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Update on Iridectomies for ICL / Toric ICL Implantation
Experts round table opinion on Nd:YAG Laser Iridotomies vs Surgical Iridectomy

   There is a trend in the market towards surgical               The following table contains a summary of
   peripheral iridectomies (PI’s). Iridectomies can              opinions from six experienced ICL / Toric ICL
   be performed either preoperatively with                       surgeons when asked about the pros and cons
   Nd:YAG laser or intraoperatively with scissors                of the three different methods for performing
   or a vitrector.                                               iridectomies.

                    Laser PIs Nd:Yag                          Surgical PI Scissors            Surgical PI Vitrector
Size                Easy to control. Usually between          Require more experience to      Require more experience to
                    0.5mm and 1.0 mm.                         control. Usually range from     control. Usually range from
                                                              1mm to 2mm.                     1mm to 2mm.
                    If too small, may affect permeability     If too big, may interfere       If too big, may interfere
                                                              with vision*.                   with vision*.
Number              Two                                       One                             One
Location            Easy to place peripheral (miotics)        More difficult to keep          More difficult to keep
                                                              peripheral. If mid-peripheral   peripheral. If mid-peripheral
                                                              may interfere with vision*      may interfere with vision*
Permeability        Less certain but possible to check        More certain that PI is pene-   More certain that PI is
                    prior to surgery and possible to redo     trated, check with visco.       penetrated, check with
                    if needed. Difficult to get full          Always possible in thick        visco.
                    penetration in thick irises (unless pre   irises.
                    Argon laser treatment performed).
Pain/discomfort     Possible (from miotic and laser)          Unlikely                        Unlikely
Patient             Adds one visit. This may increase         None, done on day of            None, done on day of
Inconvenience       patient’s loyalty and reduce surgical     surgery.                        surgery.
                    risk.
Number of           One main incision (temporal clear         Second corneal incision at      One main incision (temporal
incisions at time   corneal incision)                         12 o´clock (perpendicular to    clear corneal incision)
of surgery                                                    corneal plane )
Pigment loss /      Possible but prior to surgery             Higher risk, also during        Higher risk, also during
bleeding                                                      surgery.                        surgery.
Halos / glare /     Less risk if peripheral and controlled    Higher risk if too big and      Higher risk if too big and
diplopia *          size                                      not peripheral enough           not peripheral enough
Cosmetic            None                                      Possible if too large or too    Possible if too large or too
concern                                                       inferior                        inferior
Duration of         Less surgical time                        Increased surgical time by      Increased surgical time by
surgery                                                       up to two minutes               up to two minutes
Risk at time of     None. However, bad technique may          Increased due to additional     Increased. Potential
surgery             cause damage to crystalline lens and      incision, potential bleeding,   bleeding, potential damage
                    zonules or pupillary block if too         potential damage to zonular     to zonular fibers or
                    small and visco remains, or not           fibers or crystalline lens.     crystalline lens.
                    permeable.
Variable Cost       Low                                       Lowest                          Medium
Risk of blocked     Possible. But with two PI’s               Possible. Having only one       Possible. Having only one
iridectomies by     likelyhood that both will be blocked      increases risk.                 increases risk.
ICL                 is low.
Remain patent       Higher risk to close which would          Usually remain patent           Usually remain patent
after surgery       result in re-YAG.
STAAR Surgical recommends Laser Nd:YAG
PI’s, 1-2 weeks prior to surgery for ICL
beginners for the following reasons:
1) they allow confirmation of patency prior to
surgery
2) they allow the surgeon to be focused on the
ICL surgical steps and
3) surgical PI’s increase overall surgical time
and risk at the time of surgery.
However, to ensure safety and efficacy of laser
PI’s, one must use a good technique for Laser
PI’s.

Surgical PI’s may be a very good option for
experienced ICL surgeons willing to avoid
some of the inconveniences of laser PI’s.
However, performing surgical PI’s is an ad-                          Surgical PI with scissors, incision must be per-
                                                                     pendicular to corneal plane, unlike a self-sealing
vanced ICL surgery and one must be certain                           phaco incision. (Picture courtesy of Dr R. Zaldivar)
that these advantages outweigh the potential
risks that surgical PI’s could pose if a good
technique is not employed.




    Laser Nd:YAG PI’s at 10.30 and 1.30 clock hours.                 Surgical PI with vitrector nearly at 12 o´clock.
    (Picture courtesy of Dr D. Elies)                                Main incision needs to be temporal.
                                                                     (Picture courtesy of Dr D. Elies)




Roundtable participants:
Dr Daniel Elies (Spain), Dr Antonio Fernandez-
Porrero (Spain), Dr Göran Helagson (Sweden),
Dr Erik Mertens (Belgium), Dr Juan Pedro
Torralba (Spain), Dr Chris Van Niekerk (South                                                              Happy Holiday!
Africa)

For further information please contact:
STAAR Surgical AG, Nidau/Switzerland, Isabel Argeles (Medical Advisor), +41 32 332 88 88, iargeles@staarag.ch

				
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