Phakic refractive lens implantation in high myopic patients: one-year results

Iris-Claw Intraocular Lens Implantation in Various Clinical Indications: A 4-Year Study

An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups both before and after the surgery, but 4 years after the surgery IOP values in group IV were higher than in group III. The cECC decreased every year after the surgery in all groups, but four years after the IOL implantation, the lowest cECC values were observed in group IV. At the same time, all groups of patients showed improved BCVA, stable refraction, and a low percentage of postoperative complications.

Phakic intraocular lenses: An overview

Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.

A Survey of Intraocular Lens Explantation: A Retrospective Analysis of 23 IOLs Explanted during 2005

Purpose

To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005.

Methods

The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared.

Results

Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562±0.279 and 0.627±0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test).

Conclusions

The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.

Ocular monochromatic aberrations in a rural Chinese adult population

PURPOSE

To investigate the distribution of monochromatic aberrations in a rural Chinese adult population and the possible effect of aberrations on the development of refractive error.

METHODS

A total of 404 Chinese adults who grew up in rural Yongnian County, Handan City, Northern China, were included. Monochromatic aberrations of left eyes were measured using iTrace Dynamic Laser Refraction at 5.0-mm pupil size without cycloplegia.

RESULTS

Mean age of all participants was 49.9 ± 10.5 years (range, 31 to 86 years). Mean spherical equivalent was 0.22 ± 1.14 diopters (D) (range, -7.06 to +3.62 D). With age, the refraction demonstrated a significant hyperopic shift (r = 0.25, p < 0.01). Oblique trefoil (C3), vertical coma (C3), horizontal coma (C3), and spherical aberration (SA) (C4) significantly differed from zero (-0.065 ± 0.133 μm, -0.043 ± 0.161 μm, +0.070 ± 0.115 μm, and +0.058 ± 0.082 μm, respectively). Total root mean square values of higher-order aberrations (HOAs) were 0.296 ± 0.147 μm, with predominant ones of coma (0.180 ± 0.115 μm), trefoil (0.151 ± 0.116 μm), and SA (0.081 ± 0.060 μm). Root mean square values of total HOAs, coma, trefoil, SA, and third- to seventh-order aberrations significantly increased with age (p < 0.01). Total HOAs, SA, coma, and trefoil were not significantly different between hyperopic, emmetropic, and myopic eyes after adjusting for age (p = 0.26, 0.15, 0.24, and 0.28, respectively). Zernike coefficient of SA showed a significant difference between hyperopic (0.076 ± 0.086), emmetropic (0.056 ± 0.079), and myopic (0.028 ± 0.088) eyes (p = 0.00).

CONCLUSIONS

Ocular refraction in rural Chinese adults showed significantly hyperopic shift with age. Magnitudes of HOAs in rural Chinese adults were similar to that of other populations and significantly increased with age but showed no differences in myopic, emmetropic, and hyperopic adults. The existence of HOAs is not, in itself, sufficient to account for the myopia epidemic in China.

Intraocular optical quality of phakic intraocular lenses: comparison of angle-supported, iris-fixated, and posterior chamber lenses

PURPOSE

To evaluate internal aberrometric profiles following phakic intraocular lens (PIOL) implantation.

DESIGN

Retrospective and consecutive case series.

METHODS

One hundred and five eyes of 65 patients were included. The optical aberrations were measured with the Topcon KR-1W aberrometer. Comparisons of internal aberrations for different models were made. Comparisons at 4 and 6 mm were made also within the same model for all the lenses. Comparisons regarding the implantation site were also performed: angle-supported (AS) anterior chamber (AC) (n = 47), iris-fixated (IF) (n = 27), and posterior chamber (PC) (n = 31).

RESULTS

Root mean square (RMS) of internal optical higher-order aberrations (HOAs) changed significantly to higher values from 4-6 mm aperture diameter in each PIOL, as should be expected. However, this significant change was not detected in spherical aberration for Kelman Duet (P = .753) and in trefoil for Acrysoft (P = .059). Kelman lens showed significantly lower values of spherical aberration compared to Acrysoft at 4 mm (P = .022) and at 6 mm (P = .042). Acrysoft showed the lowest values at central zone for trefoil (P = .043) and tetrafoil (P = .002) in AC group. In the IF group, Artisan and Artiflex showed similar results for all internal aberrations. In the comparison between Visian Implantable Collamer Lens (ICL; STAAR Surgical Co, Monrovia, California, USA) and phakic refractive lens (PRL), both for posterior chamber, significantly lower values of coma were observed for ICL (P = .033). IF lenses showed clinical evidence, but not significant, of better centering capability than AS lenses (P = .096).

CONCLUSIONS

The study of intraocular aberrations is an adequate method to identify the clinical optical behavior and could help the surgeon to identify the most frequent problems related with each model.

Posterior chamber phakic intraocular lens to correct myopia: long-term follow-up

PURPOSE

To evaluate the long-term safety and efficacy of a refractive phakic intraocular lens (pIOL) (PRL) to correct moderate to high myopia.

SETTING

Department of Ophthalmology, University Medicine Charité Berlin, Berlin, Germany.

DESIGN

Retrospective cohort study.

METHODS

Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure, endothelial cell loss, and adverse events were evaluated.

RESULTS

The study enrolled 53 eyes (mean spherical equivalent [SE] -12.17 diopters [D] ± 4.12 [SD]) of 29 patients. The mean age was 34.6 ± 9.2 years and the mean follow-up, 86 ± 21.2 months. The mean UDVA improved from 1.37 ± 0.28 logMAR preoperatively to 0.14 ± 0.19 logMAR at the last postoperative visit (P<.05). The mean CDVA improved from 0.10 ± 0.18 logMAR to -0.01 ± 0.09 logMAR (P<.05). The overall mean efficacy index and mean safety index were 0.9 and 1.21, respectively, at the last follow-up visit. The mean endothelial cell loss at the last follow-up was 6.4%. The complications were slight posterior chamber (PC) pIOL decentration (5 eyes, 9.4%), severe PC pIOL decentration resulting in pIOL removal (1 eye, 1.8%), glaucoma (4 eyes, 7.5%), clinically significant cortical lens opacification resulting in cataract surgery (4 eyes, 7.5%), clinically asymptomatic anterior subcapsular cataract formation (6 eyes, 11.3%), and retinal detachment (2 eyes, 3.8%).

CONCLUSIONS

Posterior chamber phakic pIOL implantation to correct moderate to high myopia provided predictable and stable refractive results but with a high rate of serious complications over the long term.

FINANCIAL DISCLOSURE

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

The posterior chamber phakic refractive lens (PRL): a review

Implantation of phakic intraocular lenses (pIOLs) is a reversible refractive procedure, preserving the patient's accommodative function with minimal induction of higher order aberrations compared with corneal photoablative procedures. Despite this, as an intraocular procedure, it has potential risks such as cataracts, chronic uveitis, pupil ovalization, corneal endothelial cell loss, pigmentary dispersion syndrome, pupillary block glaucoma, astigmatism, or endophthalmitis. Currently, only two models of posterior chamber pIOLs are commercially available, the implantable collammer lens (STAAR Surgical Co.) and the phakic refractive lens (PRL; Zeiss Meditec). The number of published reports on the latter is very low, and some concerns still remain about its long-term safety. The present article reviews the published literature on the outcomes after PRL implantation in order to provide a general overview and evaluate its real potential as a surgical refractive option.

Preliminary in vivo positional analysis of a posterior chamber phakic intraocular lens by optical coherence tomography and its correlation with clinical outcomes

Purpose

To analyze by spectral-domain optical coherence tomography the anatomical relationship of a specific type of posterior chamber phakic intraocular lens (pIOL) implanted in cases of high to moderate myopia with the adjacent intraocular structures and to correlate it with clinical outcomes.

Methods

Prospective observational case series including 18 eyes with high to moderate myopia (spherical equivalent between −5.88 and −15.75 D) of 9 patients (age range, 29–49 years) undergoing bilateral Phakic Refractive Lens (PRL, Zeiss) implantation. Postoperative visual acuity, refraction, contrast sensitivity (CS), and ocular higher order aberrations (HOA) were evaluated. Furthermore, the in vivo position of the PRL was analyzed by means of spectral domain optical coherence tomography (3D OCT-1000, Topcon). Central (CENV), temporal (TEMV) and nasal vault (NASV) were measured. Correlation of these anatomical parameters with clinical data was also investigated. Mean follow-up was 47 ± 25 months.

Results

A statistically significant visual and refractive improvement (p < 0.01) was found postoperatively. Mean postoperative CENV, NASV, and TEMV were 157.88 ± 69.93 μm, 168.29 ± 65.02 μm, and 188.59 ± 55.99 μm, respectively. Significant difference was found between NASV and TEMV (p = 0.01). No significant correlations were found between ocular aberrometric and anatomical parameters (p ≥ 0.12). CENV, NASV and TEMV correlated significantly with 6-cycles per degree (cpd) photopic CS as well as with 18-cpd low mesopic CS (r ≥ 0.57, p ≤ 0.04). Furthermore, NASV also correlated significantly with preoperative anterior chamber depth (r = −0.65, p = 0.01).

Conclusions

This posterior chamber pIOL shows a trend to nasal position, with potential impact on refractive and visual outcomes, particularly in eyes with deep anterior chambers.

Medium-term visual, refractive, and intraocular stability after implantation of a posterior chamber phakic intraocular lens to correct moderate to high myopia

PURPOSE

To evaluate the medium-term refractive and visual outcomes and the complications after implantation of a silicone posterior chamber phakic intraocular lens (PC pIOL) for moderate to high myopia.

SETTING

Oftalmar, Medimar International Hospital, Alicante, Spain.

DESIGN

Retrospective case series.

METHODS

Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and intraocular pressure were evaluated during a medium-term follow-up. Postoperative complications were also studied.

RESULTS

The study enrolled 35 eyes (mean preoperative spherical equivalent [SE] -10.25 diopters [D] ± 3.19 [SD]) of 20 patients with a mean age of 31.83 ± 8.87 years and a mean follow-up of 57.34 ± 9.24 months. The mean UDVA improved from 2.40 ± 0.20 logMAR preoperatively to 0.08 ± 0.13 logMAR at the last postoperative visit (P<.01). The mean CDVA improved from 0.11 ± 0.09 logMAR to 0.02 ± 0.09 logMAR, respectively (P<.01). The postoperative CDVA was 0.1 or better in 30 eyes (85.71%), with 22 eyes (62.86%) gaining lines of CDVA. The final efficacy index was 1.16 and the final safety index, 1.26. Regarding predictability, 34 eyes (97.14%) had an SE within ± 1.00 D and 33 eyes (94.28%) within ± 0.50 D. The complications were PC pIOL decentration (2 eyes, 5.71%), cortical lens opacification (1 eye, 2.86%), and retinal detachment (1 eye, 2.86%).

CONCLUSIONS

Implantation of a PC pIOL to correct moderate to high myopia was efficient and predictable in the medium term, with intraocular stability in most cases. New designs and criteria for PC pIOL size selection should be developed.

FINANCIAL DISCLOSURE

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

Long-term results of phakic refractive lens implantation in eyes with high myopia

PURPOSE

To evaluate the long-term results of phakic refractive lens (PRL; Carl Zeiss Meditec) implantation in eyes with high myopia.

METHODS

In this retrospective, noncomparative, interventional case series, 143 myopic eyes of 82 patients were treated for high myopia with the implantation of the silicone PRL in the posterior chamber.

RESULTS

Mean follow-up was 3.8±1.7 years (range: 1 to 6 years). Six years postoperatively (n=34), a statistically significant reduction was noted in the cycloplegic spherical equivalent from -14.08±4.00 diopters (D) (range: -24.88 to -4.75 D) before PRL implantation to -0.45±0.62 D (range: -1.00 to 1.00 D) (P<.001). At 6 years, 67.6% (23 eyes) and 91.2% (31 eyes) were within ±0.50 and ±1.00 D of target refraction, respectively. Mean logMAR uncorrected and corrected distance visual acuity improved significantly (P<.001) (counting fingers preoperatively in all eyes to 0.17±0.15 [range: 0.54 to -0.06] and 0.19±0.19 [1.00 to -0.08] to 0.07±0.10 [range: 0.30 to -0.10], respectively). Complications included anterior capsule damage (3 eyes), temporary intraocular pressure increase (14 eyes), pigment dispersion (1 eye), and PRL decentration (1 eye). No eyes presented any signs of cataract up to 6 years postoperatively.

CONCLUSIONS

Long-term results show that PRL implantation is an effective and safe method for treating high myopia.

Optical quality and visual discrimination capacity after myopic LASIK with a standard and aspheric ablation profile

PURPOSE

To determine whether the eye's optical quality is correlated to the visual discrimination capacity of patients treated with LASIK using two different ablation algorithms.

METHODS

Visual discrimination was evaluated by the disturbance index under low illumination (Halo v1.0 software, Laboratory of Vision Sciences and Applications) in two groups of patients who underwent LASIK with two different ablation algorithms using the Allegretto Wave Eye-Q 400 Hz laser (WaveLight AG). In the first group (standard group; 30 eyes), corneal ablations were performed with the standard algorithm (preoperative spherical equivalent refraction -3.20±1.70 diopters [D]). In the second group (Q-optimized group; 38 eyes; spherical equivalent refraction -3.40±1.90 D), the ablations were made with the Q-optimized (F-CAT) algorithm. Optical quality of the eye was calculated by the Strehl ratio measured with a double-pass device (OQAS, Visiometrics SL).

RESULTS

After LASIK, both the Strehl ratio as well as visual discrimination capacity diminished in both groups, although the changes were significantly greater in the standard group than in the Q-optimized group.

CONCLUSIONS

A high correlation was found between the Strehl ratio and the disturbance index in patients who underwent LASIK, regardless of the ablation algorithm applied. Optical and visual deterioration were greater after standard ablation.

Vaulting of myopic and toric Implantable Collamer Lenses during accommodation measured with Visante optical coherence tomography

PURPOSE

To study changes in vaulting of myopic and toric Implantable Collamer Lenses (ICLs) version 4 during accommodation with Visante optical coherence tomography (OCT), and analyze the relationship between vaulting and anterior subcapsular opacification.

DESIGN

Cross-sectional study.

PARTICIPANTS

Seventy-seven eyes of 77 myopic patients were examined after implantation with an ICL (48 myopic, 29 toric). The median follow-up time was 63 months (range, 10-84).

METHODS

The distance between the posterior ICL surface and the anterior surface of the crystalline lens was measured in the nonaccommodative state and during accommodation with Visante OCT. The lenses were examined for opacification using slit-lamp microscopy.

MAIN OUTCOME MEASURES

The distance between the ICL and the anterior surface of the crystalline lens.

RESULTS

At baseline, the mean distance between the ICL and the crystalline lens was 0.31+/-0.19 mm and during accommodation 0.31+/-0.26 mm; the difference did not reach significance (P = 0.77). The distance at baseline was significantly (P = 0.01) less in older patients and significantly (P = 0.04) greater in patients with a toric ICL. Contact was observed at baseline or during accommodation in 12 eyes; there was a significantly lower incidence of contact in eyes implanted with a toric ICL (P = 0.03). Anterior subcapsular opacification developed in 10 eyes, in 5 of these the ICL touched the crystalline lens.

CONCLUSIONS

Anterior subcapsular opacification developed in 13.0% of eyes. We found no difference in vaulting of the ICL at baseline and during accommodation. There was contact between the ICL and the crystalline lens in 15.6% of the eyes. The association between anterior subcapsular opacification and contact was significant (P = 0.004).

Optical Coherence Tomography of the Anterior Segment in Eyes with Phakic Refractive Lenses

PURPOSE

To evaluate the dynamics of the phakic refractive lens (PRL) in myopic and hyperopic eyes in the nonaccommodated state and during subjective accommodation with Visante optical coherence tomography (OCT).

DESIGN

Cross-sectional study.

PARTICIPANTS

Forty-one myopic eyes and 11 hyperopic eyes of 52 patients (mean age, 34 years; range, 24-49) were examined at least 1 year after PRL implantation using Visante OCT. Thirty-one myopic eyes had the PRL model 101 and 10 eyes had the smaller PRL model 100 implanted. The hyperopic model, PRL 200, is available in only one size.

METHODS

Noninvasive high-resolution anterior OCT was used to measure distance changes between the PRL and adjacent intraocular structures in the nonaccommodative state (baseline) and during accommodation.

MAIN OUTCOME MEASURES

Mean distance changes from the anterior lens surface (ALS) to the PRL and from the corneal posterior surface to the ALS and the PRL, and changes in the pupil diameter.

RESULTS

At baseline, the mean distances between the PRL and crystalline lens were 0.38, 0.30, and 0.32 mm for the PRL 101, PRL 100, and PRL 200, respectively. The PRLs were significantly closer to the crystalline lens with increasing patient age. Three PRLs were in contact with the crystalline lens (6%), and there were lens opacities in 2 of these eyes. During accommodation, the ALS of all PRL models showed significant forward movement (P<0.05), whereas the distance between the PRL and crystalline lens decreased significantly with the PRL 101 and PRL 200 (P<0.05). The distance between the PRL 100 and crystalline lens remained unchanged during accommodation.

CONCLUSION

The PRL moved forward during accommodation in all eyes, with the distance preserved between the PRL and the ALS with the PRL 100. The distance decreased with the other 2 models. In 85% of cases, there was no mechanical contact with the ALS during accommodation.

Efficacité réfractive et tolérance de l’implant phaque myopique souple à fixation irienne Artiflex® dans la correction chirurgicale de la myopie forte : résultats à deux ans

INTRODUCTION

A new foldable version of an anterior chamber phakic lens designed to surgically correct high myopia was evaluated.

PATIENTS AND METHODS

A prospective study on the efficacy and tolerance of a foldable phakic intraocular iris-supported lens, designed to correct moderately high myopia, is presented in this article. Twenty-five eyes of 25 patients were implanted uneventfully using this lens, newly designed and called the Artiflex lens. This phakic intraocular lens is an upgraded foldable version of the Artisan (or Verisyse) lens. The follow-up was complete (24 months) for all Artiflex-treated eyes and the targeted postoperative refraction was emmetropia. Inclusion criteria were moderately high myopia ranging from -8 to -14 D, unchanged refraction for 2 years, total contact lenses wearing intolerance, refractive cylinder power no greater than 1.5 D, anterior chamber depth greater than 3 mm, and endothelial cell count greater than 2,200 cells/mm2.

RESULTS

The preoperative spherical equivalent was -9.70+/-2.37 D. The spherical equivalent was -1.07+/-0.84 D at 2 years postoperatively. The surgically induced astigmatism was 0.42 D x 67.4-degree axis. The percentage of eyes with an uncorrected visual acuity greater than or equal to 0.5 and 0.8 was 66.6% and 33.3%, respectively. Neither intra- nor postoperative complications were noted during the entire follow-up period. The mean endothelial cell count value was 2267+/-352 at 2 years postoperatively. The objective and subjective quality of vision was acceptable, associated with a high level of patient satisfaction.

DISCUSSION

The refractive results and tolerance of the Artiflex lens are satisfactory and seem to be as good as other phakic intraocular lens outcomes.

CONCLUSION

To correct moderately high myopia, the Artiflex lens seems to provide a suitable refractive efficacy and a quick visual recovery, secondary to a lowering of induced astigmatism. Furthermore, this phakic intraocular lens is associated with satisfactory safety and quality of vision at each milestone of the entire follow-up period.

Intraokularlinsen zur Korrektur von Refraktionsfehlern

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses which are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for posterior chamber lenses these are mainly cataract formation and pigment dispersion. RLE is preferable in cases of high ametropia in which the natural lens has lost its accommodative effect. The main complications for myopic RLA include retinal detachment, while hyperopic refractive lens exchange may be associated with surgical problems in the narrower anterior eye segment.

Intraokularlinsen zur Korrektur von Refraktionsfehlern

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or the removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses that are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.

New intraocular lens technology

PURPOSE

To review the current status of phakic intraocular lenses (IOLs), intraocular treatment of presbyopia, and IOLs that filter some blue light.

DESIGN

Review of current information on the subject from numerous sources.

METHODS

Medline search and Internet search engines on the topics of phakic IOLs, presbyopia or multifocal IOLs, and blue light and macular degeneration.

RESULTS

An iris fixated phakic IOLs is now approved in the United States (US). There are concerns for corneal endothelial stability and late dislocation. Other approaches include anterior chamber fixation with concerns of corneal endothelial stability and pupil elongation, and posterior chamber fixation with concerns of cataract formation, IOL dislocation, and pigment dispersion. Intraocular treatment of presbyopia includes monovision, multifocal, and accommodative IOLs. Which approach is superior today is still not clear. There are IOLs designed to block some blue light to potentially lessen the risk of age-related macular degeneration (ARMD). While there is presumptive evidence of this, no definitive study shows such a correlation. Color perception issues are unlikely to be a problem. While decreased scotopic vision has been proposed, there is no study that proves this is an issue of clinical significance.

CONCLUSIONS

The IOL field is dynamic with many new choices. Phakic IOLs and treatment of presbyopia will be an increasingly important part of ophthalmology; however, there are important unresolved issues. With better evidence that blue light is an important variable in ARMD, such an approach could rapidly become the standard.

Clinical outcomes of phakic refractive lens in myopic and hyperopic eyes: 1-year results

PURPOSE

To confirm the safety, efficacy, and predictability of the surgical correction of myopia and hyperopia with the phakic refractive lens (PRL) (Medennium Inc.).

SETTING

St. Eriks Eye Hospital, Stockholm, Sweden.

METHODS

This was a prospective clinical study of 20 eyes, 14 myopic and 6 hyperopic, that had PRL implantation at St. Eriks Eye Hospital from April to November 2002. Examinations were performed preoperatively and 1 day, 1 week, 3 months, and 1 year postoperatively. Follow-up included evaluation of the PRL rotation with retroillumination photography, evaluation of the distance between the PRL and the crystalline lens with Scheimpflug image, laser flare, endothelial cell count, uncorrected (UCVA) and best corrected (BCVA) visual acuity, residual refractive error, refractive stability, intraocular pressure, and induced cataract.

RESULTS

Postoperatively, 11 eyes (55%) gained 1 or more lines, 5 eyes (25%) had no change, and 4 eyes (20%) lost 1 line of BCVA. No eye lost 2 or more lines. Mean UCVA was 0.87+/- 0.29 postoperatively. Laser flare values were highest 1 day after operation with normalization at 3 months and without changes at 1 year (P<.05). A rotation of 10 degrees or more was found in 15 eyes (75%) during the first year. The distance between the PRL and crystalline lens was considerably less at 1 year than at baseline (P<.05). There was no statistically significant endothelial cell loss induced by the PRL (P<.05). No induced cataract, glaucoma, or inflammation was observed. In 1 hyperopic eye, horizontal iris transillumination defects were noticed at 1 year.

CONCLUSION

Safety and efficacy indexes were high at 1-year follow-up. The PRL rotated slightly in the posterior chamber. The distance between the PRL and the crystalline lens was considerably less at 1 year than at baseline.