spherical aberration
next generation akreos mi 60
Next generation : Akreos MI 60
  • Goals : develop a sub 2mm (MICS) IOL without jeopardising the stability of the implant inside the capsular bag.
  • Design new haptics that are both slender and ensure excellent stability of the implant.
  • Check the behaviour of the implant experimentally, by using a computer-generated finite element model
  • Check the behaviour of the implant experimentally, by using the Miyake technique
akreos mi60 haptic design
Akreos MI60 haptic design
  • 4 haptics angled at about 10°
  • A rigid part near the 360° barrier and forming, together with the lens, a rigid central area
  • A thinner, external flexible part
  • A curved terminal part.
pilot clinical study on akreos micro incision lens
Pilot Clinical Study on Akreos Micro-incision Lens
  • Single centre, one surgeon, 20 patients
  • Primary outcome: corneal incision size
  • Secondary outcomes:
    • Visual quality: UCVA, BCVA (Logmar chart),
    • Intracapsular stability: centration vs pupil, anterior-posterior displacement, PCO
  • Follow up: 12 months
injection technique 1 cartridge in
Injection technique 1: “cartridge in”
  • Standard injection technique, 10 patients
  • Mean incision size:
    • 2.11mm before implantation (min 2, max 2.3)
    • 2.22 mm after implantation
    • Stretch : 0,11 mm
  • Minimal incision size
    • Min 2.2 mm
injection technique 2 cartridge out

1.25 mm

Injection technique 2:“cartridge out”
  • Wound-assisted technique, 10 patients
  • ICD = incision diameter, no extra pressure during lens injection => Isobaric injection
  • Mean incision size
    • 1,77 mm before injection (min 1,7, max 1,9 )
    • 1,86 mm after injection
    • Stretch : 0,09 mm
  • Minimal incision size
    • Min 1,8 mm
  • Isobaric injection achieved with the Medicel Viscoglide 1.8 system

Short learning curve

logmar visual acuity

Stability of refraction over time

logMAR Visual Acuity
  • Gain of 6 lines of UCVA (left side)
  • Good predictability of refractive outcome
  • Good early post-op BCVA,
  • Stability of VA at 1 year
lens stability versus pupil
Lens Stability versus Pupil

Left to right: patient 10 at 15 days, 1 month, 3 month , 6 month and 1 year

  • At 1, 3, 6 month and 1 year, minimal movements were observed.
  • Y1 : 0.11mm (SD=0.088)
  • Lens very stable in bag.
posterior capsule opacification n 18
Posterior Capsule Opacification (n=18)
  • Retro-illumination pictures were analysed with EPCO 2000 software analysis of 6mm and 3mm central area
  • EPCO scores at 1-Year in line with what we are used to see with standard lenses.
conclusions
Conclusions
  • Akreos Micro-incision Lens has demonstrated to be safe and effective after 1-Year follow up
  • It allows insertion through a 1.8mm incision
  • Isobaric injection reduces incision trauma
  • Innovative design provides excellent intracapsular stability at 1 year
  • Visual acuity is excellent and stable
  • At 1 year , PCO rates are very low