Posterior Chamber Phakic Intraocular Lens for Myopia of -8 to -19 Diopters

Comparative analysis of white-to-white and angle-to-angle distance measurements with partial coherence interferometry and optical coherence tomography

PURPOSE

To perform white-to-white (WTW) and angle-to-angle (ATA) distance measurements with 2 optical devices and analyze the correlation with other anterior segment parameters.

SETTING

Department of Ophthalmology, Medical Health and Science Center, University of Debrecen, Debrecen, Hungary.

DESIGN

Comparative case series.

METHODS

In this prospective study, the WTW distance, axial length (AL), and anterior chamber depth (ACD) were measured by partial coherence interferometry (PCI) (IOLMaster). The horizontal and vertical ATA distances and ACD were assessed by anterior segment optical coherence tomography (AS-OCT) (Visante).

RESULTS

The mean PCI values were AL, 23.31 mm ± 1.52 (SD); WTW distance, 11.99 ± 0.47 mm; ACD, 2.99 ± 0.4 mm. On AS-OCT, the mean horizontal ATA was 11.43 ± 0.51 mm and the mean vertical ATA, 10.72 ± 0.66 mm. The WTW distance was significantly greater than the horizontal ATA distance, and the horizontal ATA distance was significantly greater than the vertical ATA distance (P<.0001). The correlations between WTW and horizontal ATA (r = 0.51; P<.0001), vertical ATA (r = 0.32; P<.0021), AL (r = 0.45; P<.0001), and patient age (r = -0.28; P = .023) were significant. The PCI WTW distance and ACD were significantly correlated (r = 0.55; P<.0001). There were no significant correlations between AS-OCT horizontal and vertical ATA measurements (r = -0.02; P = 0.79) or between same-device ACD measurements (r = 0.18; P = .15).

CONCLUSIONS

Although PCI WTW and AS-OCT ATA measurements are not clinically interchangeable, the WTW values correlated well with horizontal and vertical measurements and other anterior segment parameters.

Clinical outcomes of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus: 6-month follow-up

BACKGROUND

To assess the early clinical outcomes of toric implantable collamer lenses (toric ICL™, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus.

METHODS

This study evaluated 27 eyes of 14 patients with spherical equivalents of -10.11 ± 2.46 D (mean ± standard deviation) and astigmatism of -3.03 ± 1.58 D who underwent toric ICL implantation for mild keratoconus. Before, and 1, 3 and 6 months after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery.

RESULTS

LogMAR uncorrected visual acuity (UCVA) and LogMAR best spectacle-corrected visual acuity (BSCVA) were -0.09 ± 0.16 and -0.15 ± 0.09 respectively, 6 months after surgery. The safety and efficacy indices were 1.12 ± 0.18 and 1.01 ± 0.25. At 6 months, 85% and 96% of the eyes were within ±0.5 and ±1.0 D respectively of the targeted correction. Manifest refraction changes of 0.00 ± 0.35 D occurred from 1 week to 6 months. No vision-threatening complications occurred during the observation period.

CONCLUSIONS

Toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of spherical and cylindrical errors in eyes with early keratoconus throughout the 6-month follow-up period, suggesting its viability as a surgical option for the treatment of such eyes.

Long-term follow-up of first-generation posterior chamber phakic intraocular lens

We present a patient who received a first-generation posterior chamber phakic intraocular lens (PC pIOL) (Fyodorov IOL) to correct myopia 18 years previously. After a long lapse in the follow-up, the patient presented with a reduced endothelial cell count. Although the cataractogenic effect of first-generation PC pIOLs is well known, no sign of cataract was present. The patient was totally satisfied even after 18 years. To our knowledge, this is the first report of a long follow-up of a patient implanted with a first-generation PC pIOL.

Collagen copolymer toric posterior chamber phakic intraocular lens in eyes with keratoconus

PURPOSE

To assess the safety, efficacy, stability, and predictability of collagen copolymer toric phakic intraocular lens (pIOL) implantation to correct myopia and astigmatism in eyes with keratoconus.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

METHODS

This prospective study comprised keratoconic eyes that had implantation of a toric Intraocular Collamer Lens. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and postoperative complications were evaluated 1, 3, 6, and 12 months postoperatively.

RESULTS

Preoperatively, the mean spherical equivalent in the 30 eyes (21 patients) was -5.38 diopters (D) +/- 3.26 (SD) (range -13.50 to -0.63 D) and the mean cylinder, -3.48 +/- 1.24 D (range -1.75 to -6.00 D). At 12 months, 86.7% of the eyes were within +/-0.50 D of the attempted refraction and all eyes were within +/-1.00 D. For the astigmatic components J0 and J45, 83.3% of eyes and 86.7% of eyes, respectively, were within +/-0.50 D. The mean Snellen UDVA was 0.81 +/- 0.20 and the mean CDVA, 0.83 +/- 0.18; CDVA was 20/40 or better in 29 eyes 96.7% of eyes and 20/25 or better in 22 eyes (73.3%). No eyes lost more than 2 lines of CDVA; 29 eyes (96.7%) maintained or gained 1 or more lines. The efficacy index was 1.07 and the safety index, 1.16. There were no complications or adverse events.

CONCLUSIONS

The results confirm that toric ICL implantation is a predictable, effective procedure to correct ametropia in eyes with keratoconus. Predictability and stability were achieved early and remained fairly stable up to 12 months.

Long-term changes in posterior chamber phakic intraocular collamer lens vaulting in myopic patients

OBJECTIVE

Evaluation of central and midperipheral vaulting of the posterior chamber phakic intraocular Collamer lens (ICL; Staar Surgical Inc., Monrovia, CA) in eyes with moderate to high myopia.

DESIGN

Retrospective analysis of prospectively collected data.

PARTICIPANTS

Eighty-four eyes treated with the latest ICL (V4 model) and 27 eyes treated with early ICL models were examined.

METHODS

After standardized ICL implantation, patients underwent complete ophthalmologic examinations before surgery and at 1 week, 1 month, 3 months, 6 months, and at yearly intervals thereafter. Central vaulting was measured using the Jaeger device (Haag-Streit, Bern, Switzerland). From 2006 onward, vaulting was measured additionally by optical coherence tomography (Visante OCT; Carl Zeiss Meditec, Jena, Germany). Using the Visante OCT, the crystalline lens rise and the midperipheral vaulting of the ICL were assessed.

MAIN OUTCOME MEASURES

Central vaulting after ICL implantation.

RESULTS

The mean duration of follow-up was 74.1+/-23.1 months and 96.3+/-50.2 months in eyes treated with V4 and early models, respectively. Postoperative central vaulting was 466+/-218 microm (range, 30-900 microm) in eyes treated with the V4 models and 321+/-200 microm (range, 150-900 microm) in those treated with early ICL models. From the 6-month follow-up onward, a continuous and nearly linear reduction of central vaulting was observed. At the 10-year follow-up, the mean central vaulting was reduced to 184+/-159 microm (range, 6-500 microm) and 138+/-218 microm (range, 0-820 microm) in eyes treated with V4 or early models, respectively. Eyes with total vaulting had a mean central vaulting of 407+/-202 microm (range, 180-730 microm), whereas those with midperipheral contact had a significantly lower central vaulting of 105+/-87 microm (range, 0-200 microm).

CONCLUSIONS

This study revealed consistent reduction of central vaulting over a 10-year period and provides further evidence that insufficient vaulting of the ICL is responsible for the development of anterior subcapsular cataract. A minimum central vaulting of 230 microm seems to be necessary to ensure total vaulting of the ICL. If an ICL is chosen for the correction of myopia, targeting for the greatest possible postoperative central vaulting is advised to achieve safe and complete vaulting for several years.

Pupillary Block Glaucoma After Implantation of Iris-Fixated Phakic Intraocular Lens

To report a case of pupillary block glaucoma after implantation of iris-fixated phakic intraocular lens (IF pIOL). A 43-year-old man was referred for pupillary block one day after implantation of IF pIOL. Slit-lamp examination revealed extremely shallow anterior chamber, closure of peripheral laser iridotomy and contact of iris on the peripheral of the optics of IF pIOL. The intraocular pressure (IOP) was 62 mm Hg. The iris moved forward in contact with the IF pIOL and the lens remained in the physiologic position, which made the distance between the lens and the iris wide. He underwent an uneventful peripheral surgical iridectomy and the IOP decreased to 6 mm Hg. Acute pupillary block glaucoma can occur after IF pIOL implantation due to the occlusion of aqueous flow between the IF pIOL and the iris if the peripheral iridotomy closes.

Culture-positive endophthalmitis after implantation of intraocular Collamer lens

We report a case of culture-positive bacterial endophthalmitis following implantation of a Staar intraocular Collamer lens (ICL). The patient presented 4 days after uneventful sutureless surgery with decreased visual acuity, redness, and photosensitivity. Inflammation increased over the next 24 hours, which prompted a tap for culture and intravitreal injection of antibiotic agents. Vitreous culture was positive for coagulase-negative Staphylococcus epidermidis. One year postoperatively, the uncorrected distance visual acuity was 20/20; persistent anterior vitreous opacities were the only observable sequelae. Bacterial endophthalmitis is a potential complication of ICL implantation. It can be successfully diagnosed and treated if a high degree of suspicion is maintained and if appropriate diagnostic and treatment modalities are used.

Effects of white-to-white diameter and anterior chamber depth on implantable collamer lens vault and visual outcome

PURPOSE

To investigate the effects of anterior chamber depth (ACD) and white-to-white (WTW) diameter on vault in eyes with implantable collamer lenses (ICL V4, STAAR Surgical AG) and to evaluate the effect of vault on visual outcomes and other biometric changes.

METHODS

Twenty-eight eyes of 16 patients who underwent ICL implantation were retrospectively reviewed. Patients were divided into two groups (A1, A2) according to preoperative ACD (> or = 3.3 mm and < 3.3 mm, respectively), two groups (B1, B2) based on WTW diameter (> or = 11.55 mm and < 11.55 mm, respectively), and two groups (C1, C2) according to the difference of ICL diameter and sulcus length (> or = 0.25 mm and < 0.25 mm, respectively). Vault, endothelial cell density, and visual performance were compared between each set of groups. Correlations of vault with WTW diameter, ACD, and diametric difference of the ICL from the sulcus were analyzed.

RESULTS

The high ACD and WTW groups showed significantly higher vaults (0.59 +/- 0.32 mm and 0.57 +/- 0.36 mm, respectively) than the low ACD and WTW groups (0.26 +/- 0.17 mm and 0.25 +/- 0.14 mm, respectively; P = .01 and .01), whereas the differences of diameter between the sulcus and ICL were not related to significant vault differences. The WTW diameter wascorrelated more closely to the vault than the ACD or sulcus diameter (r = 0.70, P < .001), whereas the vault difference did not affect visual quality or endothelial cell density.

CONCLUSIONS

A high WTW diameter or ACD is likely to render a high vault, regardless of any difference in the ICL and sulcus diameters.

Retinal complications of phakic intraocular lenses

High myopia has always been a challenge for refractive correction. Current laser surgical techniques, however, fall short of correcting high refractive errors due to lack of predictability, regression, corneal ectasia, and introduction of high order optical aberration. Phakic intraocular lenses (IOL) have been proposed as an effective refractive surgical procedure for the correction of severe myopia, but, despite recent advances in implant material technology and design, their concept is still under clinical investigation. Most of the concern regarding the complications of phakic IOLs focuses on the anterior segment of the eye. This review examines the posterior segment complications associated with phakic IOL implantation, evaluates possible pathogenetic mechanisms and discusses posterior segment complications, prevention and management.

Visual performance after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis for high myopia

PURPOSE

To compare postoperative visual function after implantable collamer lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation and after wavefront-guided laser in situ keratomileusis (WFG-LASIK) in eyes with high myopia.

DESIGN

Retrospective, observational case study.

METHODS

We investigated 46 eyes of 33 patients undergoing ICL implantation and 47 eyes of 29 patients undergoing WFG-LASIK (Technolas217z; Bausch & Lomb, Rochester, New York, USA) for the correction of high myopia (manifest spherical equivalent < or = -6 diopters). Ocular higher-order aberrations (HOA) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan) and a CS unit (VCTS-6500; Vistech Consultants Inc, Dayton, Ohio, USA) before and 3 months after surgery, respectively. From the CS, the area under the log CS function (AULCSF) was calculated.

RESULTS

For a 4-mm pupil, the changes in ocular coma-like aberrations, spherical-like aberrations, and total HOAs after ICL implantation were significantly less than those after WFG-LASIK (P < .001, Mann-Whitney U test). The postoperative AULCSF was significantly increased after ICL implantation (P < .001), whereas after WFG-LASIK, it was significantly decreased (P < .001).

CONCLUSIONS

ICL implantation induces significantly fewer ocular HOAs than WFG-LASIK. Moreover, CS was improved significantly after ICL implantation, but deteriorated after WFG-LASIK in eyes with high myopia. Thus, in the correction of high myopia, ICL implantation seems to be superior in visual performance to WFG-LASIK, suggesting that it may be a better surgical option for the treatment of such eyes.

Objective vs subjective vault measurement after myopic implantable collamer lens implantation

PURPOSE

To evaluate the relationship between subjective measurements of vault and objective values measured with Visante optical coherence tomography (OCT) in eyes receiving an implantable contact lens (ICL) for myopia correction.

DESIGN

Observational cross-sectional study.

METHODS

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

PATIENTS

Four hundred and fifty-two eyes from 246 patients were elected to be implanted with a Visian ICL V4 (STAAR Surgical Inc, Monrovia, California, USA).

OBSERVATION PROCEDURES

Subjective and objective measurements of vault after implantation of ICL.

MAIN OUTCOME MEASURES

Subjective vault classified in 5 levels assessed using an optical section during slit-lamp examination. Objective vault was measured with Visante OCT (Carl Zeiss Meditec Inc, Dublin, California, USA).

RESULTS

Average values of objective and subjective vault were 414 +/- 228 microm and 2.1 +/- 1.0, respectively and both parameters were highly correlated (r = 0.82; P < .001). Differences in average objective vault were statistically significant among the 5 groups of subjective vault (P < .001). Subjective vault 0 corresponded to a mean OCT value of 62 +/- 49 microm with 99% confidence interval (CI) [38; 86] microm; eyes with vault 1 to 203 +/- 93 microm with 99% CI [176; 230] microm; eyes with vault 2 to 402 +/- 131 microm with 99% CI [378; 425] microm; eyes with vault 3 to 594 +/- 146 microm, 99% CI [554; 633] microm; and vault 4 to 794 +/- 182 microm with 99% CI [713; 875] microm.

CONCLUSIONS

Subjective and objective values of vault are highly correlated. In 99% of cases within the CI, objective values for eyes subjectively classified within a certain level vary within a narrow interval (+/-25 to 80 microm) around the mean value, and this interval is characteristic of each subjective level.

Changes in iridocorneal angle structure and trabecular pigmentation with STAAR implantable collamer lens during 2 years

PURPOSE

To evaluate the changes in iridocorneal angle structure and trabecular pigmentation after implantation with the STAAR Implantable Collamer Lens (ICL), as potential risk factors of secondary glaucoma.

METHODS

An ICL was implanted in 48 eyes of 29 patients with high myopia. Angle opening distance (distance between trabecular meshwork and iris) measured at 500 microm from the scleral spur and trabecular-iris angle were assessed preoperatively and at 1, 6, 12, and 24 months postoperatively by ultrasound biomicroscopy, and trabecular pigmentation was evaluated preoperatively and at 1, 12, and 24 months postoperatively by standardized gonioscopic photography.

RESULTS

Mean follow-up was 33.2 +/- 7.3 months. One-month postoperative trabecular-iris angle and angle opening distance values were significantly smaller than preoperative values by 41.5% and 31.8%, respectively (P < .001), but no significant progressive changes were observed thereafter. The mean trabecular pigmentation of four quadrants did not change significantly during the first month after ICL implantation (P = .317), but significantly decreased at 1 and 2 years postoperatively compared with the preoperative value (P = .039 and .047, respectively). Intraocular pressure (IOP) remained stable in all eyes throughout follow-up except in one eye, which showed elevated IOP and significantly increased trabecular pigmentation requiring antiglaucoma medications.

CONCLUSIONS

No ongoing narrowing of iridocorneal angle was noted after approximately 40% narrowing at 1 month postoperatively. There was no general increase in trabecular pigmentation or IOP over a mean follow-up of 33.2 months. Considering significant initial angle crowding and one eye with increased trabecular pigmentation and IOP, careful monitoring of iridocorneal angle and IOP is required during the early postoperative period, especially for 1 month.

Factors affecting vaulting after implantable collamer lens implantation

PURPOSE

To evaluate the vaulting of the STAAR Implantable Collamer Lens (ICL) over the crystalline lens after implantation.

METHODS

One hundred twenty-three eyes of 68 patients with myopic refractive errors of -3.25 to -22.75 diopters undergoing ICL implantation were examined retrospectively. The magnitude of the central vaulting of the ICL was assessed quantitatively using slit-lamp microscopy at 3 months after surgery. Multiple regression analysis was used to assess the factors affecting the amount of vaulting.

RESULTS

The mean central vaulting 3 months after surgery was 603.6 +/- 259.6 microm. Explanatory variables relevant to the vaulting were, in order of influence, the horizontal white-to-white distance (partial regression coefficient B = 0.268, P = .0002) and patient age (B = -0.007, P = .011).

CONCLUSIONS

Although the majority of the variance remains unexplained, younger patients' eyes and eyes with greater white-to-white distances are more predisposed to have higher ICL vaulting over the crystalline lens.

Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism

PURPOSE

To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism.

SETTING

Department of Ophthalmology, Kitasato University, Kanagawa, Japan.

METHODS

This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] <or=-6.0 diopters [D]; manifest refractive cylinder >or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively.

RESULTS

At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations.

CONCLUSION

Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.

Current thoughts in pediatric refractive surgery

The goal of this article is to review current literature regarding the emerging field of pediatric refractive surgery. This encompasses current thought in adult refractive surgery, published literature in pediatric refractive surgery, and future possibilities for refractive technology in the pediatric population. This study includes a comprehensive review of literature in the general refractive surgery, cornea, and pediatric literature.

Time course of accommodation after implantable collamer lens implantation

PURPOSE

To assess the time course of accommodative function after Implantable Collamer Lens (ICL) implantation and to investigate the relationship between patient age and accommodation in ICL-implanted eyes.

DESIGN

Prospective, nonrandomized clinical trial.

METHODS

We prospectively examined 69 eyes of 40 consecutive patients with myopic refractive errors of -3.25 to -22.75 diopters (D) who were undergoing ICL implantation. We assessed the amplitude of accommodation using an accommodometer before and one, three, six, and 12 months after surgery. We also investigated its relationship with patient age.

RESULTS

The accommodation was 6.36 +/- 3.94 D (mean +/- standard deviation) before surgery and 4.89 +/- 2.72 D, 4.98 +/- 2.67 D, 5.16 +/- 2.72 D, and 5.72 +/- 2.85 D at one, three, six, and 12 months after surgery, respectively. The variance of data was statistically significant (P = .02, repeated-measures analysis of variance). Multiple comparisons demonstrated significant differences between measurements made before surgery and at one month after (P = .004, Fisher least significant difference test), before surgery and at three months after (P = .007), and before surgery and at six months after (P = .01). There was a significant correlation between patient age and accommodation before (Pearson correlation coefficient, r = -0.665; P < .001) and one year after (r = -0.803; P < .001) ICL implantation.

CONCLUSIONS

Accommodation was impaired transiently in the early postoperative periods, and then recovered gradually over time, indicating that transient dysfunction of the ciliary muscles by ICL fixation may occur after ICL implantation even if the crystalline lens remained intact. As patients aged, the amplitude of accommodation became significantly smaller not only in normal eyes but also in ICL-implanted eyes.

Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy

PURPOSE

To measure the ciliary sulcus diameters in 4 different axes and to determine the correlation with white-to-white distance.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

Fourteen normal volunteers with no evidence of ocular disease.

METHODS

Twenty-eight eyes were scanned using a 35-megahertz (MHz) ultrasound biomicroscopy (UBM) in sequential meridional scan planes at 45 degrees increments. Horizontal white-to-white distance was measured using Orbscan IIz (Bausch & Lomb-Orbtek, Inc., Salt Lake City, UT).

MAIN OUTCOME MEASURES

Ciliary sulcus diameter, anterior chamber diameter, white-to-white distance, and coefficient of variation.

RESULTS

The coefficient of variation for 35-MHz UBM was 0.90%. The mean diameters+/-standard deviations of ciliary sulci were 11.55+/-0.38 mm at 45 degrees, 11.99+/-0.36 mm at 90 degrees, 11.54+/-0.36 mm at 135 degrees, and 11.32+/-0.40 mm at 180 degrees. In all eyes, vertical diameters were greater than horizontal diameters. The mean difference between vertical and horizontal diameters was 0.67+/-0.26 mm (range, 0.36-1.13 mm), and this was statistically significant (P<0.001). Horizontal sulcus diameters and horizontal white-to-white distances were not correlated (r = 0.006; P = 0.976).

CONCLUSIONS

The posterior chamber appears to have a vertically oval shape. The white-to-white technique is inaccurate at predicting the horizontal diameter of the ciliary sulcus. The 35-MHz UBM may provide a good means of measuring the ciliary sulcus diameter for the implantation of a posterior chamber phakic intraocular lens.

Unilateral lens extraction for high anisometropic myopia in children and adolescents

INTRODUCTION

A subpopulation of children with anisometropic myopia, amblyopia, and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated using lensectomy alone (clear lens extraction) or lensectomy with simultaneous implantation of an intraocular lens (refractive lens exchange).

METHODS

Clinical course and outcome data were collated retrospectively in a group of 7 children and adolescents (mean age, 9.1 years; range, 4-20 years) with neurobehavioral disorders and noncompliance with spectacle wear for anisometropic myopia. Myopia in the 7 eyes ranged -11.9 to -24.5 D (mean, -16.7 D). Goal refraction was 0 to + 4 D. Correction was achieved by lensectomy in 5 eyes and lensectomy with intraocular lens implantation in 2 eyes. Primary posterior capsulectomy/subtotal vitrectomy was performed during the primary procedure in 5 eyes (71%). Mean follow-up was 3.8 years (range, 0.5-5.4 years).

RESULTS

Myopia correction averaged 17.3 D. A total of 86% (6 eyes) were corrected within +/- 3 D of the goal refraction and the remaining 14% to within +/- 4 D. Uncorrected visual acuity improved postoperatively in all 7 eyes, albeit modestly (average gain 0.14 Snellen fraction; gain from a mean 20/2550 to a mean 20/130). Myopic regression averaged approximately 0.43 D/year. Capsular opacification necessitated YAG-laser membranectomy in the 2 eyes that had preservation of the posterior capsule at the primary procedure. Retinal detachment has not occurred in any of the eyes during the follow-up period.

CONCLUSIONS

Refractive myopic lensectomy reduced high anisometropia and improved functional vision in children who have high myopia beyond the range of excimer laser correction and who will not wear glasses. Further study is indicated to determine the long-term safety of this procedure in similar pediatric populations.

[Ultrasound biomicroscopy of posterior chamber phakic intraocular lenses: a comparative study between ICL and PRL models]

PURPOSE

To evaluate the anatomic relationships of the implantable contact lens (ICL) and the phakic refractive lens (PRL) posterior chamber phakic intraocular lenses (PCP IOL) using ultrasound biomicroscopy (UBM).

MATERIAL AND METHODS

Seventeen phakic myopic eyes corrected with ICL, and 14 phakic myopic eyes that had had PRL implantation, were examined retrospectively using UBM. The main parameters measured and compared were anterior chamber depth, central and peripheral distance between PCP IOL and the crystalline lens, and exact lens haptic position.

RESULTS

The mean distance between the PCP IOL and the central endothelium was 2398+/-203 microm and 2640+/-230 microm in the ICL and PRL groups, respectively. The central vault between the implant and the crystalline lens was greater in eyes with ICL (ICL, 402+/-194 microm; PRL, 256+/-187 microm, p<0.05). However, the incidence of lens contact on the peripheral level was higher in the ICL group (41%) than in the PRL group (29%), and the difference between the two implants in the peripheral crystalline lens-PCP IOL distance was significant (p<0.05). Both IOL haptics appeared to be correctly positioned in the sulcus in 13 (76%) eyes of the ICL group, and on the zonule in eight eyes (57%) of the PRL group.

CONCLUSIONS

PCP IOL implantation is a safe procedure for the correction of high myopia with regard to refractive results. UBM provides a unique tool to noninvasively evaluate the relations of these implants within the posterior chamber, and helps to analyze the mechanisms of crystalline lens and iris complications.

Toric Implantable Collamer Lens for moderate to high myopic astigmatism

PURPOSE

To assess the efficacy of the Toric Implantable Collamer Lens (ICL) to treat moderate to high myopic astigmatism.

DESIGN

Prospective nonrandomized clinical trial.

PARTICIPANTS

Two hundred ten eyes of 124 patients with between 2.38 and 19.5 diopters (D) of myopia (spherical equivalent [SE]) and 1 to 4 D of astigmatism participating in the United States Food and Drug Administration clinical trial of the Toric ICL.

INTERVENTION

Implantation of the Toric ICL.

MAIN OUTCOME MEASURES

Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, and postoperative complications.

RESULTS

At 12 months postoperatively, the proportion of eyes with 20/20 or better UCVA (83.1%) was identical to the proportion of eyes with preoperative 20/20 or better BSCVA (83.1%); 76.5% had postoperative UCVA better than or equal to preoperative BSCVA. The mean manifest refractive cylinder dropped from 1.93 D (+/-0.84) at baseline to 0.51 D (+/-0.48) postoperatively, a 73.6% decrease in astigmatism. Although only 21.0% of eyes had 1-D refractive cylinder preoperatively (none less), 91.4% of cases had < or =1 D of cylinder postoperatively. Furthermore, 65.6% had < or =0.5 D and 40.9% had < or =0.25 D of refractive cylinder postoperatively. Mean manifest refraction SE (MRSE) improved from -9.36 D (+/-2.66) preoperatively to 0.05 D (+/-0.46) postoperatively. A total of 76.9% of eyes were predicted accurately to within +/-0.5 D, 97.3% to within +/-1.0 D, and 100% to within +/-2.0 D of predicted MRSE. Postoperatively, 37.6% of eyes had a BSCVA of 20/12.5 or better, compared with a preoperative level of 4.8%. Furthermore, BSCVA of 20/20 or better occurred in 96.8% postoperatively, compared with 83.1% preoperatively. Mean improvement in BSCVA was 0.88 lines; there were 3 cases (1.6%) that lost > or =2 lines of BSCVA after 12 months postoperatively, whereas 18.9% of cases improved by > or =2 lines. A total of 76.4% of cases gained > or =1 lines of BSCVA, whereas only 7.5% of cases lost the equivalent amount. Three ICL removals were performed without significant loss of BSCVA, and 1 clinically significant lens opacity was observed.

CONCLUSION

The results support the efficacy and predictability of Toric ICL implantation to treat moderate to high myopic astigmatism. Important safety concerns were not identified.

Ultrasound Biomicroscopy for Determining Visian Implantable Contact Lens Length in Phakic IOL Implantation

PURPOSE

To assess the efficacy of the ultrasound biomicroscopic (UBM) method in estimating the sulcus-to-sulcus horizontal diameter for Visian Implantable Contact Lens (ICL, model V4) length determination to obtain optimal ICL vault.

METHODS

The results of postoperative ICL vaults in 30 eyes of 18 patients were retrospectively analyzed. In 17 eyes, ICL length was determined using the conventional method, and in 13 eyes, ICL length was determined using the UBM method. The UBM method was carried out by measuring the sulcus to limbus distance on each side by 50 MHz UBM and adding the white-to-white diameter by caliper or Orbscan. The ICL vaults were measured using the UBM method at 1 and 6 months postoperatively and the results were compared between the two groups. Ideal ICL vault was defined as vault between 250 and 750 microm. The relation between the ICL vault, footplate location, and ICL power was also investigated.

RESULTS

In the UBM method group, ICL vault was within the ideal range in all 13 (100%) eyes at 1 and 6 months postoperatively, whereas in the conventional method group, 10 (58.8%) eyes showed ideal vault at 1 month postoperatively (P = .01) and 9 (52.9%) eyes showed ideal vault at 6 months postoperatively (P < .01). The ideal ICL footplate location was achieved in the ciliary sulcus in 11 (84.6%) eyes of the UBM method group and 10 (64.7%) eyes of the conventional method group. However, the differences between the two groups were not statistically significant. The ICL vault was not significantly affected by the ICL power.

CONCLUSIONS

Implantable Contact Lens length determined by the UBM method achieved significantly more ideal ICL vault than that of the conventional white-to-white method. The UBM method is superior to the conventional method in terms of predicting the sulcus-to-sulcus horizontal diameter for ICL length determination.

ZB5M Anterior Chamber and Fyodorov's Posterior Chamber Phakic Intraocular Lenses: Long-term Follow-up

PURPOSE

To compare the long-term complications of two outdated phakic intraocular lenses (PIOL) implanted in eyes with high myopia to aid development of better PIOL designs.

METHODS

Sixty-two eyes of 37 patients implanted with the ZB5M anterior chamber PIOL (anterior chamber group) and 22 eyes of 14 patients implanted with Fyodorov's posterior chamber PIOL (posterior chamber group) were examined. Complications were compared after a mean follow-up of 71.15 +/- 32.17 months (range: 24 to 145 months) in the anterior chamber group and 84.14 +/- 26.43 months (range: 24 to 132 months) in the posterior chamber group (P = .07).

RESULTS

At last follow-up, pupil ovalization was present in 32 (51.6%) eyes in the anterior chamber group and 1 (4.5%) eye in the posterior chamber group (P < .001), and cataract in 5 (8.1%) eyes in the anterior chamber group and 7 (31.8%) eyes in the posterior chamber group (P = .007). Phakic intraocular lens decentration, glaucoma, retinal detachment, corneal decomposition, and monocular diplopia were additional complications encountered in both groups, with no statistically significant difference.

CONCLUSIONS

Proper understanding of these outdated PIOLs may be helpful in developing better PIOL designs.

Clinical Results With the Medennium Phakic Refractive Lens for the Correction of High Myopia

PURPOSE

To evaluate the predictability, safety, stability, complications, and biocompatibility of the phakic refractive lens (PRL) as a posterior chamber intraocular lens to correct high myopia.

METHODS

Fifty eyes of 31 patients who underwent posterior chamber PRL implantation were evaluated prospectively. Mean preoperative myopia was -12.54 +/- 4.22 diopters (D) (range: -4.50 to -23.50 D) and mean astigmatic refractive power was -1.38 +/- 1.24 D (range: -1.00 to -4.50 D). Surgical implantation was performed through a 3.0- to 4.0-mm clear cornea sutureless incision using parabulbar (sub-Tenon's) anesthesia. Intra- and postoperative complications were recorded.

RESULTS

Three months after surgery, the mean spherical equivalent refraction was -0.21 +/- 0.42 D (range: +1.00 to -1.75 D). At 6 and 12 months, mean spherical equivalent refraction was -0.23 +/- 0.38 D (range: 0 to -1.25 D). At the last examination, uncorrected visual acuity was > or = 20/40 in 41 (82%) eyes and > or = 20/20 in 22 (44%) eyes. Best spectacle-corrected visual acuity (BSCVA) was > or = 20/40 in 42 (84%) eyes and > or = 20/20 in 27 (54%) eyes. Comparison of pre- and postoperative BSCVA at 12 months showed that 12 (36.4%) of 33 eyes gained > or =1 lines of BSCVA and 7 (21.2%) of 33 eyes gained > or =2 lines. One (2%) eye developed anterior subcapsular cataract requiring lens exchange, and 1 (2%) eye developed acute angle closure glaucoma requiring YAG-iridotomy. One (2%) eye developed macular hemorrhage.

CONCLUSIONS

At 6 months and 1 and 2 years, PRL implantation yielded encouraging visual and refractive results with excellent biocompatibility. The efficacy, stability, and short-term safety of this lens was established. Serious complications, such as cataract and acute angle closure glaucoma, may occur, and long-term safety needs to be evaluated.

Macular Choroidal Neovascularization in Myopic Eyes After Phakic Intraocular Lens Implantation

PURPOSE

To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs).

METHODS

This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization.

RESULTS

Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955).

CONCLUSIONS

Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.

Iris and trabecular meshwork pigment changes after posterior chamber phakic intraocular lens implantation

PURPOSE

To evaluate the changes in laser iridotomies, intraocular pressure (IOP), angle structures, and pupil diameter after implantable contact lens (ICL) (Version 4 Staar Surgical) implantation in myopic Asian eyes.

SETTING

Department of Ophthalmology, Chung-Ang University Yongsan Hospital, Seoul, Korea.

METHODS

The ICL was implanted in 81 eyes of 43 patients with spherical equivalent greater than -6.00 diopters. Gonioscopy examination was performed 1 day after laser iridotomy and 6 and 12 months after ICL implantation. The changes in laser iridotomy sites, IOP, and pupil diameter were also evaluated.

RESULTS

Ten eyes (12.3%) had occlusion or narrowing of the laser iridotomy sites. The angle width was more than 30 degrees in all cases preoperatively but narrowed to less than 20 degrees in 16 eyes (19.8%) 6 months postoperatively. The mean pigment, measured by the semiquantitative method (grade 0 to 4), was 2.03 in the inferior angle, 0.18 in the nasal angle, 0.12 in the temporal angle, and 0.00 in the superior angle 12 months postoperatively. The pigment in all quadrants increased temporally as a result of the laser iridotomy or iris rubbing by the ICL; however, the pigments absorbed gradually and decreased to values before laser iridotomy 12 months postoperatively. There was a temporary increase in IOP from the instillation of steroid eyedrops 1 week and 1 month postoperatively; IOP returned to the preoperative level and remained there 12 months postoperatively. There was a significant decrease in pupil diameter 1 and 3 months postoperatively; the diameter returned to the preoperative size at 6 and 12 months. Pigment dispersion syndrome and pigmentary glaucoma were not seen.

CONCLUSION

Implantation of the ICL narrowed the angle width but did not increase trabecular pigmentation compared with values after laser iridotomy, indicating ICL implantation is safe regardless of the pigmentary changes in the trabecular meshwork.

Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 2. Laser-assisted subepithelial keratectomy (LASEK)

INTRODUCTION

A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated bilaterally using excimer laser technology.

METHODS

Clinical course and outcome data were collated prospectively in a group of 9 children (mean age, 10.2 years; range, 3-16 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 18 eyes ranged from -3.75 to -11.5 D (mean -16.6 D) and the desired refraction was approximately +1D. Correction was achieved by bilateral laser-assisted subepithelial keratectomy (ie, LASEK) performed under brief general anesthesia. Mean follow-up was 17 months (range, 6-36 months).

RESULTS

Myopia correction averaged 7.9 D. Eighty-nine percent (16/18 eyes) were corrected to within +/-1 D of goal refraction. Uncorrected acuity improved postoperatively in all 18 eyes, with commensurate gains in behavior and environmental visual interaction in 88% (15/17 children). Myopic regression averaged approximately 0.8 d/year. the only complication encountered was mild (1+) corneal haze in 35% of treated eyes.

DISCUSSION/CONCLUSIONS

Bilateral excimer laser surgery is effective for improving functional vision substantially in highly myopic, neurobehaviorally impaired children who have difficulties wearing glasses. Myopic regression is common. Further study is indicated to determine the long-term safety of these and alternative refractive procedures in similar pediatric populations.

Refractive surgery for high bilateral myopia in children with neurobehavioral disorders: 1. Clear lens extraction and refractive lens exchange

INTRODUCTION

A subpopulation of children with high myopia and neurobehavioral disorders is noncompliant with spectacle wear and ill-suited to correction using contact lenses. We report the results of refractive surgery in a series of these children treated using lensectomy alone (clear lens extraction), or lensectomy with simultaneous implantation of an intraocular lens (refractive lens exchange).

METHODS

Clinical course and outcome data were collated prospectively in a group of 13 children (mean age 10.4 years, range 1 to 18 years) with neurobehavioral disorders exacerbated by chronic noncompliance with spectacle wear, causing profoundly low functional vision. Myopia in the 26 eyes ranged from -14.25 to -26.00 D (mean -19.1 D). Goal refraction was approximately +1 D. Correction was achieved by lensectomy alone in 10 eyes, and lensectomy with intraocular lens implantation in 16 eyes. Primary posterior capsulectomy/subtotal vitrectomy was performed during the primary procedure in 11 eyes (42%). Mean follow-up was 4.5 years (range 1.3 to 7.5 years).

RESULTS

Myopia correction averaged 19.9 D. Eighty-one percent (21 eyes) were corrected to within +/-2 D of goal refraction and the remaining 19% (5 eyes) to within +/-4 D. Uncorrected acuity improved substantially (ie, an average 2 log units) in all 26 eyes, with commensurate gains in behavior and environmental visual interaction in 85% [corrected] of children (11/13) [corrected] Myopic regression averaged -0.16 D/year. Capsular regrowth and/or opacification necessitated vitrector or YAG-laser membranectomy in 13 [corrected] eyes (50%) [corrected] Focal retinal detachment (successfully repaired) occurred after eye contusion in one eye (4%) with cicatricial retinopathy of prematurity.

CONCLUSIONS

Bilateral refractive lensectomy is effective for improving functional vision in neurobehaviorally impaired children who have high myopia (beyond the range of excimer laser correction: see companion publication) and difficulties wearing glasses. Posterior capsule regrowth/opacification is common, necessitating secondary membranectomy. Further study is indicated to determine the long-term safety of this procedure in similar pediatric populations.

Cataractous Changes due to Posterior Chamber Flattening with a Posterior Chamber Phakic Intraocular Lens Secondary to the Administration of Pilocarpine

OBJECTIVE

To present the first reported case of cataract formation as a consequence of instillation of pilocarpine in an eye with a posterior chamber phakic intraocular lens (IOL).

DESIGN

Interventional case report.

INTERVENTION

A 46-year-old man received a hyperopic implantable collamer lens (ICL) bilaterally.

MAIN OUTCOME MEASURES

Determination of best-corrected visual acuity (BCVA); contrast sensitivity testing with and without glare; and intraocular pressure (IOP), specular endothelial cell, and slit-lamp examinations were performed serially. In addition, the distance between the ICL and crystalline lens was measured with optical coherence tomography.

RESULTS

Both eyes underwent uneventful ICL implantation for the correction of a manifest spherical equivalent of +7 diopters (D) in the right eye and +7.1 D in the left eye. The left eye was followed for 2 years without developing complications. The right eye, however, showed on the first postoperative day a fleckenlike opacification on the anterior pole of the crystalline lens after instillation on the operative day of 2% pilocarpine in an attempt to accelerate recovery from unwanted pupil dilation causing patient complaints of glare disability after surgery. Optical coherence tomography demonstrated complete contact of the ICL with the natural lens 24 hours postoperatively. Serial IOP measurements were always within the normal limits. The instillation of 1% cyclopentolate resulted in an increase in the ICL vault that measured 132 mum 24 hours later. Three days after the completion of a 3-day course of topical 1% cyclopentolate, the opacification was less dense and demarcated, and a 124-mum vault was measured. Three months postoperatively, the cataract was associated with a 3-line loss of BCVA and considerable degradation of the contrast sensitivity, especially at higher spatial frequencies and with a glare source, and corneal endothelial cell changes were within normal limits. One year after ICL implantation, the right eye had to undergo phacoemulsification and IOL implantation, which were uneventful.

CONCLUSIONS

Posterior chamber flattening with resulting crystalline lens opacification can occur immediately after the instillation of pilocarpine in an eye with a hyperopic ICL. Therefore, caution should be taken with the administration of cholinergic agonists such as pilocarpine in patients with phakic IOLs, at least if they are hyperopic ICLs.

Correction of high myopia with different phakic anterior chamber intraocular lenses: ICARE angle-supported lens and Verisyse iris-claw lens

PURPOSE

To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patients implanted with different IOLs.

MATERIALS AND METHODS

Forty eyes were implanted with phakic IOLs. The ICARE myopia lens was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from -21.875 to -10.0. The mean patients' age was 30 years. The Verisyse IOL was implanted in 20 eyes of 12 patients with spherical equivalent of the refractive error from -21.625 to -10.375D, and the mean patients' age was 32.25 years. The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up period was 12 months.

RESULTS

Twelve months after surgery, the mean refractive error (SE) was -0.19D (100% of eyes were within +/-1.0D of the target refraction) in the ICARE group, and -0.86D (95% of eyes were within +/-1.0D of the target refraction) in the Verisyse group. The postoperative refraction remained stable during the entire follow-up period. The mean uncorrected visual acuity was 0.7 in the ICARE group, and 0.69 in the Verisyse group 1 year postoperatively. There was no loss in visual acuity 1 year after surgery in the ICARE implanted eyes, one patient in the Verisyse group lost 1 line of BCVA as compared to the preoperative state. Mean endothelial cell density loss was 6.12% and 6.79% in the ICARE and Verisyse groups, respectively. There were no statistically significant differences regarding the analyzed outcome parameters between the two study groups.

CONCLUSION

The implantation of both anterior chamber phakic intraocular lenses to correct high myopia resulted in a stable and predictable refractive outcome. Efficacy and safety of surgery for both implanted lens models are very high.

Visual improvement in high myopic amblyopic adult eyes following phakic anterior chamber intraocular lens implantation

PURPOSE

To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia.

METHODS

We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1-5) numeric scale.

RESULTS

The mean age of patients was 37.3 +/- 9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10 +/- 5.41 diopters (D). The postoperative mean refraction (SE) was -1.75 +/- 0.76 D at six months. The postoperative BCVA improved an average 3.92 +/- 1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3.

CONCLUSIONS

This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.

Changes in the crystalline lens resulting from insertion of a phakic IOL (ICL) into the porcine eye

BACKGROUND

Insertion of a phakic IOL offers these advantages: the corneal optical zone is not dissected or resected; preservation of the crystalline lens results in preservation of the accommodation force; and since the phakic IOL is removable, any error or change in refraction can be countered by exchanging it. However, the cause of secondary cataracts has never been clarified or discussed to date.

METHODS

The following ICL lenses were inserted under general anaesthesia into 20 eyes of ten 3-month-old miniature pigs: a minus lens without holes into five eyes, a plus lens in two eyes, a minus lens with four holes around the lens haptics in three eyes, and a minus lens with a central hole in the optic in three eyes; and seven eyes were used as controls. The anterior segments were then photographed 1 week, 1 month and 3 months after surgery. At 3 months after surgery, Evans blue (EB) was infused into the vitreous under general anaesthesia, and after 30 min, the eyeball was enucleated, fixed and examined.

RESULTS

In the case of the ICL without holes, the anterior subcapsular opacities were observed in all the eyes, and the anterior surfaces of the crystalline lenses were not stained with EB. Use of the ICL with four holes around the lens haptics resulted in light staining of the anterior surface of the crystalline lens, but the anterior subcapsular opacities observed were mild. As for the ICL with a hole in the centre of the optic, the anterior surface of the crystalline lens was stained and no anterior subcapsular opacities were observed.

CONCLUSION

The results suggested that the insertion of an ICL brings about a change in the dynamics of the intraocular aqueous humour, reducing its circulation to the anterior surface of the crystalline lens. This is considered to cause a metabolic disturbance of the crystalline lens, resulting in anterior subcapsular opacification.

Outcome of simultaneous phakic implantable contact lens removal with cataract extraction and pseudophakic intraocular lens implantation

PURPOSE

To assess the outcome of simultaneous implantable contact lens (ICL) removal and cataract extraction with pseudophakic intraocular lens (IOL) implantation.

SETTING

CODET Aris Vision Institute, Tijuana, Mexico.

METHODS

This retrospective noncomparative interventional case series evaluated 14 eyes of 12 patients with ICL implantations who developed a cataract and simultaneously had ICL removal and cataract extraction with IOL implantation. The follow-up time was at least 6 months (range 6 to 24 months). Visual acuity (logMAR), manifest refraction, intraocular pressure, and adverse events were recorded.

RESULTS

Of the 12 patients (14 eyes), 10 patients (12 eyes) had ICL surgery to correct high myopia and 2 patients (2 eyes), to correct hyperopia. The mean uncorrected visual acuity after ICL implantation (before cataract development), before cataract surgery, and after cataract surgery were 0.48 +/- 0.32, 0.83 +/- 0.34, and 0.40 +/- 0.27, respectively. The mean best corrected visual acuity (BCVA) before ICL implantation, after ICL implantation, and after cataract surgery were 0.31 +/- 0.21, 0.28 +/- 0.19, and 0.27 +/- 0.21, respectively. The mean final manifest spherical equivalent was 0.30 diopters (D) +/- 1.07 (SD) (range +2.38 to 2.0 D). Ten eyes (71.4%) were within +/-1.0 D of the calculated target. One eye had a tear in the posterior capsule with vitreous loss during cataract surgery. No other intraoperative, perioperative, or postoperative complications were observed. No loss of BCVA was recorded at the last postoperative visit.

CONCLUSIONS

Lens opacities and cataract formation are a potential complication of ICL surgery. The removal of the ICL and the cataract with IOL implantation was found to be safe, with predictable refractive results.

Retinal Detachment in Myopic Eyes After Phakic Intraocular Lens Implantation

PURPOSE

To analyze the risk of retinal detachment in highly myopic patients who underwent implantation of phakic intraocular lenses (PIOLs).

METHODS

In a retrospective, non-comparative, interventional case series, the occurrence of retinal detachment was analyzed in 522 consecutive highly myopic eyes (323 patients) that underwent PIOL implantation. Treatment and results were reviewed. Parameters evaluated were best corrected visual acuity before and after retinal detachment surgery and time between refractive surgery and retinal detachment.

RESULTS

Fifteen (2.87%) eyes presented with retinal detachment after PIOL implantation, with a mean time between surgery and detachment of 24.4 +/- 24.4 months (range: 1 to 92 months). The risk of retinal detachment in patients with high myopia corrected by PIOL implantation was 0.57% at 3 months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months (Kaplan-Meier analysis). A comparative study between the group of patients with retinal detachment and the remaining patients without retinal detachment was performed. Differences were found in axial length (30.65 +/- 1.97 vs 29.51 +/- 2.02; P=.028, one factor-analysis of variance test).

CONCLUSIONS

The risk of retinal detachment in eyes implanted with phakic lenses for the correction of high myopia is higher in eyes with axial length >30.24 mm.