We cataract surgeons might not think of a monofocal IOL as a premium lens, but with its high Abbe number, the ZEISS LUCIA 621P IOL truly is a premium monofocal product. Here, I am going to review two clinical cases in which I’ve implanted this lens.
Case 1: A 2+ Dense Cataract
I began this surgery using the ZEISS miLoop lens fragmentation device in a carousel technique: shrinking the miLoop, opening it, spinning the lens, and repeating. When I was ready to implant the lens, I used the preloaded injector. I pulled the plunger back slightly and then advanced it forward, creating a wave of viscoelastic that pushed the lens into the bag. The IOL unfolded slowly enough that I could slip the I/A instrument behind it to extract the viscoelastic, but fast enough that by the end of the case, it was fully open and well-centered.
At the slit lamp, I noticed how clear the CT LUCIA 621P IOL looked after implantation, so I thought to review the recordings of some of the other lenses I implanted that same surgical day using the same scope. There was a noticeable difference in the amount of reflection I saw between the CT LUCIA 621P and the same-powered lens from a different manufacturer (Figure 1). The CT LUCIA 621P IOL was crystal-clear. Until you see them side by side, it’s hard to really appreciate the difference between the clarity of lenses that we use. A high refractive index results in a high reflectance (Figure 2); the refractive index of the CT LUCIA 621P is 1.49 (Table 1). Also, high refractive index makes an optic thinner, and a thinner optic is at greater risk of shifting within the capsular bag.
Figure 1. The CT LUCIA 621P IOL (A) and the Alcon Clareon IOL (B), both +21.00 D lenses, were implanted on the same day, using the same instruments, minutes apart. The same microscope light intensity was used in both pictures. The reflection seen from the Clareon IOL demonstrates that a high refractive index equals high reflectance.
Figure 2. For IOLs, refractive index has tradeoffs. The greater the n2, the thinner the lens, the more the light bends, and the greater the reflectance.
Table 1. Refractive Index.
Case 2: Dense Cataract
In the case of a dense, grade 3-4 cataract, I again used the miLoop and carousel technique to dissect the cataract into four pieces. Sometimes with dense lenses, once half the fragments are out of the capsular bag, the bag starts getting a little floppy. So, I’ll perform what I call a scaffold technique: I inject more viscoelastic, insert the IOL inside the bag, and use it to support the capsule before I remove those last pieces. To do this, I need a lens I trust to unfold controllably. This lens slips behind those nuclear fragments beautifully (Figure 3). It starts off small; both haptics are folded onto the optic.
Once the IOL has opened in the bag, I can phacoemulsify the rest of the fragments out posteriorly, right above the optic, to save some endothelial cells. This allows for a very safe and controlled cataract extraction, especially in those tough cases. At the end of this case, the optic sat beautifully well-centered inside the eye (Figure 4).
Figure 3. In the scaffold technique, Dr. Wiley inserts the CT LUCIA 621P IOL underneath remaining lens fragments to support the capsule during the final extractions.
Figure 4. The CT LUCIA 621P IOL rests in the capsular bag after Dr. Wiley removed a dense cataract.
To conclude, I have been impressed with how easy the CT LUCIA 621P IOL is to use and how clear its optics are.
The authors/speakers have a contractual or other financial relationship with Carl ZEISS Meditec AG and its affiliates and have received financial support. Not all products, uses, treatment options and protocols referenced are officially approved or supported by a product’s intended use in every market. Approved labeling and instructions may vary from one country to another. Product specifications are subject to change in design and scope of delivery as a result of ongoing technical development.
