Recurrent iritis after implantation of an iris-fixated phakic intraocular lens for the correction of myopia

Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs' heterochromic iridocyclitis

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs’ heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.

Bilateral transient pupil closure after iris supported intraocular lens implantation in a case with Marfan syndrome

A 16-year-old woman presented with Marfan syndrome and bilateral ectopia lentis. The surgical treatment including removal of the crystalline lens and implantation of an iris-supported intraocular lens in both eyes at a week interval. Postoperatively, the biomicroscopic examination showed total pupil closure bilaterally. After the topical tropicamide treatment, the pupil returned to normal shape.

Pediatric phakic intraocular lens surgery: review of clinical studies

PURPOSE OF REVIEW

To report on the accumulating peer-reviewed data of phakic intraocular lens (pIOL) implantation in the pediatric population. I evaluate and compare the published peer-reviewed articles for the reported efficacy and complications of phakic intraocular lens implantations in children for correction of clinically significant high refractive errors.

RECENT FINDINGS

Multiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment.

SUMMARY

In the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials should focus on children of various age groups to assess the variables of visual acuity gain or loss, stereopsis, contrast sensitivity, high-order aberrations, corneal physiology, and long-term complications to accurately and properly address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.

Phakic iris-claw IOL implantation, with Bursa technique, through a self-sealing scleral tunnel and without iridotomy or iridectomy

PURPOSE

To present a novel technique for the implantation of phakic iris-claw intraocular lenses (IOL) in highly myopic cases.

METHODS

Twelve cases, under the age of 40, with high myopia were included in this retrospective study. The mean follow-up span was 14.4+/-5.8 months. Phakic iris-claw IOL implantation was performed, through a 5.5 or 6.5 mm self sealing scleral tunnel with Bursa technique. No suturing and opening a peripheral iridectomy or iridotomy was required in our study. Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best-corrected visual acuity (BCVA), induced astigmatism, and intraocular pressure (IOP) assessments.

RESULTS

All eyes gained one to nine lines of BCVA of the Snellen chart. The vector analysis revealed an induced astigmatism of 0.63 D. No significant IOP change was detected throughout the follow-up.

CONCLUSIONS

The data suggest that nonfoldable iris fixated phakic IOL implantation, through a self-sealing incision with Bursa technique, is safe and requires no iridectomy or iridotomy in cases with deep anterior chambers.

Implants phakes de chambre antérieure versus chambre postérieure

At a time when some of the limitations of photoablation have been defined, such as worry concerning secondary ectasia, a renewed interest in phakic implantation has arisen. This is driven by the goal of avoiding correcting high ametropia with LASIK and is based on the development of soft foldable biomaterials. When all phakic IOLs are in front of the natural lens, two varieties of lenses can be distinguished, depending on whether it is located in the anterior or posterior chamber. The various models available in 2006 and those under current evaluation are reviewed. We do not report details of clinical studies that vary in cohort size and follow-up. The advantages and limitations are discussed for each type of phakic IOL. Adequate although not exclusive indications are deduced. There is no phakic lens that has proved to be superior to the others in terms of safety. All have the ability to provide a visual benefit with a gain in best corrected visual acuity. The difference is based on anatomical effects, requiring long-term follow-up in the evaluation of angles, lens, iris, and endothelium.

Corneal ectasia after photorefractive keratectomy

BACKGROUND

Corneal ectasia after photorefractive keratectomy (PRK) has only been occasionally reported, and its incidence has not been assessed.

METHODS

In a retrospective, non-comparative case series, incidence of corneal ectasia was evaluated in a personal consecutive 6453-case series of myopic PRK with a minimum follow-up of 18 months. Features and prognosis were evaluated in all patients with ectasia after PRK (in both personal and referred cases).

RESULTS

Ectasia was detected in three eyes of two patients (patients 1 and 2) 3 years and 1 year after PRK performed elsewhere. In addition, in the personal PRK series, two eyes of two patients (patients 3 and 4) developed corneal ectasia 5 months after surgery (incidence: 0.03%). Pre-operatively, forme fruste keratoconus was present in patients 1, 3 and 4; keratoconus in the fellow eye in patient 2; pachymetry <500 micron in patients 2 and 3. In patient 1, rigid contact lenses were prescribed, and in patient 2 deep anterior lamellar keratoplasty was needed; in patients 3 and 4, low induced astigmatism resulted, requiring driving spectacles in patient 3.

CONCLUSIONS

PRK induced corneal ectasia in predisposed eyes, even after low myopic ablations. Forme fruste keratoconus and keratoconus in the fellow eye were the main pre-operative findings. Prognosis varies according to severity.