Intracorneal inlay for the surgical correction of presbyopia

Yılmaz, Ömer Faruk; Bayraktar, Şükrü; Ağca, Alper; Yilmaz, Basak Saracoglu; McDonald, Marguerite B.; Pol, Corina van de

doi:10.1016/j.jcrs.2008.07.015

Cited by 126 publications

(115 citation statements)

References 11 publications

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“…Any insult to the cornea that significantly affects those distinctive properties will interfere with its function with subsequent affect vision. [18][19][20] Inlays should be semipermeable, allowing oxygen supplied from the tear film and glucose supplied from the aqueous humor to nourish the vital corneal cells while also allowing catabolic end products to be delivered to the aqueous humor. This mechanism is essential to prevent anterior stromal necrosis and corneal edema, which plagued older attempts at placing an inlay within the corneal stroma.…”

Section: -16mentioning

confidence: 99%

Intracorneal Inlays—Special Focus on the Raindrop

Güell¹,

Barrada²

2014

US Ophthalmic Review

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123Patient demand for spectacle independence is growing. The advances in laser and non-laser technology have allowed ophthalmologists to offer their patients the freedom to choose between depending on their glasses, or to go spectacle free. Presbyopia, defined as the age-related loss of the ability to clearly accommodate onto near objects, has become the last frontier for refractive vision correction.The complexity and illusiveness of presbyopia necessitates the ophthalmologist to tackle its pathology in different ways. Corneal, lenticular, and even scleral approaches have been previously explored in an attempt to reverse this agerelated phenomenon. Corneal monovision and presbyopic laser-assisted in situ keratomileusis (presbyLASIK) procedures gave conflicting results. Monovision gives the patient near vision on the expense of far and binocular vision; while presbyLASIK requires further development in its nomogram in order to achieve consistent postoperative results.1-3 Conductive keratoplasty, a technique in which the cornea is molded into a new shape using radiofrequency waves, has also been studied as an option for presbyopia treatment, with patients usually experiencing a large overcorrection followed by a significant regression of their refractive outcome overtime. 4Other procedures described in the management of presbyopia include scleral expansion and anterior sclerotomy techniques. 5,6 Lens surgery with implantation of multifocal or accommodating intraoperative lenses (IOLs) have also shown to reduce dependence on reading glasses; 7 however, risks associated with intraocular surgery, difficulty in lens exchange, biometric errors, patient dissatisfaction, and loss in contrast sensitivity and photopic phenomena make them far from perfect.8 Also, there is an age bracket (40-50 years old) where patients might be experiencing presbyopia symptoms but still had not developed cataract, and in these patients lens surgery is probably less than ideal.Pseudophakic patients with monofocal IOLs are also not eligible for secondary lens implantation, and in these patients an intracorneal inlay might be a good option.One of the earliest proposed methods for presbyopia correction is additive refractive keratoplasty. This term refers to procedures in which a foreign material is added to the corneal tissue to modify the refractive condition of the eye. Albeit this method is not new, recent advances in technology, its potential for reversibility, and ease of application has made it a subject of great interest to ophthalmologists in recent years. 9 HistoryAs mentioned, intracorneal inlays are far from being a novel idea. José I.Barraquer performed experiments with corneal implants as early as 1949, although with unsatisfactory results. 10 Since then, this refractive technology has undergone a series of improvements. AbstractPresbyopia remains the last frontier for refractive surgeons. With increased demand for spectacle independence at all ages, ophthalmologists are exploring different approaches for presbyopia correction. T...

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Section: -16mentioning

confidence: 99%

Intracorneal Inlays—Special Focus on the Raindrop

Güell¹,

Barrada²

2014

US Ophthalmic Review

View full text Add to dashboard Cite

show abstract

“…Any insult to the cornea that significantly affects those distinctive properties will interfere with its function with subsequent affect vision. [18][19][20] Inlays should be semipermeable, allowing oxygen supplied from the tear film and glucose supplied from the aqueous humour to nourish the vital corneal cells while also allowing catabolic end products to be delivered to the aqueous humour. This mechanism is essential to prevent anterior stromal necrosis and corneal oedema, which plagued older attempts at placing an inlay within the corneal stroma.…”

Section: The Problem With Corneal Inlaysmentioning

confidence: 99%

“…The Kamra Inlay utilises the latter part of this synkinesis in an attempt to improve near vision in presbyopes. 20 The Kamra Inlay is a 10.0 μm thin microperforated artificial aperture, with a 3.8 mm outer diameter with a central aperture (inner diameter) of 1.6 mm. The Kamra Inlay is made of polyvinylidene fluoride (PVDF), which is biocompatible in vitro, and pigmented with nanoparticles of carbon to make the inlay opaque (see Figure 1).…”

Section: The Kamra Inlaymentioning

confidence: 99%

Intracorneal Inlays – Special Focus on the Raindrop

Güell¹,

Barrada²

2014

European Ophthalmic Review

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23Patient demand for spectacle independence is growing. The advances in laser and non-laser technology have allowed ophthalmologists to offer their patients the freedom to choose between depending on their glasses, or to go spectacle free. Presbyopia, defined as the age-related loss of the ability to clearly accommodate onto near objects, has become the last frontier for refractive vision correction.The complexity and illusiveness of presbyopia necessitates the ophthalmologist to tackle its pathology in different ways. Corneal, lenticular and even scleral approaches have been previously explored in an attempt to reverse this age-related phenomenon. Corneal monovision and presbyopic laser-assisted in situ keratomileusis (presbyLASIK) procedures give conflicting results. Monovision gives the patient near vision on the expense of far and binocular vision; while presbyLASIK requires further development in its nomogram in order to achieve consistent postoperative results. 1-3 Conductive keratoplasty, a technique in which the cornea is moulded into a new shape using radiofrequency waves, has also been studied as an option for presbyopia treatment, with patients usually experiencing a large overcorrection followed by a significant regression of their refractive outcome overtime. 4 Other procedures described in the management of presbyopia include scleral expansion and anterior sclerotomy techniques. 5,6 Lens surgery with implantation of multifocal or accommodating intraoperative lenses (IOLs) have also shown to reduce dependence on reading glasses; 7 however, risks associated with intraocular surgery, difficulty in lens exchange, biometric errors, patient dissatisfaction and loss in contrast sensitivity and photopic phenomena make them far from perfect. 8 Also, there is an age bracket (40-50 years old) where patients might be experiencing presbyopia symptoms but still had not developed cataract, and in these patients lens surgery is probably less than ideal. Pseudophakic patients with monofocal IOLs are also not eligible for secondary lens implantation, and in these patients an intracorneal inlay might be a good option.One of the earliest proposed methods for presbyopia correction is additive refractive keratoplasty. This term refers to procedures in which a foreign material is added to the corneal tissue to modify the refractive condition of the eye. Albeit this method is not new, recent advances in technology, its potential for reversibility and ease of application has made it a subject of great interest to ophthalmologists in recent years. 9 HistoryAs mentioned, intracorneal inlays are far from being a novel idea. José I.Barraquer performed experiments with corneal implants as early as 1949, although with unsatisfactory results. 10 Since then, this refractive technology has undergone a series of improvements.Early inlays were composed of flint glass and plexiglass for the correction of aphakia and high myopia. Earlier trials attempted to use poly(methyl methacrylate) (PMMA) and polysulfone inlays to treat high...

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“…The KAMRA ® inlay (AcuFocus Inc., Irvine, CA, USA), a small-aperture intra-corneal inlay medical device aiming at correcting presbyopia, can be monocularly implanted into a lamellar pocket in the nondominant eye of a patient. Its mechanism of action is to restrict unfocused peripheral light rays to provide increased depth of focus and an extended range of continuous vision expanding from near to far [8,9].…”

Section: Introductionmentioning

confidence: 99%