OPH the RECORD
In this issue: Ophtec Museum Speakers at Ophtec’s ESCRS booth First Toric Artiflex implanted in the USA Ophtec on YouTube Amsterdam Top Attractions map
Is s u e d b y O p ht e c BV | E S C RS Edition 2013 | #9
14 Dr IL Hwan Koh 17 Precizon 8 Dr J. Kanellopoulos 10 Dr T. de Faber Director & Chief Surgeon of SU Yonsei Eye Clinic, Seoul; Interview
New IOL family
Femto DSAEK and ARTISAN IOL exchange
The Rotterdam Eye Hospital as the ultimate fun sight seeing trip
4 Dr A. Mohr
Retro-pupillary implantation of an Aphakic ARTISAN lens
ESCRS m a d r e t s m A
We hope to see you at our booth at the ESCRS in Amsterdam, booth # B02 www.ophtec.com
Events/Conference Calender 2013 / 2014 Oct 5-9
Amsterdam
The Netherlands
ESCRS
Oct 25-26
Seville
Spain
ASETCIRC
Nov 1-3
Ilsan KINTEX
Korea
KAO
Nov 16-19
New Orleans
USA
AAO
Nov 27-29
Brussels
Belgium
OB
Nov 30/Dec 1
Taipei
ROC-Taiwan
Taiwan Ophthalmological Society
Jan 19-24
Hawaii
USA
Hawaiian Eye
Feb 6-8
Elche
Spain
Faco Elche
Feb 6-9
Agra
India
AIOS
Feb 14-16
Ljubljana
Slovenia
W-ESCRS
Feb 16
Seoul
Korea
Korean Ophthalmologists Association
March 13-16
Drakensberg
South Africa
OSSA
March 26-28
Maastricht
The Netherlands
NOG
April 2-6
Tokyo
Japan
WOC-APAO
April 12-13
Busan
Korea
KAO
April 25-29
Boston
USA
ASCRS
May 10-13
Paris
France
SFO
May 14-17
Alicante
Spain
SECOIR
May 15-17
Nuremberg
Germany
DOC
July 5 - 6
Chennai
India
IIRSI
July 11-13
Fukuoka
Japan
JSCRS
September 13-17
London
UK
ESCRS
Dear Reader, visitor of Amsterdam, visitor of the ESCRS Congress,
Welcome to Amsterdam!
Amsterdam is the capital city and the #1 conference location of the Netherlands. Each year, the city hosts many world-class conventions, events and (trade) fairs. Many people from all over the world come to attend these events. Science is one of the main topics, being also an important economic pillar of our city. We are proud to be this year’s host of the XXXI Congress of the ESCRS, a major Ophthalmic Convention and we are glad to have you all here. I hope you will find some time to see some of the city. Knowledge and science have always been important in the city’s history and in the rest of our country. Some of our famous scientists include Antonie van Leeuwenhoek (1632-1723), who was the first to observe and describe single-celled organisms, Andreas Vesalius (1514-1564), the founder of modern human anatomy and mathematician and natural philosopher Christiaan Huygens (1629-1695). When focusing on ophthalmology in particular, the name Herman Snellen (1834-1908) who brought the ‘Snellen chart‘ to your office comes to mind. But, to me, as Mayor of Amsterdam, the period from 1860 to 1920 also comes to mind. In these years my predecessors had to deal with a terrible epidemic that blinded a lot of people. Later, this period came to be known as ‘the scourge of the Jewish district in Amsterdam‘. It was trachoma. During this epidemic the Jewish district was overcrowded and hygienic circumstances were bad owing to the absence of running water and sanitation. In 1914 the Mayor and Alderman instigated a committee to map the spreading of the disease in Amsterdam. The results were shocking. The Jewish district turned out to be the centre of the epidemic. Trachoma clinics were set up and the inhabitants of the district had to follow strict regulations. Children who did not obey these regulations were excluded from schools. Although all the measures helped a little bit, the battle against trachoma was not won until the district was redeveloped and modernized in the 1920’s. Looking at today‘s ophthalmology, we must conclude that we still have trachoma in the world. But it is also obvious that ophthalmic science has achieved a lot since those scourge years in Amsterdam. Dutch Ophthalmologist Prof. Dr Jan Worst is one of the scientists who added major contributions to this development. His strong and deep desire to help people to improve their eyesight, together with his creative mind, has introduced several unique solutions to the ophthalmic world. Today we see the same characteristics, creativity and the desire to help people in Ophtec, the firm founded by Jan Worst’s wife and run by his son today. To the general public the company may not be well-known, but specialists such as you, l’m sure, know the company and its unique products. You can also find Ophtec subsidiaries all over the world these days. Ophtec has won major prizes in the field of innovative entrepreneurship, locally as well as nationally. Even in these years of economic recession the company is thriving. Ophtec is a company we can all be proud of! Enjoy your stay in Amsterdam! E.E. van der Laan Mayor of Amsterdam
content 4. Dr A. Mohr
Retro-pupillary implantation of an Aphakic ARTISAN lens
7. ESCRS in-booth speakers
An overview
8. Dr J. Kanellopoulos
PBK & Vitreous Glaucoma
10. Dr T. de Faber
The Rotterdam Eye Hospital as the ultimate fun sight seeing trip
14. Dr IL Hwan Koh
Interview
16. Distributor in the spotlights Alexandre Pontes 17. PRECIZON IOL Family 18. Ophtec Museum 20. Ophtec short news 22. First Toric ARTIFLEX implanted in the USA 24. Amsterdam Top Attractions Colofon OphTheRecord is published by Ophtec BV Interviews: Marij Thiecke, Concept & Copy, Haren; Kim Sauter, Tekst & Training Amsterdam; Jake Shon, Ophtec Korea E-mail: r.den.besten@ophtec.com Photos: Susanne Bouwmeester Air Photo Amsterdam: www.harteloh.nl Graphic design: www.mennoschreuder.nl Print: Scholma Druk, Bedum All rights reserved. © Ophtec BV 2013 PO Box 398 | 9700 AJ | Groningen | The Netherlands T: +31 50 525 1944 | F: +31 50 525 4386 www.ophtec.com Picture front cover: ‘Magere Brug’, Amsterdam The famous skinny bridge across the river Amstel and opposite of the Carré theatre, is an Old Dutch design wooden bridge known as a double-swipe (balanced) bridge.
OPH THE RECORD 3
“
The only obvious contraindication for a retro-pupillary iris claw lens is aniridia Dr Andreas Mohr
Ophthalmologist for 28 years, chief of surgery and director since 2000 at eye clinic St Joseph-Stift in Bremen, Germany University of Heidelberg (study of human medicine) Residency in ophthalmology Municipal eye hospital Frankfurt Scientific program in collaboration with the Hoechst Company: keratophakia with silicon implants Fellow-ship in oculoplastic surgery Fellow-ship in vitreo-retinal surgery deputy in the eye hospital Frankfurt
4 OPH THE RECORD
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>> Sunday 12:30
In an instruction video that Dr Andreas Mohr from Bremen, Germany, recently recorded for Ophtec, he demonstrates the steps for retro-pupillary implantation of an Aphakic ARTISAN lens. We interviewed Dr Mohr about this procedure and why it is his preferred solution for aphakic patients. By Kim Sauter The retro-pupillary implantation technique itself is relatively easy. In an aphakic patient or in a situation without proper capsule support the iris claw lens is inserted, with the back of the lens facing the front, in the anterior chamber. With a push-pull forceps the lens is placed in horizontal position, and two opposite paracenteses are made at 9 and 3 o’clock. Using a special T-shaped forceps, the IOL is then pushed behind the iris, through the pupil opening. To narrow the pupil symmetrically, a miotic solution is injected. Finally, using a small spatula/forceps the iris tissue is pushed between the claws of the lens and fixated to the back of the iris. Is the procedure as easy as it looks on video? According to Dr Mohr it is: ‘The only obstacle beginning ophthalmologists must conquer is not a lack of skills, nor a lack of appropriate instruments, but a lack of confidence in the method. At the beginning, one has to overcome the fear of loosing the IOL in the vitreous cavity. When ophthalmologists first practice this technique on an artificial or pigs’ eye, much to their surprise, they experience how easy it really is.’ And they no longer worry about loosing the IOL, as they can hold it in the forceps until they see a small slit of iris tissue going down a bit, which reassures them that they have fixated the claw properly.’ In fact, it was the difficulty of the standard procedure that made Dr Mohr start implanting iris claw lenses retro-pupillary first in 1998 as an alternative. Back then, without vacu-fixation instruments he found it almost impossible to spread the enclavation mechanism and grasp enough iris tissue within the rounded claw in vitrectomized - and therefore soft - eyes. Not only did he discover that fixing the
IOL at the back of the iris was much easier, it was also less time consuming than other techniques. At an ophthalmic conference in the U.S.A in 2000, Dr Mohr still encountered much resistance, but since then the number of surgeons using this method has been growing steadily. By now, Mohr himself has performed over 2000 retro-pupillary fixations and his message of confidence is that it is a very safe technique. What makes the ARTISAN iris claw lens suitable for retropupillary implantation? Dr Mohr lists the advantages: It is easy, it’s fast, and because it mimics a normal posterior chamber lens it protects the endothelium better, there is less inflammation, and complication management is easy. The angulation by 5° of the haptic
“Normal” position of the ARTISAN Aphakia lens
of the iris claw guarantees a safe distance to the pigment epithelium. Although an iridectomy is recommended as a standard procedure for any ARTISAN lens, Dr Mohr states that a peripheral iridectomy (PI) is not necessary if the IOL is fixated at the back of the iris: ‘The lens hangs behind the iris like a hammock at some distance from the pupillary opening, which allows fluids to flow through it. This way, it can not cause any pupillary blockage. This is also valid in vitrectomy and planned gas or oil filling whereas an anterior implantation could cause major troubles. The fact that you flip the lens 180 degrees, with the back facing the front, affects the dioptry of the lens of course, but this is easily calculated in advance. You don’t need any high costs instruments: you can use the conventional instruments that you find in any kind of anterior segment surgery.’
Retropupillary position of the ARTISAN Aphakia lens, with the back of the lens facing the front, in the anterior chamber.
Iris Fixation | Model 205 ARTISAN® Aphakia Optic:
Haptics:
Overall Ø:
5.0 mm | biconvex* Iris Claw® 8.5 mm
A-Constant Retro-pupillary
116.8 (ultrasound) 116.9 (optical)
AC Depth:
3.3 mm
Dioptric Powers:
2.0 D to 30.0 D (1.0 increments) 14.5 D to 24.5 D (0.5 increments)
Also available:
ARTISAN® Pediatric Aphakia 4.4/6.5 and 4.4/7.5 Designed for small eyes
* +2.0 D to +9.0 D Convex-plano
OPH THE RECORD 5
‘A foldable ARTISAN Aphakia would be truly revolutionary’ Dr Mohr seldom encounters complications, but those that do occur are easily solved. ‘If, for example, the IOL would loosen due to a trauma to the eye, it can be lifted up and re-enclavated. The procedure of fixing the IOL behind the iris can be repeated safely as often as is necessary. This means that it is also suitable for pediatric purposes. For example, if a 5-year-old child severely subluxates its natural lens, it must be taken into acount that the dioptric power will change as it grows older. Transsclerally fixated lenses are difficult and even harmful to remove. An iris claw lens fixed at the back of the iris is easily replaced by another lens with higher or lower refractive power.
for a retro-pupillary implantation? ‘The only obvious contraindication is aniridia’, Dr Mohr answers jokingly. More seriously, he continues: ‘as long as there is enough supporting tissue to hold the IOL, you’re fine. Any calm anterior situation is a suitable case for retro-pupillary fixation. It’s only not recommended with acute rubiosis and uveitis, but those are not good candidates for any IOL until the intraocular situation is calm again.’
The technique advocated by Mohr has many advantages, but is every iris suitable
‘A foldable ARTISAN Aphakia would be truly revolutionary.’
Does this mean that there is nothing left to wish for? Dr Mohr has his answer ready: ‘A foldable aphakic iris claw lens is what I would love to see. The iris claw lens is now rigid, which means you need to open the eye 5.4 millimeters.’
Retropupillary Fixation Technique ‘Step by Step’ A-Constant
The recommended A-constant is 116.8 (ultrasound) or 116.9 (optical).
Main Incision
A 12 o’clock 5.5 mm main incision is recommended.
Paracenteses
Two paracenteses at 3 o’clock and 9 o’clock are recommended.
Do not constrict the pupil
Leave the pupil at a minimum size of approximately 3 mm to allow the lens to reach the retropupillary position through the pupil.
Viscoelastic
Inject viscoelastic (ArtiVisc) 1% from the periphery of the eye, but never directly into the pupillary area.
Implantation of the IOL
The ARTISAN Aphakia IOL will be inserted with the convex side downward and will be brought into the horizontal position from 3 o’clock to 9 o’clock.
Bringing the IOL behind the iris and constrict the pupil
The IOL will be grasped again in the centre of the optic and inserted behind the iris through the pupil, while simultaneously injecting a miotic solution to constrict the pupil. Make sure to hold the IOL firmly until it is fixated on both sides.
IOL fixation on the IRIS
The IOL needs to be lifted and tilted slightly in order to show the contour of the “claws”. A fine spatula is inserted through the paracentesis and exerts gentle pressure on the slotted centre of the lens haptic, the “claw”. The same manoeuvre is now repeated on the other side.
Finalizing the procedure
Carefully remove all of the viscoelastic to avoid a high pressure. Close the incision and apply postoperative care.
(source ‘ARTISAN Aphakia IOL, Training Manual’ as recommended by Dr A. Mohr)
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Video: Andreas Mohr “the Dark Side of the Moon”
Amsterdam ESCRS ‘booth’ speakers during the congress - An overview Dr A. Anbari, Syria
Dr J. Cazal, Spain
Retroiridis fixation of Aphakic ARTISAN: Why, When, & How?
Two years follow up after implantation of Iris Claw family intraocular lens in phakic eyes by a novel surgeon.
Saturday 12:15
Saturday 14:30 | Sunday 14:00
Dr T. de Faber, The Netherlands ARTISAN in Pediatrics unique/challenging cases.
Sunday 12:15
Dr T. Ferreira, Portugal
Dr C. Forlini, Italy
Dr J.L. Güell, Spain
ARTIFLEX toric after intracorneal ring segments implantation in keratoconus.
The gold standard of the secondary IOL implantation in the MIVS era: iris flexibility and the endless possibilities to implant an ARTISAN.
CXL & ARTIFLEX Toric.
Saturday 11:15 | Sunday 11:15
Saturday 11:30 | Sunday 11:30
Sunday 11:00
Dr L. Izquierdo, Peru
Prof C.K. Joo, Korea
Dr J. Kanellopoulos, Greece
Sutureless ARTISAN implant with Femtosecond technology.
Effects of a preloaded capsular tension ring on stability of intraocular lens with hydrophilic and hydrophobic acrylic materials.
Retropupillary fixation of the ARTISAN in PK, DSAEK and IOL dislocation cases, a review of technique and outcomes.
Saturday 10:00 | Monday 11:15
Saturday 14:00 | Sunday 10:45
Saturday 10:30 | Sunday 13:30
Dr J.B. Lee, Korea
Dr S. Mahjoub, Tunisia
Dr R. R. Mesa, Spain
Some considering factors when we use ARTISAN/ARTIFLEX to get better surgical outcomes.
ARTISAN in Keratoconus.
Why I changed from other PIOLs, angle supported and ICL, to ARTIFLEX.
Saturday 13:30 | Sunday 10:30
Saturday 10:45
Saturday 12:30 | Sunday 13:00
Dr A. Mohr, Germany
Dr T. Monteiro, Portugal
Prof M. O’Keefe, Ireland
Retropupillary fixation development of technique, rationale, and broad uses.
ARTISAN / ARTIFLEX: Surgical pearls.
General use of iris fixation, concept for Pediatric, Trauma, and Refractive.
Sunday 12:30
Sunday 14:15 | Monday 10:45
Saturday 13:00 | Sunday 12:00
Dr. F. Pérez, Venezuela
Dr F. Poyales, Spain
Prof M.E. Prost, Poland
Why I use ARTISAN/ARTIFLEX versus other Phakic IOL or laser.
IPS & Aniridia IOLs: Presenting the latest video.
ARTISAN IOLs in very young children.
Saturday 11:00 | Sunday 10:00
Saturday 12:00 | Sunday 11:45
Sunday 12:45 | Monday 10:15
Dr K. Rosenthal, USA
Dr L. Zunino, Argentina
Reliability of endothelial cell counts.
ARTISAN Aphakia Lens in Adults and Pediatrics: Interim Results from Two Multicenter Phase III Clinical Studies.
ARTISAN Family vs Other PIOLs.
Sunday 13:15 | Monday 10:30
Sunday 10:15 | Monday 10:00
Saturday 10:15 | Monday 11:00
Dr G. van Rijn, The Netherlands
OPH THE RECORD 7
PBK & vitreous glaucoma Watch & Read
Treatment: Femto DSAEK and ARTISAN IOL exchange Femto DSAEK and ARTISAN IOL exchange www.youtube.com/ophtecbv
A. John Kanellopoulos, MD Laservision Gr External Diseases, Cornea Transplantation & Refractive Surgery Director, LaserVision.gr Eye Institute Professor of Ophthalmology NYU Medical School, New York, NY.
8 OPH THE RECORD
Dr John Kanellopoulos recently posted the video ‘IOL exchange Dsaek’ on YouTube. Ophtec asked dr Kanellopoulos to tell more about this surgery.
surgeon. This will keep the lens optic away from the iris and pupillary aperture, thus limiting iris “rub” and limiting pigment scuffing.
We have, in the past, published results with using the ARTISAN aphakia intraocular lens to exchange an anterior chamber intraocular lens or a dislocated intraocular lens in bullous keratopathy, combined with penetrating keratoplasty. These clinical findings were prior to the DSEAK era and were published in the Journal of Cornea in 2005.
One of the main causative factors in pseudophakic bullous keratopathy, besides surgical trauma, may be movement donesis, of the anterior chamber intraocular lens and/or its approximation to the cornea endothelium. We always make an effort to remove the angle supported anterior chamber intraocular lens carefully. In those cases where the haptics are embedded within the angle from pupillary synechiae, special attention is given when the haptics do not move freely. Amputating the haptic and trying to “fish” it from the other side of the anterior-posterior synechiae is usually successful. This is done in order to avoid severe iris trauma and iridodialysis with possible inadvertent severe angle injury and haemorrhage.
Since then, we have slightly changed our technique. With the advent of femtosecond lasers, we are performing mainly bladeless DSEAK for bullous keratopathy instead of penetrating keratoplasty. With the aid of the WaveLight Refractive Suite FS-200 femtosecond laser, we achieve excellent results in both the host DSEAK incisions and possible combined astigmatic keratotomy, and the trephination of the donor DSEAK button. The laser uses very accurate parameters and a multitude of patterns in order to establish higher accuracy, safety and predictability. The video shown with this article demonstrates this effect. Over the last several years, we have also shifted to using the ARTISAN Aphakia lens retropupillary. In order to do this, we flip the lens upside down to have the concave portion of the lens looking towards the
Following the anterior angle supported IOL removal, if there is vitreous present in the pupillary plane or in the anterior chamber, a thorough vitrectomy is performed and one or two surgical iridectomies are placed with the anterior chamber vitrectomy. We use the Constellation device, which uses a Venturi pump and offers excellent aspiration and extremely high cutting rates up to 5.000 cuts per minute in order to reduce vitreous traction to the macula and peripheral retina.
We use 0.5ml of triamcinolone solution in the pupillary plane in order to better delineate and color the free vitreous and possible adhesion bands. Some portion of the triamcinolone “sinks” in the posterior chamber and reduces the chance of cystoid macular edema which, by the way, may be present in a lot of these cases, so a proper macular OCT when possible is a useful aid to assess macula function in these patients. It is common that traumatic cataract surgery is combined with chronic macular edema and this has to be addressed, in my opinion, at the time of surgery as well. Once the anterior vitreous is cleaned and the pupil is round and relatively in the center, if there are peripheral synechiae (usually superiorly of the pupil towards the cataract wound), an attempt is made to release these and establish a central pupil. If there is significant iridodialysis or surgical iris incision, an attempt is made to perform a surgical iridoplasty and re-approximate the iris borders in to establish a relatively round pupil. Then, I orient the ARTISAN aphakia IOL with curved side looking in and concave side out, as noted previously. My preferred orientation is horizontal; so I first enclavate the haptic to my left (temporal side). While holding the IOL’s central optic with the special ARTISAN forceps in my right hand, I direct the left haptics over the iris and the right haptics under the iris. I then tilt the lens slightly, to have the haptics of the lens protrude under the iris and push the iris forward. This enables me to establish the exact position of where the iris is going to be enclavated. A little bit of manual adjustment needs to be done there by the surgeon and, using the enclavation needle, enclavate with several passes a good amount
of iris tissue within the claw haptic of the ARTISAN lens. This is done blindly as the haptic is on the posterior side of the iris. Sometimes the iris may allow a part of both or one haptic to come through, which is not a significant problem; it inadvertently helps in the visualization of the proper enclavation of the lens. Then a shift of hands; the left hand is now used to fixate the lens optic and the left haptics of the lens are brought posteriorly. If the pupil is very small, this may be challenging. In that case I use a Sinsky hook to aid the tight pupillary opening to come around the residual part of the lens and cover the left side haptic. It should be noted that, in the surgical view, the haptics appear to be on the right side but one has to remember that in reference to the eye, this is upside down and these are the left side haptics (nasal side of the eye). In a similar fashion as noted previously, a little tilt of the lens will allow the haptic that has not been enclavated yet to be pushed against the iris from behind the iris to establish the position. It is very critical here to “play” with this position for a few seconds to establish that the lens is placed horizontally and that the horizontal axis goes through the center of the pupil. This will allow for better centration of the retropupillary-fixated ARTISAN aphakia lens. Once the proper axis and position are established, the enclavation needle used now with the surgeon’s right hand is used to push iris material through blindly several times, to enclave a good part of the iris within the last set of the claw haptics. The lens then is left to sit back. Using a Sinskey hook we then push on the lens a few times, very gently, to establish that the lens is not moving and is firmly
is a speaker Dr Kanellopoulos g the ESCRS: rin du in our booth
os, Greece
Dr J. Kanellopoul
ation of the Retropupillary fix AEK and IOL ARTISAN in PK, DS a review of s, se ca dislocation tcomes. technique and ou
>> Saturday 10:30 Sunday 13:30
attached to the iris. Any residual vitreous is removed from the pupillary aperture, making sure that the iridectomy or iridectomies that were performed are open. The anterior chamber is filled with BSS and the DSEAK is performed. In case of a full thickness graft, methylcellulose gel is used to fill the chamber and then the cornea graft is placed in the circular cornea defect and sutured in place with usually 16 interrupted sutures or 8 interrupted and one 16-bit running 10.0 nylon sutures. This procedure is obviously better illustrated through video, but I just wanted to summarize that the retropupillary fixation of the aphakia ARTISAN lens offers an excellent alternative to treat aphakia or intraocular lens exchange in patients with corneal pathology. It offers great ease of procedure when compared to scleral fixation of the lens or suturing the lens on the iris. It avoids the lens haptics in traditional three-piece intraocular lenses to be pushing into the angle inducing synechiae and/or IOP problems. This technique offers little chance of IOL displacement, and has proven in our hands to be a very powerful tool in combination with femtosecond assisted DSEAK and/or penetrating keratoplasty.
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Tjeerd de Faber Degree in Medicine (Nijmegen en Rotterdam, The Netherlands) Resident family medicine, resident ophthalmology (OZR, Rotterdam) Fellowship pediatric ophthalmology (Houston, TX, USA) Pediatric ophthalmologist since 1991 (OZR, Rotterdam)
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The Rotterdam Eye Hospital as the ultimate fun sightseeing trip By Marij Thiecke
Eye surgeon Jan-Tjeerd de Faber on pediatric eye surgery: communication, innovation, and using the old scalpel In the recently renovated Oogziekenhuis Rotterdam (for those not fluent in Dutch: Rotterdam Eye Hospital), some 20,000 children are treated for visual problems annually. Chief medical staff and pediatric eye surgeon Jan-Tjeerd de Faber has been enthusiastically caring for visually impaired kids (ranging from 0-14 years) that have been frequenting his office since 1991. The needs of his target group differ from average cataract- and refraction procedures in the fact that many patients are subject to a lifelong medical scrutiny, in which the eye surgeon is just one of the frequented medical specialists. De Faber: ‘I love my work. It is precise, and visually oriented: in 98%, the problem is clear in the blink of an eye. This initial blink being, of course, the first small step towards a possible solution. The ARTISAN lens does help some of my patients - in Holland we can certainly count ourselves lucky with Jan Worst’s invention.’ Tunnel De Faber: ‘At the tender age of 5, I knew that my calling was a career in medicine. Nevertheless, it took some maturing and medical wandering before I decided to specialize in pediatric eye surgery. My first preference was living the life of a GP: my aim would be to help patients from A to Z with their questions. And, if needs be, to redirect them to another specialist. In real life, the psychosomatic needs of my patients prevailed. Well. There I was, at the still youthful age of 26, living the GP dream. When a problem became vaguely interesting, a referral to a medical specialist seemed the only logical option. The remainder of issues on my desk seemed to center around lower back pain, and fear of driving through the Maastunnel [an impressive tunnel in Rotterdam]. This picture is, maybe too simplistic but this challenge was, from my perspective, not interesting enough. So, I decided to be a tropical doctor, a gynaecologist located in underdeveloped areas. However, after a year or so, this specialization didn’t feel right for me as well.’
Tangible ‘And then, my eyes were opened. Literally, when I did my internship in eye surgery while I studied for my American License – I performed tests on monkeys with amblyopia. Why? Because in eye surgery, the field of expertise is blessed with an enormous level of tangibility and visual directness. In 98% of the cases at hand, the problem can be identified in the blink of an eye. And exactly that kind of clarity is what I turned out to be looking for. Also, the condition of the eye is in many of the cases a direct reflection of the condition of the body. In some cases, I see a child with a bad lens before me, and realize almost instantly that the kid has a high impact disease, which regretfully comes in a package deal with, say, lifetime interference of a cardiologist. For instance, a systemic condition in which an aneurism of the aortic arch lurks quietly in some dark yet frightening corner. Many kids remain my patient although they might have become worried parents themselves, due to the hereditary nature of their condition. This special situation occurred only a few months ago. And, last but not least, by working with kids and their parents, the ‘social’ component of my specialization is taken care of enough to give me satisfaction after each working week.’ Playful diagnosis ‘Obviously, treating kids with visual problems differs from treating adults. First, going to the eye surgeon should be a fun experience. If a child doesn’t co-operate, finding out quickly what’s wrong will be very difficult. And thus, the art of playful diagnosis is essential. A very suitable assistant is my iPhone: some apps work very well as a funny yet effective visual distraction. Also, unplugged help in the form of dolls work fine. During this calculated distraction, when the kid looks sideways for instance, the problem manifests itself: one eye lags behind, doesn’t move at all, or moves in the wrong direction.’
Fig 1. Lens subluxation with Marfan syndrome, right eye to nasal, left eye to cranial
Fig 2. Lens subluxation with Marfan syndrome, right eye to nasal, pre-surgery
Fig 3. Lens subluxation with Marfan syndrome, right eye to nasal, pre-surgery and post-surgery with ARTISAN lens
Calculating uncertainty ‘In the Rotterdam Eye Hospital, we see around 20,000 kids each year. This includes referrals from abroad. The problems vary from strabismus, congenital cataract (infant cataracts) and congenital glaucoma to firework accidents with eye injuries. With our team of 9 orthoptists and 3 pediatric ophthalmologists, we try to solve the visual issues we are confronted with. Aphakic infants after catatract surgery (until 6 months of age) are usually fitted with contact lenses. From an age of 7 months and more, we have the possibility to implant an artificial lens in the capsular bag. Just cutting your way through the eye is in many cases not the best option as the eye needs 18 years to mature, and the axial length progression is not very predictable in this patient group as well. This means that there is a set of uncertain factors in this particular patient group which needs to be included in the decision whether to operate.’
OPH THE RECORD 11
eaker Dr de Faber is a sp g the ESCRS: rin in our booth du
e Netherlands Dr T. de Faber, Th trics ARTISAN in Pedia g cases. in ng unique/challe
>> Sunday 12:15
Opening of KinderOOGcentrum by Mayor Aboutaleb (left), with Tjeerd de Faber (right).
Hereditary bad luck, environmental misfortune, and fireworks ‘Many of my patients are diagnosed with a hereditary condition. Think of the Marfan syndrome (fig. 1-3), or Homocystinury. In these cases, the connective tissue is too weak, causing lens subluxation. Here, we see that surgery is almost inevitable. Sacrificing the natural lens is also seen in Persistent hyperplastic primary vitreous PHPV. In these cases, the ARTISAN lens is a good alternative. I remove the natural lens, and connect the new lens to the iris. A similar procedure is often the solution of choice in children afflicted with Down syndrome. Here, a cataract is a frequently observed symptom. And, I also get the occasional trauma caused by unwanted contact between the eye and, say, an elbow or some kind of firework. On top of that, we see children who suffer from the visual aftermath of infections in utero – think of notorious rubella side effects.’ Haptic mishaps ‘The majority of complications after procedures are caused not by the lens implant, but by the patient. Being a kid means having an inquisitive nature, discovering the world. In their quest, kids have a tendency to get stuff stuck in their eyes; an elbow, a football or something else not meant for too close encounters. In case of such an incident, the haptic(s) might come loose, in which surgery is inevitable. To prevent these mishaps from occurring, the education of parents is essential. We aim to inform them of the consequences of possible complications. Showing pictures is a good way to get the message across – for instance a photograph taken through a slit lamp: ‘This is what an eye is supposed to look like. If you see anything else, anything at all, contact me immediately. If you wish your kid to play karate or any other contact sports after surgery, contact me also – I’ll show you
12 OPH THE RECORD
pictures of an eye you wouldn’t want your kid to walk around with.’ The post-op choices the child makes in many cases are also important for the parents to be involved in – the impact is often quite large. Just imagine: you at 14, with sharp vision but with bi- or multifocal glasses to compensate for the absence of accommodation. Or: you at 14, having to abandon your favorite contact sport. As a parent, you need to address this. Usually, parents are good at explaining these unwanted yet inevitable choices. And yes, sometimes, a puzzled frown is in order – the incident where a boy enthusiastically chose water polo as a less damaging sport than karate jumps to mind.’ Trendsetter ‘In The Netherlands, we have been forerunners in solving problems with visual acuity for some time now. The ARTISAN lens has, of course, contributed to our image. The FDA has approved the lens for implantation in phakic eyes, but yet approval for aphakic eyes – the original intention of the ARTISAN - is still pending! So, in the USA physicians have to fidget with a lens sutured to the sclera, a surgical procedure I would never choose. Endothelium ‘The ARTISAN lens is a work of genius in its simplicity, and also works for many children. Technically speaking, the only issue is that the lens is situated close to the endothelium. So, the lens might wiggle if the kid in question rubs its eyes. And, kids are talented eye rubbers, you can’t change that fact of life. We of course monitor the kids and the loss of endothelium is not worrisome, but we are also hardly equipped to measure the initial value. So, is there a chance that endothelium is lost? Yes. But in my opinion, the cake is certainly worth the candle. Another possible complication lies
in the snotty nature of kids. Their lachrymal ducts join the snot sessions enthusiastically, of course, which increases the chance on inflammation – around 1 in 4-500 kids suffer from an infection. This is why I always insert antibiotics in the anterior chamber during intra-ocular procedures.’ Visual fireworks ‘I already mentioned it: a visit to our Eye Hospital should be similar to an exciting outing to the child. That’s why I am so happy with the recently completed renovation of the pediatric ward. Our hospital has become even more child friendly. Naturally, we want to share our medical enthusiasm and knowledge providing top information and professional procedures, but also we feel the need to diminish one of our target groups as soon as possible, namely fireworks victims and plain firework culprits. Yes, safety glasses might look simpleton, but the argument crumbles when the option of continuing life minus one eye is considered.
Fireworks victim
That is why we developed and launched www. vuurwerklesbrief.nl [fireworks education], an education kit for 12 year olds. This way, we aim to educate future fireworks users on the life long complications resulting from birdbrain actions in which fireworks and eyes are combined. So: communicate, innovate and the old scalpel: there is still much work ahead.’
ARTISAN Aphakia ®
#1 Backup Lens in complicated Cataract Cases
Based on the long term experience of Iris Fixation, the ARTISAN® Aphakia IOL is a predictable, safe, high precision implant, correcting the eye when it is not correctable by other means. Pediatric lenses are available upon request for juvenile or congenital cataract cases.
Main Features & Benefits Iris Fixation | Model 205 ARTISAN® Aphakia Optic:
5.0 mm | biconvex*
Haptics:
Iris Claw®
Overall Ø:
8.5 mm
A-Constant:
115.0 (ultrasound) 115.7 (laser interference, estimated)
AC Depth:
3.3 mm
Dioptric Powers:
2.0 D to 30.0 D (1.0 increments) 14.5 D to 24.5 D (0.5 increments)
Also available:
ARTISAN® Pediatric Aphakia 4.4/6.5 and 4.4/7.5 Designed for small eyes
* +2.0 D to +9.0 D Convex-plano
P Iris fixation P One size fits all P Long term clinical experience P Predictable, stable, reliable P Also fit for retro pupillary fixation
ARTISAN® Training Course ARTISAN and ARTIFLEX (P)IOLs may only be implanted by OPHTEC-trained eyesurgeons. To this end, OPHTEC organises intensive worldwide training courses on a regular basis. Register now for an ESCRS wet-lab training.
For more information or registration send an E-mail to marketing@ophtec.com Video: ‘ARTISAN Aphakia the ideal IOL for secondary implantation’ by Dr J.L. Güell
www.ophtec.com
>> VacuFix™
vacuum system for a perfect enclavation • best positioning and centration of the (P)IOL • fixed reproducable amount of iris tissue
OPH THE RECORD 13
Dr IL Hwan Koh Director & a chief surgeon of the SU Yonsei Eye Clinic, located in Seoul, Korea. Graduated from Medical School of Yonsei University Completed Intern & Resident from Yonsei Hospital Achieved Certificate of Ophthalmologist from Yonsei Hospital Foreign Professor at Medical School of Catholic University Foreign Assistant Professor at Medical School of Yonsei University Director at Bundang Severance Eye Clinic
>> Marvelous results are achieved when combining several established treatments By Jake Shon
14 OPH THE RECORD
Dr IL Hwan Koh, practicing ophthalmology for 14 years, is well known in Korea for keratoconus & refractive surgery of high myopia at or above -6D. He has been serving since 2004 as a a director & a chief surgeon of the SU Yonsei Eye Clinic, located in Seoul, Korea. During that time, he has gained extensive experience in treating Keratoconus with Intrastromal Corneal Rings and Corneal Collagen Cross-Linking. Now, he is the surgeon who has performed the largest number of Intacs & Keraring surgery in Asia. During the last 10 years Dr Koh has implanted more than one thousand phakic IOLs including the ARTISAN and ARTIFLEX. His specialty has been to treat challenging cases with combined surgery i.e., the ARTIFLEX after Intacs, the ARTIFLEX after Keraring, and the ARTIFLEX after laser ablation. Dr Koh chose to become an ophthalmologist because this field has unique characteristics that surgeons from other fields are not able to deal with easily. The reason that he was developing in challenging cases was that these were relatively difficult to handle even in ophthalmology. It concerned severe myopias, keratoconus and complications associated with laser vision correction (corneal ectasia, myopic regression, decenterec or small optical zones, epithelial in-growth, etc.). He believes that the case which is either keratoconus or keratectasia. The harder to cure has more potential to be results were excellent both objectively and developed in future. subjectively. But it is very important to note that this procedure is possible only after Trial and Safety the progress of keratoconus / keratectasia is Each time when he meets patients, who bogged down naturally as well as artificially. have difficult eye conditions, he always Therefore Dr Koh carefully evaluates whether has the same concerns. That is about how these disorders are still progressing or not he should solve the inner conflicts between before performing lens implantation. If the his desire to challenge the new field and disorder is ongoing or expected to progress, apprehension about the patients’ safety. The thing he worries about most is to make he performs intra-corneal ring insertion or corneal collagen cross-linking first. In this a decision based on objective judgment way, he can stop the progress of keratoconus, which is not one-sided. He always says “In and make the corneal surface close to normal. my opinion, the most important thing is working hard to become an expert in various This would minimize irregular astigmatism and high order aberration. If he can be sure surgical methods. If a surgeon is favoring that those disorders have been stopped after a certain method and becomes familiar long-term observation, he directly performs with performing one specific method only, phakic IOL implantation without special he might lose the chance to make better choices. Also, it will limit him to make various treatment. He mentions “Although this method shows good results in most cases, applications. I believe that a marvelous result is achieved when we combine several making higher precision of nomogram for lens power decision in Keratoconus patient established treatments in various ways. still remains an assignment to solve for me. This method is going to help us to achieve Also, since it is more difficult to evaluate the appropriate safety quickly as well.” endothelial cell loss precisely in keratoconus cases, keeping up the efforts to check this ARTIFLEX and ARTISAN for Keratoconus part as precisely as possible is a very Dr Koh has been performing ARTISAN/ important problem to solve as well.” ARTIFLEX implantation for patients with
SU Yonsei Eye Clinic, Seoul
Another challenge The other field in which Dr Koh is interested is studying the care of keratoconus with irregular astigmatism. Firstly, correct the corneal surface by topo-guided (T Cat) laser ablation. Secondly, perform corneal collagen cross-linking. Lastly, implant a phakic IOL after stabilizing the corneal irregularity. If the result of this method is achieved as acceptable, visual acuity after phakic IOL implantation might have improved dramatically. Then patients can expect to have almost the same eyes as normal. “It is obvious that I would have more comfort both physically and mentally, if I perform surgery only on eyes with a good condition. Since I do not have to feel any extra worries about the result in those cases, sometimes the desire to treat only those patients who have good eye conditions comes up in my mind. However, I would like to offer hope to patients with difficult eye conditions as well. Also, those cases bring more satisfaction after finishing surgery successfully to both patients and surgeons. That is the reason that I make a constant effort.”
OPH THE RECORD 15
Distributor in the spotlights
Alexandre Pontes, Adapt’s Business Director
Adapt Produtos Oftalmológicos Ltda. is a leading supplier in Ophthalmic products in Brazil . They offer a large variety of high quality products. Since 2012 Adapt distributes the Ophtec ARTISAN & ARTIFLEX lenses in Brazil. A few questions for Alexandre Pontes, Adapt’s Business Director, about the cooperation with Ophtec
When did you start working with Ophtec, and which Ophtec products do you sell? We started our partnership on the second half of 2012, when Mr. Tiago Guerreiro, export manager at Ophtec, and Sr. Martins, director of House of Vision, proposed us this business opportunity. We are now selling ARTISAN and ARTIFLEX PIOLs.
What is your background? I have graduated in Business and Corporate Management.
How do you experience the cooperation? Ophtec is a very supportive company with products that have an outstanding quality.
How did you get started in this business? I started back in 1987 promoting the pharmaceutical line of Alcon in Brazil. After some time, I was promoted to Surgical Marketing Planning Manager and left the company in 1999 to join Allergan until 2002 after a company spin-off. In 2003, together with 3 partners we started a surgical company in Rio de Janeiro and bought Adapt in São Paulo afterwards.
Is the ARTISAN lens well know Brazil? Yes it is, we have more than 10 years of protocol study.
How many employees does Adapt have, and when was the company founded? We have now 80 people working at Adapt, the company has been founded in 1993.
16 OPH THE RECORD
What tip(s) do you like to share with other Ophtec distributors around the world? We just started to work with ARTISAN and ARTIFLEX PIOLs but we believe that the secret of success relies in four main points: 1. Follow-up. For instance, when a client asks to make a calculation we need to close the circle; did he/she made the final order? Why not? If the surgeon makes the request we need
to fully understand what the final surgical result of that implant will be. Our belief is that we only sold the PIOL when the PIOL is actually implanted and the result is a success. This means that we need to be careful along the entire process: pre, intra and postop. 2. We believe in the round table meetings. Meetings that allow a small group of doctors, 5 to 10, to discuss results and techniques. Because the meetings are small, there is a lot of interaction, bringing us the best results. 3. Training of the sales people. We need to have a well-trained sales force that understands and is able to respond to the surgeon’s questions. It is fundamental not only to get the client but also to gain his/her loyalty when they feel they can trust us. 4. Educational material for the patient. The patient needs to understand the advantages of using the ARTISAN. Moreover, we need to convince him/her that without this PIOL he/she will lose the benefit of having a significant higher quality of life.
EW • NEW • NEW • NEW • NEW • NEW • NEW • NEW • NEW • NEW • NE
Family EX
PE
CT
ED
S table platform , P remium optics , M icro incision
P Proven stability P Unique Aspheric Toric surface more tolerant of misalignment P 2.2 mm micro incision
Optic Diameter Overall diameter Angulation A-constant:
6.0 mm 12.5 mm 0° 118.5 (optical) 118.0 (ultra sound)
P Unique anterior Aspheric Toric Surface P Average rotation of the benchmark practice was 1.9° P 360° square edge optic optimized PCO barrier
P Premium Toric - Set
Rotational stability study1) showed:
P Average degree of rotation of 3.1° between baseline and 4-6 months post-operative
P 88% of eyes had a change of axis ≤ 5° P 97% of eyes had a change of axis ≤ 10° 1)
data on file, Ophtec BV OPH THE RECORD 17
Ophtec NEWS
Exhibit of old instruments and implants Early this year Jan Worst, M.D. opened an exhibit of Old Instruments and Implants at Ophtec Groningen. The objects shown in a number of showcases are selected from a private collection of the Worst family, Ophtec and some of the employees. The items give an idea on what was going on in the ophthalmic world around 40 years ago. Still a young history, but very different from the ophthalmic world today. The exhibit shows a.o. the Development of Cataract surgery with Intraocular lenses, Instruments especially designed by Jan Worst M.D. and Innovations for developing countries. A few of these products are shown here.
18 OPH THE RECORD
Needle forceps
Cryoextractor
The Needle forceps has been the first instrument designed by Jan Worst and Klaas Otter in 1956, to remove non-magnetic foreign bodies from the eye. The Optical Spatula was used to enlarge the visual field during the surgical procedure.
The Cryoextractor with a retractable tip, used for ICCE, was a most elegant instrument which, filled with CO2 snow and frozen onto the natural cataractous lens at –40 degrees, could extract the lens without any effort. The instrument had been invented by Krawicz and sophisticated by Worst & Otter.
Pigtail probe Goniotomy needle
The Pigtail probe has been designed by Worst in 1962. It was meant to reconstruct the tearduct using silicone tubes. It has been used mainly in case of torn puncta. Guided by a double suture, a silicone tube is pulled through the canalicular system and stays inside until the wound has been properly healed.
Rust ring remover
This ”Hydrostatic” AC needle, often used for Goniotomy, was used in combination with a Prismatic Goniotomy lens with a scleral rim. The defective chamber angle could be observed and a safe and effective surgery be performed. Children from various countries around the world with buphthalmus (“ox-eyes”) and often still very young have been operated by Jan Worst at Refaja Hospital, Stadskanaal.
Chalazion Curette
A battery driven electric Rust ring remover (1961) is used to remove a rustring formed around a piece of iron. The burr size should be selected somewhat larger than the rustring. Healthy corneal tissue will resist the scraping action while the foreign material will be removed.
Keratoprosthesis
The ultrasharp loop-shaped Chalazion Curette of Worst has been made to remove chalazions, pterygia and small cysts. The loop is excessively sharp on the inside for excision and has a blunt non-cutting edge to allow evacuation with scraping movements. It has been available in 3 sizes.
Wet sterilized IOL
The “champagne-cork” Keratoprosthesis (1982) was used when the cornea had been severely damaged. The prosthesis, sutured with fine stainless steel wire, has been mosly successful in cases like caustic soda burns.
Medical Workshop sterilized the IOLs in a glass container with different solutions on both sides. The sterile lens in caustic soda on one side and sodium bicarbonate to neutralize the caustic soda on the other side. The FDA prohibited this technique in 1978 in favour of the “dry” ETO sterilization still used today.
OPH THE RECORD 19
Ophtec
• SHORT NEWS •
FOCUS ON
Walter Nazaire,
Ophtec Export Manager Born in France, roots originally in Haiti. w.nazaire@ophtec.com Regions: Northern Africa, Middle East, Turkey, France, Austria, Russia and Eastern Europe.
Labtician team during the COS meeting
According to you, which Ophtec product is most special? Without hesitating: the ARTISAN Aphakia. A unique product with a worldwide reputation. Business wise, the ARTISAN aphakia gives us the chance to get into any ophthalmic center and to gain business. This is a unique competitive advantage. Which worldwide congresses are the most important ones? Why? The ESCRS is the most important for Ophtec because our main business is in Western Europe. We are selling direct in Spain, Portugal, Germany, The Netherlands and Belgium. The American congresses are important for the South Latin Americans but as we are working on FDA approvals, I expect the AAO and the ASCRS to bring us new leads and more potential target and business in the coming years. What do you like most about your job? First, to achieve sales. It’s a good feeling to get new customers, new orders. But the most interesting and exciting part is the way and the process of achieving and creating sales and how to move forward in a sales process. There’s not one solution, there are many but this makes it an exciting challenge. Further, I can not deny that travelling is good fun. I like to discover new countries, new cultures and to meet new people. Travelling is a chance not given to anyone, it increases open-mindedness and helps to understand the world and I am aware of that chance. What do you do in your spare time? Enjoying life with my family of course. For the rest: I play tennis, play guitar and jog to stay fit.
20 OPH THE RECORD
New look for ARTISAN & ARTIFLEX patient information Ophtec will launch a new line of ARTISAN/ ARTIFLEX patient information, including a website and a brochure, during the ESCRS congress. The lay-out is inspired by twitter, facebook, blogs and other social media platforms. For more information contact marketing@ophtec.com
ARTISAN/ARTIFLEX launch during COS meeting
During the COS (Canadian Ophthalmologist Society) annual meeting in Montreal that was held from June14 to June 17 the ARTISAN/ARTIFLEX lenses were launched by Labtician Ophthalmics, Ophtec’s new commercial partner in Canada. This four-day meeting boasts an outstanding international and Canadian faculty presenting the latest in ophthalmic research and practice. The COS Annual Meeting includes invited lectures, scientific papers, wet labs and workshops, as well as networking opportunities and an extensive exhibition of ophthalmic equipment and services. Labtician Ophthalmics Inc. as the new commercial partner to Ophtec took the opportunity to launch the ARTISAN & ARTIFLEX Iris
fixated IOLs at the COS Montreal meeting. The lenses were represented at the Labtician booth. Ophtec’s Tiago Guerreiro was at the Labtician booth and held individual training sessions with all interested customers. In addition to booth displays, the Labtician and Ophtec team participated in two 2-hour COS sponsored training courses on specialty lens implants including Iris fixated IOLs. The course faculty included Dr Ike Ahmed, Devesh Varma, and Rusty Ritenour. “We are delighted to have Labtician as our partner in Canada. Labtician’s experience will ensure that Canadian surgeons will have the opportunity to access new products and learn new skills related to iris fixated IOLs.” - Tiago Guerreiro, Export Manager at Ophtec
• SHORT NEWS •
New on our YouTube channel www.youtube.com/ophtecbv
Retropupillary (Phakic) ARTISAN in extreme myopic case.
ARTISAN Toric PIOL implantation
By Dr Kanellopoulos
By Dr R. Fernández Buenaga
Femto DSAEK and ARTISAN IOL exchange
Iris Prosthetic Elements (IPS)
By Dr Kanellopoulos
By Dr J. Cazal
Iris Prosthesis Implant Congenital Cataract
Implantation of the Aniridia lens, several cases
By Dr Ammar Issa
By Dr G. Sciuto
ARTISAN Aphakia IOL implantation
ARTISAN Aphakia enclavation using VacuFix
By Dr Adrián Hernández Martinez
By Dr V.I. Apostolov
Ophtec secures exclusive distribution for Corneal Cross linking system Ophtec BV secures exclusive distribution for Peschke GMBH Corneal Cross linking system for The Netherlands, Belgium, Portugal and Spain
Cross-Linking and the Eye - Transforming soft tissue into a more rigid tissue. Corneal collagen cross-linking is a technique using UV light and a photosensitizer to strengthen chemical bonds in the cornea. The goal of the treatment is to halt progressive and irregular changes in corneal shape known as ectasia. These ectatic changes are typically marked by corneal thinning and an increase in the anterior and/or posterior curvatures of the cornea, and often lead to high levels of myopia and astigmatism. The most common form of ectasia is keratoconus and less often ectasia is seen after laser vision correction such as LASIK. The Peschke system (CCL Vario) is the global leader in installed systems, with knowledge solutions for applications of cross linking and the eye. The CCL Vario corneal cross-linking system was designed with a special focus on effectiveness, safety and user friendliness. The CCL Vario system comes with one diode and special optics which homogenizing the beam. Thus hot spots are being avoided and
the endothelium is sufficiently protected. To offer more flexibility, CCL Vario enables the surgeon to choose between three energy levels: 3 mW, 9 mW and 18 mW. This allows the surgeon to choose the ideal energy/time combination for the intended treatment: Standard - Accelerated - Express Cross-linking. At the end of the procedure the system switches off automatically. To guarantee the high level of safety the beam of the CCL Vario has a wasteline at a distance of 45 mm from the optics and a depth of focus of approx. +/- 5 mm. To protect the limbal stem cells and to focus the beam on the clear cornea only the CCL Vario has a continuously adjustable aperture from 7 mm to 11 mm. The CCL Vario is portable with a table mount and comes in a sturdy transport case allowing the surgeon to be mobile. More information: marketing@ophtec.com Video: ARTIFLEX Toric and Collagen Cross-linking in Keratoconus. Dr J.L. Güell
Ophtec FOCUS ON
Tiago Guerreiro, Ophtec Export Manager From Setúbal, Portugal t.guerreiro@ophtec.com Regions: South America, Mexico and Canada, UK, Italy, Greece and Switzerland. Which Ophtec products are most special according to you? Without any question the ARTISAN family. It is extremely gratifying to hear from different surgeons all over the world that the ARTISAN has “saved” a patient’s eye. Some of these complicated cases have barely a solution and the ARTISAN Aphakia IOL is a problem solver. On the other hand, when I see that the ARTISAN also helps young patients with extremely high myopia and hyperopia, I get the ‘feel good’ sensation. These young patients had to use thick glasses that made their daily life difficult. After the ARTISAN implant they feel a ‘new person’. You’ve visited Operating Rooms in a lot of different countries. What are the differences? There are many differences but similarities too. In my experience the biggest difference is the way that some hospitals/clinics are organized. It has much to do with the local culture. I remember being in theatre at 11:45 PM in Oporto. The surgeon had to be quick as surgery could not go on after midnight. Can you imagine this happening in The Netherlands? What do you like most about your job? I like the fact that I am able to meet doctors, distributors and industry colleagues locally. Experiencing the local issues gives me a better understanding of the specific market needs. Being an export manager, gives me the opportunity to travel and meet many different people in different parts of the world. That is very exciting and important for me. What do you do in your spare time? As a Benfica fan, I like to watch them playing soccer. But what I like most is to spend time with my son and my wife.
OPH THE RECORD 21
First Toric ARTIFLEX implanted in USA
Find Ophtec in your region:
The Netherlands (head office) Ophtec BV Schweitzerlaan 15 9728 NR Groningen, The Netherlands Tel. +3150 5251944 | Fax +31505254386 info@ophtec.com Asia Pacific Ophtec Asia-Pacific CO, Ltd. Flat 9D Willow Mansion 22 Taikoo wan Road Taikoo Shing, Hong Kong Tel: +852 28871762 | alex@ophtec-ap.com Germany Ophtec GmbH Drögensee 12 a, 22397 Hamburg, Germany Tel: +49 40 60096 978 a.lindstaedt@de.ophtec.com Japan Ophtec Japan Inc. 2-7-29, Kitaaoyama, Minato-ku, Tokyo 107-0061 Tel: +81 35919 4366 | yamada@ophtec-ap.com North America Ophtec USA Inc. 6421 Congress Ave., Suite 112, Boca Raton FL 33487 USA Tel: +1 561 989-8767 rick.mccarley@usa.ophtec.com
Left to right: Aleksandra Stopinska, C.O.T., Andrew C. Shatz, M.D., Jean Pak, OPHTEC USA, Victoria Groeniger, R.N.
We are proud to announce that Dr Andrew Shatz, SightTrust Eye Institute, Sunrise, Florida, implanted the first Ophtec ARTIFLEX Toric Lens in the United States on August 22, 2013. Dr Shatz was granted special approval by the FDA to use this amazing ‘implantable contact lens’ to help a patient who had become unable to tolerate contact lenses or glasses and was legally blind without them.
Prior to surgery, the patient was unable to see things that were more than a few inches from the face without strong prescription lenses. The patient’s vision at the 1-day post-operative visit was 20/25 at distance and 20/20 at near. This patient was thrilled and will now be able to pursue a lifelong dream of serving in the United States Air Force!
ARTIFLEX Toric IOL P
iris fixation
P
small incision
P
no rotation post op
P
large optical zone
Optic:
6.0 mm
Haptics:
Iris Fix®
Overall diameter: 8.5 mm Dioptric range:
-1.0 D to -13.5 D in combination with a cylinder of -1.0 D to -5.0 D
More Ophtec (P)IOLs through www.ophtec.com 22 OPH THE RECORD
Portugal Ophtec Portugal Edificio Central Park Rua Alexandre Herculano, Torre 1, 4 B 2795-240 Linda-a-Velha Portugal Tel: +351 215 900 801 | Fax: +351 210 936 453 s.bayan@prt.ophtec.com South Africa Ophtec South Africa (Pty) Ltd Visiomed Office Park, Building 1 Unit 4, 269 Beyers Naude Drive, Blackheath Ext.1 Johannesburg, South Africa Tel: +27 105903135 | deon@ophtec.co.za South Korea Co, Ltd Ophtec South Korea 7th FL. YungJeon Building 154-10, SamSeoung-Dong, GangNam-Gu, Seoul, 135-879 South Korea Tel: +82-2-508-0522 | y.m.goo@kr.ophtec.com Spain Lio Ophtec España SL C/ Azalea, 1 Edif. B Planta 1 Oficina 3 Miniparc I- El Soto 28109 Alcobendas, Madrid España Tel: 900 993 174 y.hernandez@es.ophtec.com
Ophtec
| Cataract Surgery
DualTec Kit ™
Complete Implantation System The DualTec™ IOL Injector is a single use lens injector for the implantation of one- and three piece acrylic and polysiloxane IOLs. The special feature to switch over from push to twist function and reverse gives perfect ergonomy for a precise implantation. The DualTec™ Kit features complete sets of a DualTec™ Injectors and Locking Wing System™ cartridges required to implant your IOL of choice.
Main Features & Benefits P 2.2 mm incision (one piece acrylic IOLs) 2.8 mm incision (three piece acrylic IOLs) 3.2 mm incision (three piece silicone IOLs) P Switch for freedom of choice: PUSH or TWIST
Perfect ergonomy for precise implantation
P Single use
Safe, hygienic, constant quality
P Cartridge
When the cartridge ‘clicks’ it’s closed
PACKAGING
Injector + cartridge (in blister, box of 10) • OD 655 DualTec™ Kit 3P Acrylic 2.8 • OD 665 DualTec™ Kit 1P Acrylic 2.0 • OD 640 DualTec™ Kit 3P Silicone 3.0 Cartridge (in blister, box of 10) •OD 502 •OD 522 •OD 401
LWS™ Cartridge 3P Acrylic 2.8 LWS™ Cartridge 1P Acrylic 2.0 LWS™ Cartridge 3P Silicone 3.0
Photo: www.harteloh.nl
Museumplein 10 1071 DJ Amsterdam, +31 (0)20 573 2911
Stedelijk museum
Prinsengracht 267 Amsterdam +31 (0)20-5567100
Anne Frank House
Amsterdam >> City Info
Museumstraat 1 1071 XX Amsterdam +31 (0) 20 6621 440
Rijksmuseum
Paulus Potterstraat 7 1071 CX Amsterdam, +31 (0)20 570 5200
Van Gogh museum
Amstel 51 Amsterdam +31 (0) 20 530 8755
Hermitage
Jodenbreestraat 4, 1011 NK Amsterdam +31 (0) 20 520 0400
Rembrandt House
You can’t miss these top attractions while you are visiting Amsterdam!