Retinal detachment after phakic intraocular lens implantation in severe myopic eyes

Retinal complications post posterior chamber phakic intraocular lens implantation at a tertiary eye hospital in the Eastern Province of Saudi Arabia

PURPOSE

Phakic intraocular lenses treat higher degrees of myopia not possible previously with conventional refractive surgery. The aim of this study is to report the incidence and risk factors of retinal complications after posterior chamber PIOL implantation and assess the differences in biometric parameters between patients who developed such complications versus those who did not.

METHODS

This retrospective study recruited 514 patients who underwent ICL implantation to correct myopia at a tertiary eye hospital center in the Eastern province of Saudi Arabia. Follow up period was at least one year. Medical records of the patients were reviewed to obtain the required data. Associations between respondents' characteristics and retinal complications were evaluated using the Chi-squared test.

RESULTS

The mean (SD) age was 27.7 (± 6.5) years ranging from 18 to 47. Laser treatment was performed in 14 cases (2.7%). Retinal complications occurred in six cases (1.2%). The risk of retinal complication was significantly higher among patients with high axial length (OR = 1.3, 95% CI 1.2, 1.4) and patients with high pre-spherical equivalent before ICL (OR = 1.09, 95% CI 1.03, 1.4).

CONCLUSION

Patients with higher axial length and higher pre-spherical equivalent before ICL implantation are at high risk of retinal complications.

Ten-year prevalence of rhegmatogenous retinal detachment in myopic eyes after posterior chamber phakic implantable collamer lens

PURPOSE

To determine and compare the prevalence of rhegmatogenous retinal detachment (RRD) in myopic eyes operated of posterior chamber phakic implantable collamer lens (ICL) with a control group of nonoperated myopic eyes over 10 years of follow-up.

SETTING

Clinica Baviera, Madrid, Spain.

DESIGN

Retrospective cohort study.

METHODS

There were 2 study cohorts: one with patients operated with ICL and a control group of nonoperated patients. The primary outcome of RRD was measured retrospectively, first through chart review of ICL-operated patients with at least 10 years of follow-up, then secondarily through telephone questionnaires and specialist verification for those with incomplete follow-up. Prevalence and incidence were calculated and compared, as well as their possible association with other risk factors.

RESULTS

58 operated patients completed follow-up in our clinic. A survey of 3849 more patients was conducted for a total of 252 operated with a mean spherical equivalent (SEQ) of -12.6 diopters (D) and 221 nonoperated with a mean SEQ of -10.5 D. 7 eyes developed an RRD in the operated vs 5 eyes among the nonoperated (prevalence 1.71% vs 1.25%, respectively, P = .773). The equivalence tests, the two one-sided test and the null hypothesis test between groups, were within the 0.02 limits, confirming the null hypothesis, and compared survival curves did not show significant differences ( P = .59).

CONCLUSIONS

ICL implantation surgery for high myopia did not affect the prevalence of RRD in operated eyes compared with similar nonoperated eyes, in this long-term study.

Macular hole following phakic intraocular lens implantation: A case report

BACKGROUND

Phakic intraocular lens (pIOL) implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia. However, it is associated with multiple complications.

CASE SUMMARY

This report describes a case of full-thickness macular hole (MH) in a patient with a history of bilateral pIOL implantation for the correction of myopia of –12.00 diopters in both eyes 7 mo ago. The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.

CONCLUSION

In rare cases, MH can occur following pIOL. In this present case report, we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.

Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results

PURPOSE

To evaluate a 12-year follow-up of myopic patients after iris-fixated phakic intraocular lenses (IF pIOLs) implantation. Setting. Ophthalmology Department, Military University Hospital in Prague (Czech Republic).

DESIGN

Single-center retrospective cohort study.

METHODS

We describe the results of a cohort study that included 85 eyes of 46 myopic patients who underwent implantation of Verisyse myopia, Veriflex, and Verisyse myopia toric (all Abbott Medical Optics, Inc.) intraocular lenses. Refractive functions and adverse events were assessed preoperatively, at 6 months, and 1, 2, 5, and 12 years after IF pIOL implantation.

RESULTS

Mean spherical equivalent was measured as -9.37 ± 2.87 D, 0.14 ± 0.61 D, and -0.42 ± 1.08 D, preoperatively, at 6 months and 12 years postoperatively, respectively. There was a significant reduction in the cylinder after surgery. At 12 years postoperatively, 90% of eyes had uncorrected distance visual acuity (UDVA) of 20/40 and 64% of 20/20. The safety index was 1.10 for the whole postoperative follow-up period. We found cataract formation in 3 eyes (3.5%). The endothelial cells loss (EC loss) directly caused by IF pIOL implantation was 6.0%, 8.10%, 12.8%, and 11.9%, at 1, 2, 5, and 12 years, respectively. In our cohort, 95% of eyes lost a higher percentage of EC than would be expected from a physiological loss at 12 years postoperatively. We found a significant negative interaction between preoperative pachymetry and EC loss, indicating that the lower pachymetry leads to a faster decline in endothelial cells density (ECD). IF pIOL re-enclavation was found in 28% of eyes. 7% of subluxations were caused by trauma. The mean time of nontraumatic re-enclavation was 6 years postoperatively.

CONCLUSIONS

The study confirmed the advantages of IF pIOL implantation due to rapid visual recovery and stable visual function over the 12-year follow-up and also showed the influence of lower corneal pachymetry regarding EC loss.

Long-Term Outcomes of Retinal Detachment in Phakic Eyes After Implantation of Implantable Collamer Lens V4c for High Myopia Correction

Aim: To estimate whether implantable collamer lens (V4c ICL) implantation increases the risk of retinal detachment in high myopia comparing with myopes with Rigid Gas-Permeable (RGP) correction.

Methods: This prospective study was comprised of an ICL group (704 eyes) and an RGP group (628 eyes). Patients were enrolled according to the inclusion criteria and exclusion criteria, then divided into the ICL group and RGP group. Patients in the ICL and RGP groups received V4c ICL implantation and RGP fitting respectively. Retinal details, spherical equivalent refraction (SE), uncorrected distance visual acuity (UDVA), corrected distance vision acutivity (CDVA), axis length (AL), anterior chamber depth (ACD) and other relevant parameters were recorded at different time points. Rhegmatogenous retinal detachment (RRD) morbidity and incidence, RRD morphology and relevant parameters were analyzed.

Results: All enrolled patients were followed for 3–6 years. Patients characteristics before the refractive procedure did not show a statistical difference. At the end of the follow up, all the RD cases were RRD. The RRD morbidity of the ICL group and RGP group was 1.99% (14 eyes) and 0.96% (6 eyes) respectively, which did not show statistical difference (P = 0.12). During the first year after refractive procedure, the RRD incidence of the ICL group was 0.85% (6/704), while this number of the RGP group was 0.16% (1/628). It did not show statistical difference (P = 0.08).

Conclusion: Compared with RGP fitting, V4c ICL implantation for high myopia correction does not add RRD risk in the long term. V4c ICL implantation is a safe method for high myopia correction.

Phakic intraocular lens implantation for the correction of hyperopia

The prevalence of myopia is much higher than hyperopia. Hence, there are relatively few studies investigating phakic intraocular lens (pIOL) implantation for the correction of hyperopia. This review aimed to summarize the available relevant literature on the efficacy and safety of pIOL implantation for the correction of hyperopia and hyperopic astigmatism. At present, two types of pIOLs are used to correct hyperopia and hyperopic astigmatism: anterior chamber iris-fixated pIOLs and posterior chamber implantable collamer lenses. Both have been found to be safe and effective. No serious events (eg, retinal or choroidal detachment, endophthalmitis) were reported in the reviewed articles. Implantation of pIOLs might be the optimal refractive surgery for the correction of high hyperopia.

Macular hole following phakic intraocular lens implantation and its management

A 28-year-old male presented to retina clinic with complains of blurring and distortion in right eye for past 1 week. There was history of implantation of phakic intraocular lens (pIOL) bilaterally 4 months back. Ophthalmic examination revealed a full-thickness macular hole in the right eye. Pars plana vitrectomy with inverted internal limiting membrane flap was planned. Post-operatively, patient had a good gain in vision (20/40) with closure of the hole. Macular hole is an unusual complication of pIOL. A detailed pre-operative fundus screening is indispensable. Early presentation and timely intervention can optimize the visual outcome.

Retinal detachment after acute posterior vitreous detachment resulting from posterior chamber phakic intraocular lens implantation

A 39-year-old woman presented with an early posterior vitreous detachment (PVD) after the implantation of an Implantable Collamer Lens phakic intraocular lens (pIOL). The patient detected PVD, noticing metamorphopsia early after surgery; it was confirmed with optical coherence tomography 5 days postoperatively. She was examined by a retinal expert, and no retinal tears were found. However, 15 days postoperatively, the patient had a retinal tear; 38 days later, a retinal detachment (RD) occurred despite treatment with argon laser photocoagulation. Prompt treatment and adequate patient cooperation achieved a final good uncorrected distance visual acuity (20/20). To our knowledge, this is the first description of the whole sequence involving early PVD leading to RD after pIOL implantation. This case highlights the importance of a fundus examination before and after surgery and of informing patients about the small chance of RD and visual symptoms.

Update on Treating High Myopia With Implantable Collamer Lenses

The purpose of this article is to provide updates on the treatment of high myopia with the implantable collamer lens (ICL). The ICL has become an important technique used in intraocular refractive surgery. With improvements in material, design, and application, the ICL has good efficacy, predictability, long-term safety and stability, manageable complications, and reversibility. More and more refractive surgeons are taking note of the ICL. This article reviews the material characteristics and the latest designs of the ICL along with the clinical applications, visual quality, and future development.

Retinal Complications After Anterior Versus Posterior Chamber Phakic Intraocular Lens Implantation in a Myopic Cohort

PURPOSE

To compare the incidence and characteristics of retinal complications following implantation of two types of phakic intraocular lenses (PIOLs) in patients with myopia.

METHODS

In this comparative, retrospective study, 603 eyes of 344 patients with myopia underwent implantation of either an Artisan iris-fixated phakic intraocular lens IOL (Artisan; Ophtec, Groningen, Netherlands) (Artisan group) or a Visian implantable collamer lens (ICL; STAAR Surgical Company, Monrovia, CA) (ICL group) between June 2005 and December 2013. Preoperative, operative, and postoperative clinical data were collected on the incidence of retinal complications, including rhegmatogenous retinal detachment (RRD) or choroidal neovascular membrane (CNVM).

RESULTS

The Artisan lens was implanted in 185 (30.68%) eyes and 418 (69.32%) eyes underwent ICL implantation. Mean follow-up was 26.78 months (range: 9 days to 98 months). Mean preoperative spherical equivalent (SE) was -12.44 ± 4.43 D (range: -1.13 to -31.00 D). The overall rate of retinal complications was 1%. Postoperatively, 3 (0.7%) eyes developed RRD in the ICL group, and no eyes developed RRD in the Artisan group. Submacular hemorrhage was observed in 1 (0.24%) eye in the ICL group. Two (1%) eyes developed CNVM in the Artisan group. The mean time from PIOL implantation to retinal complications was 15.6 months (range: 0.03 to 43 months).

CONCLUSIONS

Implantation of ICL or Artisan phakic IOL demonstrated comparable rates of retinal complications. Anterior chamber PIOL does not increase the risk of retinal detachment or CNVM in patients with myopia.

Retinal detachment surgery in eyes with iris-fixated phakic intraocular lenses: Short-term clinical results

PURPOSE

To evaluate the safety of retinal detachment (RD) surgery in eyes with iris-fixated phakic intraocular lenses (pIOLs) and the efficacy of the pIOLs in correcting myopia after RD surgery.

SETTING

Single university-based tertiary referral center.

DESIGN

Retrospective case series.

METHODS

Eyes that had RD surgery (RD group) and healthy fellow eyes (control group) of the same patients were evaluated over 1 year. Surgical success, corrected distance visual acuity (CDVA), anterior chamber depth (ACD), endothelial cell density (ECD), and intraocular pressure (IOP) were assessed preoperatively and postoperatively to evaluate the safety of the surgery. The uncorrected distance visual acuity (UDVA) and spherical equivalent were assessed to evaluate the efficacy of the pIOL after RD surgery.

RESULTS

Twenty-two eyes of 11 patients were assessed. Reattachment was achieved in 10 eyes (90.9%) with the first intervention. After 1 year, the mean UDVA was 0.16 ± 0.15 logMAR (SD) in the RD group and 0.09 ± 0.12 logMAR in the control group (P=.332). The mean CDVA was 0.03 ± 0.07 logMAR in the RD group. The differences in the mean postoperative ACD and ECD between the 2 groups were not significant (P=.088 and P=.270, respectively). The mean IOP in the RD group was significantly higher than in the control group up to 1 month postoperatively; thereafter, the difference was not significant.

CONCLUSIONS

Preservation of a pIOL during RD surgery did not diminish the safety of the surgery. The efficacy of the pIOL in correcting myopia was not markedly compromised.

Iris-fixated phakic intraocular lens implantation after retinal detachment surgery: long-term clinical results

PURPOSE

To assess the efficacy and safety of iris-fixated phakic intraocular lens (pIOL) implantation to correct myopia in eyes with previous retinal detachment (RD) surgery.

SETTING

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, South Korea.

DESIGN

Retrospective case series.

METHODS

Patients having pIOL implantation in both eyes were enrolled. Eyes that had scleral buckling or encircling (RD group) and healthy fellow eyes (non-RD group) were evaluated over a 6-year follow-up. The corrected distance visual acuity (CDVA), endothelial cell density (ECD), intraoperative complications, and long-term complications were safety outcomes. Uncorrected distance visual acuity (UDVA), predictability, and stability of refraction were efficacy outcomes.

RESULTS

The study comprised 34 eyes (17 patients). The mean postoperative CDVA and ECD were not significantly different between groups, and no patient lost CDVA. The rate of transient intraocular pressure spike was significantly higher in the RD group (P=.043). After 3 years and 6 years, the mean postoperative UDVA was 0.06 logMAR ± 0.09 (SD) and 0.08 ± 0.10 logMAR, respectively, in the RD group and 0.04 ± 0.08 logMAR and 0.04 ± 0.09 logMAR, respectively, in the non-RD group (P=.518 and P=.478, respectively). The rate of eyes within ±0.50 diopter of the desired refraction and the postoperative refraction was not significantly different between groups. No eye had vitreoretinal changes requiring secondary surgical intervention.

CONCLUSION

Iris-fixated pIOL implantation corrected the myopic refractive error in patients who had scleral buckling or encircling surgery for RD with a high degree of efficacy, safety, and long-term stability.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.