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Optical Coherence Tomography Position Analysis of Retropupillary Iris-Fixated Intraocular Lens in Iris Tissue. J Ophthalmol 2022; 2022:5948208. [PMID: 35982770 PMCID: PMC9381219 DOI: 10.1155/2022/5948208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this study was to evaluate a micrometer-accurate analysis of the retropupillary Verisyse® intraocular lens (IOL) (Ophtec, Groningen NL; Santa Ana, USA) enclavation in the iris tissue. Methods A retrospective consecutive case series was conducted at the Department of Ophthalmology, University Hospital Mainz. Patients with an optical coherence tomography (Spectralis®, Heidelberg Engineering®; Heidelberg, Germany) examination after retropupillary Verisyse® IOL implantation were included retrospectively. The enclavation geometry was measured using the Eye-Explorer® from Heidelberg Engineering® (Heidelberg, Germany). Seventeen measuring positions were determined nasally and temporally at the corresponding enclavation points. Results 72 eyes of 67 patients after implantation of a retropupillary Verisyse® IOL were analyzed. The average age was 68 ± 17.2 years (63% female; 38% male). The analysis of the position of the Verisyse® IOL showed highly homogeneous data in all measured points. The depth of the anterior chamber showed a positive correlation with width of the posterior deflection of the iris tissue behind the enclavation (Pearson r: 0.321, p=0.041). The offset of the haptics showed greater deviations, and the lens diopter implanted was higher (r = 0.337, p=0.007). Conclusion This is the first study that analysis the exact enclavation of retropupillary implanted Verisyse® IOL. It provides new information about the intrastromal course of the haptics in the iris tissue. It could be shown that the haptics do not run parallel in the iris tissue, but are anchored in the iris tissue with an average offset of 95 µm. This rebuts previous assumptions about the intrastromal course and provides new information.
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Drolsum L, Kristianslund O. Implantation of retropupillary iris-claw lenses: A review on surgical management and outcomes. Acta Ophthalmol 2021; 99:826-836. [PMID: 33683012 DOI: 10.1111/aos.14824] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
Iris-claw lenses have gained increasing popularity over the last years and are by many surgeons regarded as viable options in eyes with insufficient capsular or zonular support. The iris-claw lens has two haptics with fine fissures for folding (enclavating) the mid-peripheral part of the iris stroma and can either be placed in front of or posterior to the iris. In particular, the retropupillary implantation has been increasingly chosen probably due to having an anatomical position similar to that of the crystalline lens. The present review is based on a literature review and also on the authors' clinical experience with this lens, and it focuses on surgical techniques and outcomes especially related to the characteristics of this lens, having haptics with claws that fixate the lens to the posterior iris. Implanting retropupillary iris-claw lenses has a relatively short learning curve, and there are only few complications reported during surgery. Retropupillary iris-claw lenses have demonstrated generally favourable efficiency and safety. However, the outcomes are probably more influenced by the reason for surgery and eye comorbidity than the lens itself. Albeit seldom reported, the postoperative complications have mostly been related to atrophy of the iris at the site of the haptics, or IOL decentration or disenclavation of one of the haptics. To date, however, there are few randomized clinical trials comparing this lens to other lens alternatives in eyes exhibiting insufficient capsular or zonular support for placing the lens in the ciliary sulcus. In the future, prospective studies with large samples should be performed to gain insights into the long-term safety of retropupillary placed iris-claw lenses, and for comparisons with the various other techniques of lens fixation.
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Affiliation(s)
- Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Choi EY, Lee CH, Kang HG, Han JY, Byeon SH, Kim SS, Koh HJ, Kim M. Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation. Sci Rep 2021; 11:726. [PMID: 33436860 PMCID: PMC7804091 DOI: 10.1038/s41598-020-80292-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Chul Hee Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea.
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Eldanasoury AM, Roozbahani M, Tolees S, Arana C. Long-Term Effect of Anterior Chamber Depth on Endothelial Cell Density in Patients With Iris-Fixated Phakic Intraocular Lenses. J Refract Surg 2019; 35:493-500. [DOI: 10.3928/1081597x-20190708-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
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Randon M, Queromes P, Pierre-Kahn V. [Long term postural myopic shift assessment after posterior iris-claw aphakic intraocular lens implantation]. J Fr Ophtalmol 2019; 42:968-973. [PMID: 31208908 DOI: 10.1016/j.jfo.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Posterior chamber iris-claw intraocular lens (IOL) is often used in aphakic eyes with inadequate capsular support. Postoperatively, patients may describe better capabilities for near reading in a face-down position. The goal was to evaluate the indications, visual outcomes and complications of this IOL and to compare postoperative spherical equivalent between the prone and the face-down position. MATERIALS AND METHODS Retrospective single-center case series of 31 eyes of 28 patients who underwent surgery between 2007 and 2016. Visual outcomes, early and late complications were analyzed. The refractive measurements were also assessed using a portable refractometer in prone and face-down position for each patient. The spherical equivalents were then compared. RESULTS The mean follow up was 29 months (3-73). The final mean corrected visual acuity (0.17±0.5 SD LogMar) was significantly better than preoperatively (0.5±0.50 SD LogMar) (P<0.05). Postoperative refractive error was within±2 diopters of emmetropia in 95 % of patients. The mean spherical equivalents in prone and face down position were different (P<0.05),-0.44 diopters (-4;+2.75) and-1.38 diopters (-5.25; 1) respectively. A mean myopic shift of-0.95 diopters (-5.25; 1.00) was observed in face down position. Cystoïd macular edema (6 %) and IOL disenclavation (9.6 %) were the main complications. DISCUSSION A posterior iris-claw intraocular lens appears to be an effective and relatively safe IOL to treat aphakia with poor capsular support. When the patient's head is bent forward, a mean myopic shift of 1 diopter is observed. This may support the idea that this IOL could be considered as an accommodative implant. Anterior movement of the iris-IOL complex due to gravity may be responsible for this myopic shift.
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Affiliation(s)
- M Randon
- Service d'ophtalmologie, hôpital Foch, Suresnes, France.
| | - P Queromes
- Service d'ophtalmologie, hôpital Foch, Suresnes, France
| | - V Pierre-Kahn
- Service d'ophtalmologie, hôpital Foch, Suresnes, France
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Chen M, Hu H, He W, Lu Y, Zhu X. Observation of anterior chamber volume after cataract surgery with swept-source optical coherence tomography. Int Ophthalmol 2018; 39:1837-1844. [PMID: 30182270 DOI: 10.1007/s10792-018-1012-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the changes in the anterior chamber volume (ACV) with swept-source optical coherence tomography (SS-OCT) after cataract surgery and the factors that influence these ACV changes. METHODS This was a prospective cohort study. Fifty-one patients who underwent cataract surgery were enrolled. Their ACV, anterior chamber depth, and angle widths were measured with SS-OCT before and 1 day, 1 week, and 1 month after surgery. The associations between the changes in ACV and posterior vitreous detachment (PVD) and axial length (AXL) were determined. RESULTS Compared with the preoperative volume, ACV increased significantly at all three time points after surgery (all p < 0.001). ACV was greater at 1 week after surgery than at 1 day after surgery (p < 0.001). Both AXL and the presence of PVD were significantly associated with the change in ACV at 1 day after surgery (p = 0.005). However, neither PVD nor AXL affected the change in ACV between 1 day and 1 week after surgery. CONCLUSIONS ACV stabilized in the first week after cataract surgery. The absorption of irrigation fluid and balanced salt solution in the vitreous cavity contributed to the change in ACV 1 week after surgery. Eyes with longer AXL and PVD tended to show less change in ACV at 1 day after surgery.
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Affiliation(s)
- Minjie Chen
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Hailin Hu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,Key Laboratory of Myopia, Ministry of Health, 83 Fenyang Road, Shanghai, 200031, People's Republic of China. .,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
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Abstract
The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in a video in the online version of this article. A complete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of a trained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.
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Galvis V, Tello A, Carreño NI, Berrospi RD, Niño CA, Cuadros MO. Aphakic iris-claw intraocular lens pseudophakic pseudoaccommodation. J Cataract Refract Surg 2017; 43:146. [PMID: 28317669 DOI: 10.1016/j.jcrs.2016.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/13/2016] [Indexed: 11/25/2022]
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Reply. J Cataract Refract Surg 2017; 43:146-147. [DOI: 10.1016/j.jcrs.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 11/13/2016] [Indexed: 11/22/2022]
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Sekundo W, Bertelmann T, Schulze S. [Retropupillary iris claw intraocular lens implantation technique for aphakia]. Ophthalmologe 2015; 111:315-9. [PMID: 24599663 DOI: 10.1007/s00347-013-2852-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA). MATERIAL AND METHODS A literature search and review of implantation techniques, patient selection, potential complications and management strategies. RESULTS This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications. CONCLUSIONS The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.
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Affiliation(s)
- W Sekundo
- Augenklinik, Philipps Universität Marburg sowie Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldinger Str., 35043, Marburg, Deutschland,
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Leitritz MA, Ziemssen F, Bartz-Schmidt KU, Voykov B. Using a slit lamp-mounted digital high-speed camera for dynamic observation of phakic lenses during eye movements: a pilot study. Clin Ophthalmol 2014; 8:1361-7. [PMID: 25071365 PMCID: PMC4111662 DOI: 10.2147/opth.s64722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate a digital high-speed camera combined with digital morphometry software for dynamic measurements of phakic intraocular lens movements to observe kinetic influences, particularly in fast direction changes and at lateral end points. Materials and methods A high-speed camera taking 300 frames per second observed movements of eight iris-claw intraocular lenses and two angle-supported intraocular lenses. Standardized saccades were performed by the patients to trigger mass inertia with lens position changes. Freeze images with maximum deviation were used for digital software-based morphometry analysis with ImageJ. Results Two eyes from each of five patients (median age 32 years, range 28–45 years) without findings other than refractive errors were included. The high-speed images showed sufficient usability for further morphometric processing. In the primary eye position, the median decentrations downward and in a lateral direction were −0.32 mm (range −0.69 to 0.024) and 0.175 mm (range −0.37 to 0.45), respectively. Despite the small sample size of asymptomatic patients, we found a considerable amount of lens dislocation. The median distance amplitude during eye movements was 0.158 mm (range 0.02–0.84). There was a slight positive correlation (r=0.39, P<0.001) between the grade of deviation in the primary position and the distance increase triggered by movements. Conclusion With the use of a slit lamp-mounted high-speed camera system and morphometry software, observation and objective measurements of iris-claw intraocular lenses and angle-supported intraocular lenses movements seem to be possible. Slight decentration in the primary position might be an indicator of increased lens mobility during kinetic stress during eye movements. Long-term assessment by high-speed analysis with higher case numbers has to clarify the relationship between progressing motility and endothelial cell damage.
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Affiliation(s)
- Martin Alexander Leitritz
- Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Focke Ziemssen
- Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Karl Ulrich Bartz-Schmidt
- Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Bogomil Voykov
- Centre for Ophthalmology, University Eye Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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Response to: position-dependent accommodative shift of retropupillary fixated iris-claw lenses. Graefes Arch Clin Exp Ophthalmol 2013; 251:2485-6. [PMID: 23740518 DOI: 10.1007/s00417-013-2389-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022] Open
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Galvis V, Tello A, Carreño NI, Revelo ML. Aphakic retropupillary iris-claw intraocular lens (IOL) pseudophakic accommodation. Graefes Arch Clin Exp Ophthalmol 2013; 251:2483-4. [PMID: 23733035 DOI: 10.1007/s00417-013-2388-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 05/19/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, FOSCAL, Floridablanca, Colombia
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