PIOL

indications

Gold standard for correcting larger ametropies
Indication to correct minor and moderate ametropia only if:

• Schirmer test < 5 mm, fluorescein staining of epithelial lesions of the cornea or conjunctiva
• thin cornea < 480 um
• irregular topography (inferior steepening > 1.5 D, posterior float > 14 um, etc.)
• Scars in the Area of Corneal Stroma
• Martial Arts, Police

Scope of application for PIOLs
(Information provided by manufacturers)

• Myopia from -6 dpt (from -1)
• Farsightedness from +3 dpt (from +1)
• Astigmatism from 5 dpt (from 1)
• Age > 18 years
• Stable eyeglass values (<0.5 dpt. for 6-12 months)
• No pregnancy/ breast-feeding

Contraindications

• Cataract or glaucoma
• Inflammatory eye diseases (e.g. uveitis)
• Endoth cell density < 2000/mm2
• Internal anterior chamber depth (endothelium to front lens surface)
  
  • Myopia < 2.8 mm
  • hyperopia < 3.0 mm for hyperopia)
• Pregnancy, breast-feeding
  
  • Possible 3 months after weaning

Preparation

• Topography/tomography (Pentacam®)
• White to white (Pentacam®)
• Biometrics (Pntacam®)
• ICL® /IPCL® calculation by opticians
• OCT M P and photos (for documentation)
• corneal endothelial mirror microscopy (for documentation)
• Information -> see PIOL consent form (i.B. pain/inability to work at least 1-2 days, up to 4 weeks)
  • UP to 100% possible for 2 weeks in case of illness (CL intolerance, skin scar, etc.)
• Preoperative preparation
  • Yellox Eye Drops 2x/D/Nevanac 3mg 1x/Day/Nevanac 1mt 3x/day for 5 days until surgery
  • Oxybuprocaine 0.4% SDU eye drops 3x every 5 minutes

Edit surgical material

• Prepare a sterile operating room
• Undiluted hibidil solution/povidone iol solution 5-10%
• 6x round swab
• BSS solution
• Large ICL® clip and packaging to open
• incisions
  
  • 1.2 mm
  • 2.4 mm
• Lidocaine 1.0%
• viscoelastic discursive (e.g. HPMC 2%)
• ICL® manipulator/spatula
• I/A
• Shooter
  
  • ICL® green/yellow from Mediconsult
  • IPCL® /ICL® blue/white 2.4 mm
• Dreieckstupfer
• Miostat® solution
• Aprokam® solution
• BSS solution

Operation process

See Operation Report

Post-operative therapy

• prophylaxis
  
  • Tobradex® eye drops every hour until the first follow-up
  • Diamox 250 mg Tbl 1x immediately after surgery 1x at night 1x the next morning
• Analgesia when needed
  • Dafalgan 500mg Tbl 4x/day to 8x/day
    (Cave: Total 4g/day only if no alcoholism or liver problems are known)
  • Mefenacid 500mg Tbl 3x/day

Post-operative procedure

• 1 day: Follow-up
  • Therapy: Tobradex® eye drops 4x/day, Yellox eye drops 2x/day procedure: Control in 1 week with Autoref (no vision check) and anterior segment OCT, Optava eye drops for moisturizing as needed control in approximately 7 days with Autoref (no visual check)
  • Test module “ICL1"
    OX 1 day after ICL/IPCL implantation
    Previous bulb sections
    Conjunctiva: easily injected
    Cornea: smooth, clear
    Anterior chamber: deep, irritant
    IRIS/Pupil: round, plays, medical miosis, ICL/ IPCL in loco, right centered
    Natural lens clear
    Fd: central retina unobtrusive
    Anterior segment OCT (OCT front section settled): Vault XXX μm
    Therapy: Tobradex® eye drops 4x/day, Yellox eye drops 2x/day
    Procedure: Inspection in 1 week with autorefractometer (no visual inspection) and anterior segment OCT
  • cave:
    
    • Always applanatory tonomtria
    • PIoL and distance from the natural lens (vault) must be visible
    • Vault should be between 250-700 um (may change in the first few days to weeks)
• 1 week
  
  • Substantiate Therapy as After Cataract Surgery, Anterior Segment OCT
• 1 month
  
  • Snuff out therapy, anterior segment OCT and endothelial cells
    
• 1 year
  
  • Anterior segment OCT and corneal endothelium mirror microscopy
  • Examination of peripheral retina in mydriasis (only in patients with myopia of > 6 diopters, peripheral retinal degeneration or retinal symptoms) -> also draw the patient's attention to the symptoms of vitreous dissection

miscellaneous

• If there is increased cell irritation or fibrin accumulation without pain on the first postoperative day -> suspicion of TASS (Toxic Anterior Segment Syndrome)
  • Increasing topical steroids and close follow-up
    • Early treatment improves prognosis
    • Can take several days until the cornea completely clears
    • Cave: Differential diagnosis of endophthalmitis
• Visual acuity may take a few days (e.g. in the case of post-operative corneal edema)
• Post-correction as a touch-up with PRK/Transprk/LASIK after at least 6 months with stable topography

sources

• CRC guidelines 2024
• Information from manufacturers (ICL®, IPCL®)