The Rayner Breakfast Seminar

This morning, Rayner hosted a very successful Breakfast Seminar chaired 
by Mr. Charles Claoué (London, UK) with an internationally renowned faculty. 
Many aspects of cataract surgery and the current status of IOLs were discussed and delegates were also introduced to some exciting new possibilities in IOL technology.

The seminar was very well attended and the majority of delegates found it to be both extremely interesting and highly informative.

Following an introduction by the Chairman, Dr. Wolfgang Haigis (Wurzburg, Germany) presented on the subject of A-constants. “Immersion and contact ultrasound require different lens constants”, he said, “and ultrasound and IOLMaster biometry also require different lens constants with the IOLMaster constants being higher than the manufacturers’ recommended ultrasound constants”. Dr. Haigis also explained that as different centres may use different instruments and different surgeons may apply different surgical techniques, it was important to be aware of induced astigmatism. He suggested that spherical equivalent should be used for optimisation and customisation. “Customize your A-constant”, he said, “….it’s worth it!”.

Dr. Steve Arshinoff (Toronto, Canada), this year’s Rayner Medallist, presented on Simultaneous Bilateral Cataract Surgery (SBCS). Dr. Arshinoff is one of the foremost advocates of SBCS and since 1996, he has performed over 2,000 procedures (4,000 eyes). “Patients are happier, get quicker and better results than with separate procedures and not a single eye has suffered a deleterious effect because of the bilaterality of their surgery”, he explained. “The bottom line is that SBCS is better, not easier, but with excellent results and patients and staff love it!”, he said.

Mark Packer MD (Eugene, Oregon, USA) discussed the clinical experience in the USA with the Rayner C-flex^® IOL. He commented on the excellent visual results achieved with best case visual acuity of at least 20/40 at 12 months, pooled at 99.5% in comparison to the historical control data at 96.7%. Overall, visual acuity of at least 20/40 at 12 months pooled was 98.2% in comparison to the historical control data at 92.5% and PCO rates were found to be low and acceptable.

Dr. Guy Kleinmann (Salt Lake City, Utah, USA) delivered a fascinating presentation on “Antibiotic-soaked hydrophilic acrylic IOLs” or more specifically, the possibility of C-flex^® being used as a drug delivery system for the fourth generation fluoroquinolones. “There has been a gradual increase of post-operative endophthalmitis in the USA since 1992 with most cases being attributed to the external surface flora of the eye”, he explained. “Preventive antibiotic treatment, although not proven directly to be effective, is very popular”. Dr. Kleinmann developed a study protocol to examine the possibility of C-flex^® as a drug delivery system for commercially available gatifloxacin and moxifloxacin. His results suggested that C-flex^® is capable of serving as an excellent and safe drug delivery system for fourth generation fluoroquinolones and the concentrations achieved in his studies exceeded those of all topical drop protocol studies.

Mr. Ashok Vyas (Scarborough, UK) gave a convincing presentation on the advantages of the new Rayner single use Soft-tipped injector. Following a brief description of its physical characteristics, Mr. Vyas went on to explain how easily the lens is loaded and with the benefit of surgical footage, he went on to show how the soft thermoplastic elastomer tip completely fills the lumen of the injector nozzle to avoid any override and subsequent damage to the lens during injection. “The 2mm diameter nozzle now offers the conventionally designed C-flex^® lens with all its design attributes to be successfully implanted through a 2.2mm incision following MICS, with all its fluidics and wound advantages”, Mr. Vyas concluded.

Dr. Kleinmann echoed Mr. Vyas’ sentiments in his second presentation entitled “Evaluation of the R-INJ-04 Soft Tipped Injector”. He explained that with many injectors, particularly those with hexagonal cartridges, there is a significant risk of lens damage through scratching, stress fractures, cracks, tear lines and surface deposits. Dr. Kleinmann also concluded, “Our results suggest that theR-INJ-04 Soft Tipped Injector with a rounded nozzle is safe for the implantation of the C-flex^® IOL”.

Professor Marek Prost (Warsaw, Poland) presented on the Paediatric Scleral Fixation of the Rayner Superflex^® Lens. “Up to now”, he explained, “there is no preferred technique of surgical treatment of congenital lens dislocation”. In a 4-year study involving 120 children aged from 2 years to 7 years with congenital lens dislocation, in every case, Professor Prost performed a lensectomy with scleral fixation of a Rayner Superflex^® IOL. The results were convincing and Professor Prost concluded that lensectomy with scleral fixation of Superflex^® should be regarded as one of the options for the surgical treatment of congenital lens dislocation in children.

Dr. Julián Cezón (Seville, Spain) discussed his initial experience with Rayner’s new M-flex^® Multifocal IOL. Dr. Cezón has considerable experience with many types of multifocal IOL and the first implantation of M-flex^® in Spain was carried out in April, 2006. He concluded that M-flex^® was safe and effective providing good distance and intermediate vision with an acceptable near vision.

Professor Gerd Auffarth (Heidleberg, Germany) delivered an excellent presentation on Rayner Toric IOLs and with the aid of videos demonstrating pre-operative assessment techniques and intra-operative procedural tips, Dr. Auffarth described the Rayner Toric IOL’s excellent stability and centration with minimal rotation with 80% of all eyes resulting in refractions +/- 1.0D of target. Professor Auffarth also noted that the correction of higher astigmatism to +11.0D torus was possible and transscleral fixation was also a possibility with the Rayner Toric lens. He concluded his presentation by saying, “The Rayner Toric IOL provides excellent results – in cataract surgery, in refractive surgery and after keratoplasty”.

Following an open discussion with questions to, and answers from, the faculty, the seminar was brought to a close.