2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 9: Accommodative and Nonaccommodative Treatment of Presbyopia
Accommodative Treatment of Presbyopia
Several scleral surgical procedures have been evaluated for use in the reduction of presbyopia. They share the objective of attempting to increase zonular tension by weakening or altering the sclera over the ciliary body to allow for its passive expansion. Thornton first proposed weakening the sclera by creating 8 or more scleral incisions over the ciliary body (anterior ciliary sclerotomy, ACS). Results were mixed, and any positive effect appeared short-lived. A prospective study of ACS using a 4-incision technique was discontinued because of significant adverse events, including anterior segment ischemia. In 2001, the American Academy of Ophthalmology stated that ACS was ineffective and a potentially dangerous treatment for presbyopia. Another method involving the placement of scleral expansion bands is under study (Fig 9-4). The LaserACE procedure (Ace Vision Group Inc., Silver Lake, OH) employs a laser to increase the plasticity of the sclera over the ciliary body in order to increase the efficiency of accommodation. This technique is under investigation.
A, The scleral expansion band is inserted in a scleral tunnel over the ciliary body parallel to the limbus. B, The appearance of the band after placement, prior to conjunctival closure. C, The appearance of the well-healed band.
(Courtesy of Refocus Group.)
Hamilton DR, Davidorf JM, Maloney RK. Anterior ciliary sclerotomy for treatment of presbyopia: a prospective controlled study. Ophthalmology. 2002;109(11):1970–1977.
Kleinmann G, Kim HJ, Yee RW. Scleral expansion procedure for the correction of presbyopia. Int Ophthalmol Clin. 2006;46(3):1–12.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.