Results of cataract extraction after implantable contact lens removal

Short-Term Efficacy and Safety of Cataract Surgery Combined with Iris-Fixated Phakic Intraocular Lens Explantation: A Multicentre Study

The purpose of this study was to evaluate the short-term efficacy and safety of cataract surgery for patients with iris-fixated phakic intraocular lenses (pIOLs). This study included 96 eyes of 91 patients. The changes in the logMAR uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective spherical equivalent (SE), astigmatism, and endothelial cell density (ECD) were collected retrospectively. The intraoperative and postoperative complications also were investigated to assess the surgical safety. The preoperative UCVA and BCVA improved significantly at month 1 postoperatively, respectively (p < 0.001 for both comparisons). The efficacy and safety index at month 1 postoperatively were 1.02 ± 0.56 and 1.31 ± 0.64, respectively. The SE at month 1 postoperatively was significantly (p < 0.001) higher compared to preoperatively, whereas the subjective astigmatism did not differ significantly (p = 0.078). The ECD significantly decreased at month 1 (p < 0.001). The most common postoperative complication was intraocular pressure elevation exceeding 25 mmHg in 10.4% of eyes, which was controlled with medications in all cases until month 1 postoperatively. No intraoperative complications developed. Cataract surgeries for patients with iris-fixated pIOLs were performed safely with good visual outcomes.

Etiology and outcomes of current posterior chamber phakic intraocular lens extraction

This study was aimed to review the etiology and the outcomes of current posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical) extraction. This review comprised 770 eyes of 403 consecutive patients undergoing ICL extraction. We evaluated prevalence, etiology, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), predictability, and patient satisfaction. ICL extraction was required in 8 of 770 (1.0%) eyes. The most common reason was the progression of the pre-existing cataract formation in 5 eyes (63%), followed by residual refractive errors in 3 eyes (38%). Of the 7 eyes targeted for emmetropia, 7 (100%) and 6 (86%) achieved UDVAs of 20/40 and 20/20 or better, respectively. Three eyes (38%) showed no change in CDVA, 3 eyes (38%) gained 1 line, 2 eyes (25%) gained 3 or more lines. 88% and 100% were within ± 0.5 and 1.0 diopter (D), respectively, of the targeted correction. Patient satisfaction improved significantly, from 3.0 ± 1.4 preoperatively, to 8.0 ± 2.4 postoperatively. No vision-threatening complications occurred. ICL extraction was required in approximately 1% of ICL-implanted eyes. Visual and refractive outcomes were good, and patient satisfaction was overall high, even in ICL-extracted eyes.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

Background

To evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens – pIOL – explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOLs.

Methods

This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months. The uncorrected and best corrected distance visual acuities (UDVA, CDVA), endothelial cell density before and after bilensectomy were assessed, as well as the cause of bilensectomy and intra or postoperative complications.

Results

There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy (p = 0.00). The main reason for bilensectomy was cataract development (93.1% of the cases), followed by miscalculation of lens size, and corneal edema. The endothelial cell count remained stable without a statistically significant change after surgery (p = 0.67). The refractive efficacy index was 0.8, none of the patients lost lines of CDVA after surgery, 73% of the patients were within ±1 D (spherical equivalent) of the target refraction. Intraoperative complications were one posterior capsule rupture with the intraocular lens (IOL) implanted in the sulcus, and 3 eyes required the use of pupil expanders for adequate pupil dilation. Postoperatively, one eye developed retinal detachment. The three pIOLs models explanted were the Implantable Collamer Lens (ICL), Implantable Phakic Contact Lens (IPCL) and the Phakic Refractive Lens (PRL).

Conclusions

Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses (PC pIOLs). There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Five-Year Endothelial Cell Loss After Implantation With Artiflex Myopia and Artiflex Toric Phakic Intraocular Lenses

PURPOSE

To evaluate the long-term changes in endothelial cell density (ECD) after the implantation of 2 types of foldable iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism.

DESIGN

Prospective clinical cohort study.

METHODS

Two-hundred and ninety-three and 188 eyes implanted with, respectively, the Artiflex Myopia and Artiflex Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January 2004. One-hundred and forty-six eyes from the myopic and 64 eyes from the toric groups completed a 5-year follow-up. Main outcome measures were chronic endothelial cell (EC) loss, percentage of eyes with a ≥25% decrease in ECD, and the percentage of eyes with an ECD < 1500 cells/mm².

RESULTS

Chronic EC loss showed an annual decline of 64 cells/mm² in the myopic (P < .001, standard error 3.58) and 62 cells/mm² in the toric (P < .001, standard error 3.77) groups. Total chronic EC loss from 6 months to 5 years postoperatively was 10.5% in the myopic and 10.2% in the toric groups. After 5 years, an ECD decrease of ≥25% occurred in 4.4% and 4.3% of eyes, and an ECD < 1500 cells/mm² was reported in 3.0% and 0.0% of eyes, respectively. Explantation of a pIOL owing to EC loss was required in 3.1% and 0% of eyes.

CONCLUSION

Chronic EC loss was around 10% over a 5-year period in eyes implanted with the foldable myopic (toric) pIOL. In up to 3.1% of eyes significant EC loss resulted in subsequent pIOL explantation.

Four-year Follow-up of the Changes in Anterior Segment After Phakic Collamer Lens Implantation

PURPOSE

To assess the changes and relationship in central vaulting, flare intensity, and crystalline lens thickness during a follow-up period of 4 years after implantable collamer lens (ICL) implantation in eyes with high myopia.

DESIGN

Retrospective observational study.

METHODS

Ninety-eight eyes of 50 patients were followed up with routine measurements of central vaulting, crystalline lens thickness, endothelial cell density, and aqueous flare postoperatively. Data were analyzed by repeated-measures analysis of variance. The relationship between the annual change in crystal lens thickness after surgery and age was evaluated by Pearson correlation coefficient and linear regression.

RESULTS

There was a continuous reduction in central vaulting and endothelial cell density as well as an increase in crystalline lens thickness in ICL eyes from 1 month onward to 5 years postoperatively (P < .001). Although the trend of variation during the individual visit period was accentuated, the variation turned out to be smaller between 12 and 36 months or 60 months postoperatively (P = .42, P = .65). Aqueous flare intensity increased significantly after surgery and returned to normal 1 year later. Additionally, a positive correlation between patient age and crystalline lens thickness (r = 0.617, P < .0001) was observed in eyes with ICL implantation.

CONCLUSIONS

The changes in central vaulting, endothelial cell density, and crystalline lens thickness are more prominent during the first year after ICL implantation, tending to be relatively stable afterwards. The anterior inflammation during the early postoperative period synchronizes with the sharp progression of crystalline lens changes within the first year.

Prevalence of cataract after collagen copolymer phakic intraocular lens implantation for myopia, hyperopia, and astigmatism

PURPOSE

To evaluate the prevalence of cataract after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation with different models at different ages and for different refractive powers.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

DESIGN

Retrospective nonrandomized clinical study.

METHODS

The pIOL (models V4, V4b, or V4c) was implanted in all cases.

RESULTS

The study included 3420 eyes (1898 patients). The mean patient age at surgery was 31.2 years ± 6.4 (SD) (range 18 to 50 years) and the mean spherical refractive error, -7.27 ± 5.24 diopters (D) (range -26.5 to 12.5 D). Twenty-one eyes (0.61%) of 15 patients had pIOL explantation (all model V4) because cataract developed. The mean age of the patients who had explantation was 39.43 ± 4.57 years; 7 were younger than 40 years, and 8 were 40 years or older. The mean spherical equivalent was -10.1 ± 5.41 D; 3 eyes had a pIOL power less than -10.50 D, 4 eyes between -10.50 D and -13.50 D, and 14 higher than -13.50 D. The mean time between pIOL implantation and cataract surgery was 4.2 ± 1.8 years. No eye with implantation of the latest models (V4b and V4c) developed cataract. The mean vault distance in eyes that developed cataracts was 103 ± 69 μm.

CONCLUSIONS

The incidence of cataract was low after pIOL implantation at the 6-year follow-up. The rate of cataract was higher in older patients and in those with high refractive errors.

FINANCIAL DISCLOSURE

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

Prevention and management of collagen copolymer phakic intraocular lens exchange: causes and surgical techniques

PURPOSE

To analyze causes leading to explantation and exchange of Implantable Collamer Lens phakic intraocular lenses (pIOLs) and examine the surgical techniques of pIOL exchange.

SETTING

Wuhan Aier Eye Hospital, Wuhan, China.

DESIGN

Retrospective analysis of prospectively collected data.

METHODS

Different techniques were used to explant the pIOLs based on the amount of vaulting. Preoperative and postoperative data were collected to evaluate possible causes leading to pIOL exchange and the safety of pIOL exchange.

RESULTS

Of 616 myopic eyes with previous pIOL implantation, 16 eyes of 15 patients having pIOL exchange were reviewed. Eight surgeries (50%) were performed because of low vaulting (≤100 μm) and another 8 (50%) because of too high vaulting (≥1000 μm). The causes leading to low vaulting included increased crystalline lens thickness (≥4.0 mm), low anterior chamber depth (ACD) (<3.1 mm), and a too-small pIOL (<12.0 mm). The high vaulting was primarily the result of oversized white-to-white (WTW) measurements with Scheimpflug pachymetry (Pentacam) or the use of a digital caliper by an unskilled examiner and of ciliary body cysts. Six months after pIOL exchange, the vaulting ranged from 162 to 715 μm. No anterior subcapsular cataracts or other complications occurred during the observation period.

CONCLUSIONS

The main causes of abnormal vaulting and subsequent pIOL exchange included a thick crystalline lens, low ACD, too-small pIOL, WTW measurement error, and ciliary body cysts. Phakic IOL explantations were individually designed based on the vaulting to achieve proper safety and efficacy.

FINANCIAL DISCLOSURE

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

Observing implantable collamer lens dislocation by panoramic ultrasound biomicroscopy

PURPOSE

Observe the image characteristics and dislocation of implantable collamer lenses (ICL) following their use to correct high myopia.

METHODS

A total of 127 patients (242 eyes); 64 females (50.3%) and 63 males (49.7%) were included in this retrospective study with ICL V4 implantation and mean spherical equivalent -9.08±2.04 diopters (D). Panoramic ultrasound biomicroscopy (UBM) was utilized to observe anterior segment morphology and ICL location at various follow-up periods (1 week preoperative, followed by 1, 3, 6, and yearly postoperative).

RESULTS

Twenty-eight ICL eyes (11.2%) were noted to have abnormal postoperative positioning. The central vault of 12 eyes was too high with ICL decentration, mean central vault 1.14±0.39 mm; 10 eyes were too low but without ICL decentration, mean central vault 0.13±0.11 mm. The remaining subjects were only ICL decentration without abnormal central vault, mean central vault was 0.54±0.28 mm.

CONCLUSIONS

This study shows the abnormal characteristics regarding ICL locations. The ICL dislocation closely correlates with the central vault. The ICL dislocation is the primary cause of several postoperative complications. Panoramic UBM is one of the most effective imaging means to observe the ICL positioning and its stability after implantable surgery.

Successful toric intraocular lens implantation in a patient with induced cataract and astigmatism after posterior chamber toric phakic intraocular lens implantation: a case report

Introduction

We report the case of a patient in whom simultaneous toric phakic intraocular lens removal and phacoemulsification with toric intraocular lens implantation were beneficial for reducing pre-existing astigmatism and acquiring good visual outcomes in eyes with implantable collamer lens-induced cataract and astigmatism.

Case presentation

A 53-year-old woman had undergone toric implantable collamer lens implantation three years earlier. After informed consent was obtained, we performed simultaneous toric implantable collamer lens removal and phacoemulsification with toric intraocular lens implantation. Preoperatively, the manifest refraction was 0, -0.5 × 15, with an uncorrected visual acuity of 0.7 and a best spectacle-corrected visual acuity of 0.8. Postoperatively, the manifest refraction was improved to 0, -0.5 × 180, with an uncorrected visual acuity of 1.2 and a best spectacle-corrected visual acuity of 1.5. No vision-threatening complications were observed.

Conclusion

Toric intraocular lens implantation may be a good surgical option for the correction of spherical and cylindrical errors in eyes with implantable collamer lens-induced cataract and astigmatism.

Long-term evaluation of the central vault after phakic Collamer® lens (ICL) implantation using OCT

PURPOSE

The aim of this work is to evaluate the changes in the central vault after using implantable Collamer® lenses (ICL) to correct myopia.

METHODS

This cohort study included 133 eyes; mean spherical equivalent -9.47 ± 3.71 diopters (D) (range: -2.75 to -22.25 D) who underwent ICL V4 implantation. Besides a complete ophthalmologic examination, the central vaulting was measured with Visante OCT and evaluated between different periods of follow-up (1 week, 1, 3, and 6 months, and yearly postoperatively). Post-operative time ranged from 6 to 73 months.

RESULTS

Within the first 6 months, the mean central vaulting dropped from 510 ± 238 μm (range 100 to 940 μm) to 439 ± 231 μm (range 90 to 910) a significant decrease by 71 ± 58 μm (range -170 to 30 μm) (p = 0.028) with a trend to a lower reduction after this period. After 36 month from ICL implantation, this variation tends to be smaller with the majority of the eyes having a mean decrease smaller than 2 μm per month. Initial vault (Spearman Rho = -0.237, p = 0.006) was the factor more significantly associated with decrease in vault; eyes presenting a reduction in vault >100 μm had an average initial vault that was 141 μm and 184 μm higher than eyes with no change or with increase in vault over time, respectively.

CONCLUSIONS

This study shows a continuous reduction of central vault over time. The reduction is highest during the first 6 months and tends to be lower and slow down over time. The decrease of vaulting was more pronounced in eyes with larger initial vaulting.

Central vault after phakic intraocular lens implantation: correlation with anterior chamber depth, white-to-white distance, spherical equivalent, and patient age

PURPOSE

To compare the central postoperative vault of a phakic intraocular lens (pIOL) to correct myopia, myopic astigmatism, and hyperopia and identify ocular and lens parameters that might predict the vault amount.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

DESIGN

Cohort study.

METHODS

Three months after implantation of Implantable Collamer Lens pIOLs to correct myopia, hyperopia, and myopic astigmatism, central vault was measured using optical coherence tomography. Patients were divided into groups according to the preoperative anterior chamber depth (ACD) to compare the effects of ACD, white-to-white (WTW) distance, and lens diameter on postoperative pIOL vault.

RESULTS

Hyperopic pIOLs had statistically significantly lower vault followed by myopic pIOLs and toric pIOLs, which had a higher mean value and narrower range (260 to 860 μm). Measured vaults had a positive correlation with preoperative ACD (r = .32, P<.001) and WTW (r = .29, P<.001) and a negative correlation with preoperative spherical equivalent (SE) (r = -0.21, P<.001) and patient age (r = -0.12, P=.025). Eyes with a vault of 250 μm or less had a shallower ACD than eyes with a vault between 250 μm and 750 μm (mean difference -0.11 mm; P=.012) and those with a vault greater than 750 μm (mean difference -0.25 mm; P<.001).

CONCLUSIONS

Central vaulting was lower in hyperopic eyes. Current nomograms for pIOL diameter selection based on ACD and WTW might yield ideal vault and may have to be adjusted for older patients, shallower ACD, lower WTW, and lower SE.

Implantable collamer posterior chamber intraocular lenses: a review of potential complications

PURPOSE

To review the peer-reviewed literature reporting postoperative complications of the most recent models of Visian Implantable Collamer posterior chamber intraocular lenses (ICL, STAAR Surgical Co).

METHODS

A literature search of the PubMed database was performed to identify all articles related to ICL complications. Articles were obtained and reviewed to identify those that reported complications using the latest ICL designs.

RESULTS

Cataract was the major postoperative complication reported: 136 (5.2%) in 2592 eyes. Of those, 43.4% (n=59) were reported within 1 year, 15.4% (n=21) between 1 and 3 years, and 35.3% (n=48) ≥ 3 years after ICL implantation. Twenty-one (15.4%) cataracts were reported as surgically induced, 46 (33.8%) eyes had poor vault (<200 μm), and cataract surgery was carried out in 27.9% (n=38) of eyes. Early acute intraocular pressure increase was also reported to be relatively frequent, whereas acute pupillary block was less frequent and mostly resolved with additional iridotomies. A total of 42 ICLs were explanted due to cataract and IOP. Reported endothelial cell loss varied from 9.9% at 2 years to 3.7% 4 years postoperatively. This loss was reported to be more pronounced within the first 1 to 2 years, with stability or lower progression after that time.

CONCLUSIONS

The majority of reported complications after ICL implantation are cataract formation. The improvements in lens geometry and more accurate nomograms applied to the selection of the lens to be implanted, in addition to the surgeon's learning curve, might be factors in the decreased occurrence of postoperative complications reported currently.