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Karjou Z, Karimi S, Yaghoobi M, Nikkhah H, Safi S. Pars plana lensectomy and iris-claw Artisan intraocular lens implantation in patients with Marfan syndrome. Oman J Ophthalmol 2023; 16:64-68. [PMID: 37007247 PMCID: PMC10062075 DOI: 10.4103/ojo.ojo_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/13/2022] [Accepted: 12/02/2022] [Indexed: 02/23/2023] Open
Abstract
RATIONAL The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome. MATERIALS AND METHODS In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019. RESULTS Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery. CONCLUSIONS Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.
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Cakir I, Demir G, Yildiz BK, Öcal MC, Yildirim Y, Agca A. Efficacy and safety of iris-supported phakic lenses (Verisyse) for the treatment of high myopia: 5-year results. Int Ophthalmol 2021; 41:2837-2845. [PMID: 33864187 DOI: 10.1007/s10792-021-01841-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Evaluating efficacy and safety of iris-supported phakic lenses (Verisyse) for high myopia treatment. METHODS Patients treated with Verisyse (Abbott Medical Optics, Santa Ana, CA, USA) intraocular lens (IOL) implants were evaluated retrospectively. Patients with follow-up periods of more than 5 years were included in the study. Pre- and postoperative fifth-year spheric equivalent (SE) of manifest refraction values, uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), and endothelial cell density (ECD) values were recorded. Complications were evaluated. RESULTS Forty-seven eyes of 31 patients were included in the study. Pre- and postoperative fifth year mean SE was - 12.50 ± 3.51D and - 0.72 ± 0.40D, respectively. Pre- and postoperative fifth-year UDVA was 1.56 ± 0.22 and 0.33 ± 0.18 logMAR (p < 0.001), respectively. The safety index (pre- and postoperative CDVA) was 1.39 ± 0.63 at the 5-year follow-up (p > 0,05). The efficacy index (ratio of mean postoperative UDVA to mean preoperative CDVA) of the patients was 1.14 ± 0.60. The mean postoperative endothelial cell loss at 5 years was -7.42%. None of the patients had lost 25% of their preoperative endothelial cells at 5-year follow-up. The mean postoperative endothelial cell loss was -3.05% at 1 year, -1.23% between years one and three, -1.02% between the third and fifth years. CONCLUSION Verisyse IOL implantation is an effective and safe for high myopia surgical treatment. However, the 5-year follow-up period is not sufficient to evaluate the safety profiles in terms of endothelial cells.
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Affiliation(s)
- Ihsan Cakir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey.
| | - Gökhan Demir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey
| | - Burcin Kepez Yildiz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey
| | - Mevlüt Celal Öcal
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey
| | - Yusuf Yildirim
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey
| | - Alper Agca
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Street Number:2, Beyoglu, Istanbul, Turkey
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Middle- and long-term results after iris-fixated phakic intraocular lens implantation in myopic and hyperopic patients: a meta-analysis. J Cataract Refract Surg 2021; 46:125-137. [PMID: 32050242 DOI: 10.1097/j.jcrs.0000000000000002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects. The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects of iris-fixated pIOLs on myopic and hyperopic eyes with a follow-up of at least 2 to 4 years. Visual and refractive results after implantation for correction of myopia are positive and the complication rate is low. Endothelial cell loss appears to be at an acceptable rate, although the range of endothelial cell change is too wide to draw firm conclusions. Care should be taken when considering an iris-fixated pIOL for hyperopic eyes because complication rates, particularly pigment dispersion, might be higher than those in myopic eyes. More well-designed, long-term studies are needed, especially in hyperopic eyes. The authors advocate for standardized reporting of refractive surgery data. Initiatives proposed by journal authors and editors to achieve uniformity should be supported.
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Jonker SMR, Berendschot TTJM, Saelens IEY, Bauer NJC, Nuijts RMMA. Phakic intraocular lenses: An overview. Indian J Ophthalmol 2020; 68:2779-2796. [PMID: 33229653 PMCID: PMC7856940 DOI: 10.4103/ijo.ijo_2995_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Soraya M R Jonker
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Noël J C Bauer
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
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Abo-Shasha R, Li B. Management of pupillary seclusion and occlusion of an iris enclaved intraocular lens. Can J Ophthalmol 2020; 56:e7-e9. [PMID: 32730747 DOI: 10.1016/j.jcjo.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Bo Li
- Western University, London, Ont
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Shajari M, Scheffel M, Koss MJ, Kohnen T. Dependency of endothelial cell loss on anterior chamber depth within first 4 years after implantation of iris-supported phakic intraocular lenses to treat high myopia. J Cataract Refract Surg 2018; 42:1562-1569. [PMID: 27956282 DOI: 10.1016/j.jcrs.2016.08.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effect of the anterior chamber depth (ACD) on the central corneal endothelial cell density (ECD) in eyes after implantation of an iris-fixated phakic intraocular lens (pIOL). SETTING Department of Ophthalmology, Goethe-University, Frankfurt, Germany. DESIGN Retrospective nonrandomized case series. METHODS An Artisan pIOL was implanted in eyes of highly myopic patients. Follow-up examinations at 1, 12, 24, 36, and 48 months included evaluation of ECD and adverse events. Three cohorts based on the ACD were established and their ECDs compared. All eyes had 1-year and 4-year postoperative ECD measurements available. Statistical analysis included linear regression analysis to evaluate the influence of ACD on ECD. RESULTS The study comprised 95 eyes (52 patients). Four years after surgery the mean spherical equivalent changed from -11.06 diopters (D) ± 4.77 (SD) to -0.42 ± 0.47 D. Severe adverse events were not detected. There was a significantly higher ECD loss after 4 years in patients with an ACD of less than 3.00 mm than in those with an ACD greater than 3.40 mm (-224 cells/mm2) (P < .01). There was no significant difference in ECD between eyes with an ACD of 3.00 to 3.39 mm and eyes with an ACD less than 3.00 mm (P = .23) or more than 3.40 mm (P = .08). CONCLUSIONS The iris-claw pIOL precisely and safely corrected high myopia. However, the loss in ECD can be considerable. Establishing stricter exclusion criteria for ACD might reduce this loss. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Mehdi Shajari
- From the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
| | - Magdalena Scheffel
- From the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
| | - Michael Janusz Koss
- From the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
| | - Thomas Kohnen
- From the Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany.
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Corneal Endothelial Tolerance After Iris-Fixated Phakic Intraocular Lens Implantation: A Model to Predict Endothelial Cell Survival. Cornea 2018; 37:591-595. [DOI: 10.1097/ico.0000000000001527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohammadpour M, Heidari Z, Hashemi H. Updates on Managements for Keratoconus. J Curr Ophthalmol 2017; 30:110-124. [PMID: 29988906 PMCID: PMC6034171 DOI: 10.1016/j.joco.2017.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/07/2017] [Accepted: 11/05/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose Keratoconus is a progressive disease of the cornea which can lead to blindness as irregular astigmatism increases. Currently, a variety of methods are available for the treatment of keratoconus, and in certain cases, it may be difficult to choose the most appropriate option. This article reviews available treatment modalities for keratoconus to provide the practitioner with practical and useful information for selecting the most suitable option for each individual patient. Methods To review treatment methods for different stages of keratoconus, PubMed (United States National Library of Medicine) and Scopus (Elsevier BV) databases were searched using the keywords “keratoconus”, “contact lens”, “cross-linking”, “Intacs”, “keratoplasty”, “gene therapy”, and “irregular astigmatism”, and related articles were reviewed based on disease assessment parameters and treatment methods. Results Various methods are available for the treatment of keratoconus: eyeglasses and contact lenses in the early stages, cross-linking for stabilizing disease progression, intrastromal corneal ring segments (ICRS) for reducing refractive errors or flattening the cornea, and penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), conductive keratoplasty, gene therapy and more recently, bowman layer transplantation (BL transplantation) in advanced stages of the disease. To achieve optimum results, it is essential to choose the best option for each individual patient. Conclusions A commonality of the reviewed papers was the advancement of novel diagnostic and treatment methods in ophthalmology, which can delay the need for corneal grafting. A better understanding of keratoconus treatment options can help enhance visual rehabilitation and prevent blindness in keratoconus patients.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Zahra Heidari
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Corresponding author. No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Català-Mora J, Cuadras D, Díaz-Cascajosa J, Castany-Aregall M, Prat-Bartomeu J, García-Arumí J. Anterior iris-claw intraocular lens implantation for the management of nontraumatic ectopia lentis: long-term outcomes in a paediatric cohort. Acta Ophthalmol 2017; 95:170-174. [PMID: 27535343 DOI: 10.1111/aos.13192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the feasibility and long-term safety of lensectomy and iris-claw intraocular lens (IOL) implantation to treat children with severe ectopia lentis in a paediatric tertiary hospital. METHODS Prospective cohort study of 21 eyes from 12 patients with severe ectopia lentis and visual acuity <20/63. All eyes underwent 23-gauge pars plana vitrectomy, lensectomy, iridectomy and Artisan IOL implantation in the anterior chamber with iris-claw enclavation via pars plana. Mean age at surgery was 8.0 ± 5.3 yo (range 3-17 years). A full ophthalmologic examination including best-corrected visual acuity (BCVA), biomicroscopy, intraocular pressure (IOP) measurement, fundus evaluation and central endothelial cell count (cECC) was performed pretreatment, at 3 months' postsurgery, and every 6 months thereafter. Ultrasound biomicroscopy (UBM) was performed 12 months after surgery. RESULTS Mean follow-up was 39.3 ± 13.0 months. Best-corrected visual acuity (BCVA) (mean ± SD) improved from 0.91 ± 0.29 logMar preoperatively to 0.18 ± 0.23 logMar at final follow-up (p < 0.0001). Mean distance from the endothelium to the anterior IOL surface after surgery was 3.11 ± 0.61 mm. Postsurgically, cECC loss was 5.04% ± 9.58% with an annual cECC loss rate of 3.16% ± 4.46%. One patient developed IOL dislocation and retinal detachment after severe ocular contusion requiring vitrectomy, IOL refixation and gas tamponade. Another patient developed cystoid macular oedema, managed with intravitreal dexamethasone. CONCLUSION This technique is both feasible and effective to manage severe ectopia lentis in children. Lifetime ophthalmic follow-up including cECC measurement, IOL position monitoring and fundus examination is mandatory in these patients.
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Affiliation(s)
- Jaume Català-Mora
- Hospital Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
- Ophthalmological Institute del Pilar; Barcelona Spain
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
| | - Daniel Cuadras
- Advisory Service and Statistical Methodology Research; Fundació Sant Joan de Déu; Esplugues de Llobregat Barcelona Spain
| | | | | | | | - José García-Arumí
- Surgery Department; Universitat Autònoma Barcelona; Barcelona Spain
- Hospital Vall d'Hebron; Barcelona Spain
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Bouheraoua N, Bonnet C, Labbé A, Sandali O, Lecuen N, Ameline B, Borderie V, Laroche L. Iris-fixated phakic intraocular lens implantation to correct myopia and a predictive model of endothelial cell loss. J Cataract Refract Surg 2015; 41:2450-7. [PMID: 26703496 DOI: 10.1016/j.jcrs.2015.05.030] [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] [Received: 01/19/2015] [Revised: 05/12/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To report long-term results of Artisan phakic intraocular lens (pIOL) to correct myopia and to propose a model predicting endothelial cell loss after pIOL implantation. SETTING Quinze-Vingts National Ophthalmology Hospital, Paris, France. DESIGN Retrospective, interventional case series. METHODS Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and central endothelial cell count (ECC) were determined before and at yearly intervals up to 5 years after pIOL implantation. Linear model analysis was performed to present a model that describes endothelial cell loss as a linear decrease and an additional decrease depending on postoperative loss. RESULTS A total of 49 patients (68 eyes) implanted with pIOLs from January 2000 to January 2009 were evaluated. The mean preoperative and final spherical equivalent (SE) were -13 ± 4.10 and -0.75 ± 0.74 diopters (D), respectively. The mean preoperative and final central ECC were 2629 ± 366 and 2250 ± 454 cells/mm(2), respectively. There were no intraoperative complications for any of the eyes. One eye required surgery for repositioning the pIOL, and 1 eye required pIOL exchange for postoperative refractive error. The model predicted that for patients with preoperative ECC of 3000, 2500, and 2000 cells/mm(2), a critical ECC of 1500 cells/mm(2) will be reached at 39, 28, and 15 years after implantation, respectively. CONCLUSIONS Implantation of the pIOL was an effective and stable procedure after 5 years of follow-up. The presented model predicted EC loss after pIOL implantation, which can assist ophthalmologists in patient selection and follow-up. FINANCIAL DISCLOSURE The authors report no conflict of interest.
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Affiliation(s)
- Nacim Bouheraoua
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France.
| | - Clemence Bonnet
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Antoine Labbé
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Otman Sandali
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Nicolas Lecuen
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Barbara Ameline
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Vincent Borderie
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
| | - Laurent Laroche
- From the Quinze-Vingts National Ophthalmology Hospital (Bouheraoua, Bonnet, Sandali, Lecuen, Ameline, Borderie, Laroche), Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR S 968 (Bouheraoua, Labbé, Borderie, Laroche), Institut de la Vision, Paris, France; Sorbonne Universités (Bouheraoua, Labbé, Borderie, Laroche), UPMC Univ Paris 06, UMR S 968, Institut de la Vision, Paris, France; CNRS (Bouheraoua, Labbé, Borderie, Laroche), UMR 7210, Paris, France; Quinze-Vingts National Ophthalmology Hospital (Labbé), and Ambroise Paré Hospital (AP-HP), Versailles Saint Quentin en Yvelines University, Versailles, France
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Kwon HJ, Nam SM, Stulting RD, Lim CY, Seo KY. Comparison of surgically induced astigmatism following iris-claw PIOL insertion with scleral, limbal, or corneal incisions. J Refract Surg 2014; 30:330-5. [PMID: 24893358 DOI: 10.3928/1081597x-20140416-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/05/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare surgically induced astigmatism (SIA) based on incision site and evaluate the clinical results and astigmatic stability of iris-claw phakic intraocular lens (Artisan lens; Ophtec BV, Groningen, Netherlands) implantation. METHODS Eighty-five eyes of 53 patients with myopia who underwent Artisan lens implantation with a 6.2-mm incision and follow-up of 6 months were retrospectively observed. SIA was assessed using keratometric astigmatism at 6 months postoperatively for the incision sites of the sclera, limbus, and cornea, and the efficacy, safety, predictability, and astigmatic stability were also calculated. RESULTS SIA obtained using Naeser's polar method (KP[90]SIA) was -0.48 ± 0.35 for scleral incisions, -0.99 ± 0.35 for limbal incisions, and -1.14 ± 0.54 for corneal incisions. Corresponding net astigmatism values, as calculated with KP(90)SIA and KP(135)SIA, were 0.70 ± 0.48 (177°), 1.04 ± 0.37 (175°), and 1.21 ± 0.57 (1°), respectively, with SIA increasing the nearer the incision was to the cornea center. Six months after surgery, the efficacy index was 1.03 and the safety index was 1.08. Ninety-eight percent of patients were within 1.50 diopters of attempted refraction. CONCLUSIONS The values of SIA after Artisan lens insertion showed significant differences among three incision locations, despite the absence of significant differences in preoperative steep corneal axis astigmatism values at the incision locations. It would be applicable for refractive surgery in the aspect of minimizing astigmatism after surgery.
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Sayman Muslubas IB, Kandemir B, Aydin Oral AY, Kugu S, Dastan M. Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia. Int J Ophthalmol 2014; 7:376-80. [PMID: 24790887 DOI: 10.3980/j.issn.2222-3959.2014.02.32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/27/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia. METHODS This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred. RESULTS Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit. CONCLUSION Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.
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Affiliation(s)
| | - Baran Kandemir
- Eye Clinic, Dr. Lütfi Kirdar Kartal Education and Training Hospital, Istanbul 34864, Turkey
| | - Ayse Yesim Aydin Oral
- Eye Clinic, Dr. Lütfi Kirdar Kartal Education and Training Hospital, Istanbul 34864, Turkey
| | - Suleyman Kugu
- Eye Clinic, Dr. Lütfi Kirdar Kartal Education and Training Hospital, Istanbul 34864, Turkey
| | - Metin Dastan
- Eye Clinic, Kars Government Hospital, Kars 36000, Turkey
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Moshirfar M, Imbornoni LM, Ostler EM, Muthappan V. Incidence rate and occurrence of visually significant cataract formation and corneal decompensation after implantation of Verisyse/Artisan phakic intraocular lens. Clin Ophthalmol 2014; 8:711-6. [PMID: 24748765 PMCID: PMC3986296 DOI: 10.2147/opth.s59878] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the incidence rate and indications for explantation of Verisyse phakic intraocular lenses (pIOLs) over a 13.6 year period. Subjects and methods Case series describing six cases of explantation of Verisyse pIOLs, out of 213 eyes with Verisyse pIOLs, implanted over a 13.6 year period by one surgeon at one institution, with mean follow-up of 5.6 years per eye. Results Four pIOLs were removed to facilitate extraction of a visually significant cataract, one was removed due to both cataract formation and development of corneal decompensation, and another was removed due to development of localized peripheral corneal decompensation. The incidence rate of pIOL removal was five per 1,000 patient-years with pIOL. Mean time from insertion of pIOL to cataract removal was 9.3 years (range 4.0–12.6 years). Mean time from insertion of pIOL to development of corneal decompensation was 10 years (range 6.9–13 years). There was no increase in the rate of cataract extraction in the pIOL population compared to the general population. Conclusion Cataracts may develop in patients with pIOLs, necessitating removal of the pIOL. Corneal decompensation is a serious complication that appears to be directly related to pIOLs. Corneal decompensation can occur up to 13 years following implantation of pIOLs, and long-term follow-up is important to monitor for this complication.
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Affiliation(s)
- Majid Moshirfar
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Erik M Ostler
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Valliammai Muthappan
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
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Moran S, Kirwan C, O'Keefe M, Leccisotti A, Moore T. Incidence of dislocated and subluxed iris-fixated phakic intraocular lens and outcomes following re-enclavation. Clin Exp Ophthalmol 2014; 42:623-8. [DOI: 10.1111/ceo.12310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/06/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Moran
- Eye Laser Department; Mater Private Hospital; Dublin Ireland
| | | | - Michael O'Keefe
- Eye Laser Department; Mater Private Hospital; Dublin Ireland
| | - Antonio Leccisotti
- School of Biomedical Sciences; University of Ulster; Coleraine UK
- Siena Eye Laser; Monteriggioni Siena Italy
| | - Tara Moore
- School of Biomedical Sciences; University of Ulster; Coleraine UK
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Intraocular Lens Implants: A Scientific Perspective. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Doors M, Budo CJ, Christiaans BJ, Luger M, Marinho AA, Dick HB, Güell JL, Nuijts RM. Artiflex Toric foldable phakic intraocular lens: short-term results of a prospective European multicenter study. Am J Ophthalmol 2012; 154:730-739.e2. [PMID: 22835511 DOI: 10.1016/j.ajo.2012.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the short-term efficacy, predictability, stability, and safety of the foldable Artiflex Toric phakic intraocular lens (pIOL; Ophtec) for the correction of myopia with astigmatism. DESIGN Prospective, nonrandomized multicenter study. METHODS One hundred fifteen eyes of 73 patients were implanted with an Artiflex Toric pIOL. Mean implanted spherical and cylindrical powers were -7.10 ± 2.70 diopters (D) and -2.14 ± 0.80 D, respectively. Total follow-up was 6 months. Outcome parameters included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), subjective manifest refraction (used for vector analysis), intraocular pressure, and endothelial cell density (ECD). RESULTS At 6 months, 99.0% of eyes had a UCVA of ≥20/40, and 81.8% of eyes were ±0.5 D of the intended refraction. In 74.5% postoperative UCVA was equal to or better than preoperative BSCVA; 2 eyes lost 2 or more lines of BSCVA postoperatively because of the development of synechiae. In 75.5% of eyes the remaining cylinder was ±0.5 D. There was a significant decrease in ECD after 3 months (4.8% ± 11.9%), with no additional decline between 3 and 6 months. There were few complications, except for the incidence of pigment and nonpigment precipitates (14.8% and 12.2%, respectively at 6 months). Mean misalignment was 0.6 ± 1.5 degrees (range 0-8). CONCLUSIONS The Artiflex Toric pIOL effectively and safely corrects myopia and astigmatism in the short term, with stable and predictable visual results after 6 months, when strict inclusion criteria are applied. Deposition of pigment and nonpigment precipitates on the pIOL warrants further investigation.
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Sedaghat M, Zarei-Ghanavati M, Ansari-Astaneh MR, Patel V, Sikder S. Evaluation of sterile uveitis after iris-fixated phakic intraocular lens implantation. Middle East Afr J Ophthalmol 2012; 19:199-203. [PMID: 22623859 PMCID: PMC3353668 DOI: 10.4103/0974-9233.95249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the clinical features, and visual outcomes of sterile uveitis after iris-fixated phakic intraocular lens implantation (pIOLs) (Artisan-Artiflex® and Verisyse-Veriflex®). Material and Methods: In this retrospective non-comparative case series, the medical records of 117 eyes implanted with Artisan-Artiflex® (Ophtec BV, Groningen, Netherlands) and Verisyse-Veriflex® (AMO, Santa Ana, CA) iris claw phakic IOLs were analyzed for postimplantation sterile uveitis. The mean age of the 87 patients included in the study was 27.2±7.4 years. Of these patients, 56 (64.3%) were men and 31 (35.6%) were women. Patient age, gender, IOL brand type, refractive error, optic diameter, unilateral vs bilateral implantation, and anterior chamber depth were analyzed. Features of uveitis, uncorrected and best corrected visual acuity (VA) at presentation and at follow-up visits were examined. The mean follow-up time was 14.6 months (range: 6-37 months). Results: Clinically significant uveitis was observed in 12 of 117 eyes (10.3%) in a total of ten patients. Of these ten patients, four (40%) were women and six (60%) were men, and the mean age was 25.1±5.3 years (range: 18-36 years). Among those with bilateral implantation, 6.9% of patients developed bilateral uveitis, while 13.8% (4 of the 29 implanted bilaterally) developed unilateral uveitis. Foldable pIOL implantation was the only variable associated with the development of uveitis (P=.03). Conclusion: Although the prognosis is usually benign, sterile uveitis occurred in 10.3% of patients after iris-fixated pIOL implantation. The implantation of a foldable pIOL was the only variable associated with sterile uveitis. Appropriate medical management can be effective treatment, without the need for pIOL replacement.
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Affiliation(s)
- Mohamadreza Sedaghat
- Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashad, Iran
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Kara N, Bozkurt E, Yazici AT, Demirok A. Bilateral transient pupil closure after iris supported intraocular lens implantation in a case with Marfan syndrome. Middle East Afr J Ophthalmol 2012; 19:262-4. [PMID: 22623873 PMCID: PMC3353682 DOI: 10.4103/0974-9233.95270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
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.
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Affiliation(s)
- Necip Kara
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW To review the evidential basis of current practice in refractive lens exchange (RLE) vs. phakic intraocular lens (pIOL). RECENT FINDINGS Visual outcomes after pIOLs are better than RLE. With RLE, there still remain risks of retinal detachment, cystoid macular oedema, glare, halos and posterior capsule opacification. With pIOLs, risks include pigment dispersion, cataract formation, glaucoma and inflammation. The decision to choose between either is broadly based on age and type of refractive error, and the choice follows thorough evaluation and counselling taking into consideration patient's needs and expectations. SUMMARY With advancing technology, newer IOL models for RLE and phakic correction are becoming available. pIOLs provide better visual outcomes for distance correction and currently do not provide near-vision correction possible with RLE.
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Rigid iris-fixated phakic lens implantation for high myopia: novel trapezoidal corneal versus scleral incisions. Eur J Ophthalmol 2011; 22 Suppl 7:S114-9. [PMID: 21928256 DOI: 10.5301/ejo.5000058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare refractive performance of implantation of an iris-fixated phakic intraocular lens (PIOL) through a novel trapezoidal corneal and a scleral tunnel incision. METHODS Sixty-nine eyes selected to undergo PIOL implantation were randomly assigned to 1 of 2 groups: 5.2-mm trapezoidal corneal incision (TCI), 34 eyes; 5.2-mm scleral tunnel incision (STI), 35 eyes. Visual acuity, refraction, corneal astigmatism, tonometry, and endothelial cell density were recorded preoperatively and postoperatively. Surgically induced astigmatism (SIA) was calculated using vector analysis. RESULTS No intraoperative complications were noted. One day after surgery, the quantity of cells in the anterior chamber was significantly lower in TCI group than in STI group (p=0.019). The percentage of eyes with uncorrected visual acuity (UCVA) of ≥20/25 was 41.2% for TCI and 17.1% for STI; the difference was statistically significant (p=0.03), but not thereafter. The mean corneal astigmatism was significantly lower in the TCI group than in the STI group (p=0.01) 3 months postoperatively and subsequently. No significant between-group difference in SIA was found during the follow-up. There was no significant difference in best-corrected visual acuity and endothelial cell loss between groups, postoperatively. CONCLUSIONS The TCI and STI techniques are comparable in terms of safety and induction of astigmatism for the rigid iris-fixated PIOL implantation. However, the TCI is easy to perform and provides a faster visual recovery and lower postoperative corneal astigmatism compared with the STI.
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Management of corneal endothelial decompensation caused by iris-fixated phakic intraocular lenses with descemet stripping automated endothelial keratoplasty. Cornea 2011; 30:1045-7. [PMID: 21832965 DOI: 10.1097/ico.0b013e3182035dd0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe 2 cases of corneal decompensation after iris-fixated phakic intraocular lens (pIOL) implantation requiring Descemet stripping automated endothelial keratoplasty (DSAEK). MATERIALS AND METHODS Case reports and literature review. RESULTS Two cases of corneal decompensation after pIOL implantation are reported. The average age at presentation was 52 years (range: 37 to 67 years) in 2 women. The mean presentation time of corneal decompensation after pIOL implantation was 29 months (range: 22 to 36 months). Both the affected eyes required pIOL explantation and DSAEK to treat corneal decompensation. One patient (1 eye) had concurrent cataract surgery to maximize visual rehabilitation. The mean follow-up after DSAEK surgery was 14 months (range: 12 to 16 months). The best-corrected visual acuity was 20/50 (range: 20/40 to 20/60) at the last follow-up. CONCLUSIONS Despite a good safety profile for iris-fixated pIOLs, some patients may still develop corneal decompensation after implantation. We report a pair of cases with corneal decompensation severe enough to warrant endothelial transplantation and pIOL explantation, with and without concomitant cataract surgery.
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Izquierdo L, Henriquez MA, McCarthy M. Artiflex phakic intraocular lens implantation after corneal collagen cross-linking in keratoconic eyes. J Refract Surg 2011; 27:482-7. [PMID: 21210571 DOI: 10.3928/1081597x-20101223-02] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 11/09/2010] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the safety, efficacy, and stability of the Artiflex (Ophtec BV) foldable anterior iris-claw phakic intraocular lens (PIOL) following corneal collagen cross-linking (CXL) in select cases of progressive keratoconus. METHODS This prospective, comparative study, conducted between March 2007 and June 2008, involved 11 eyes with progressive keratoconus. Inclusion criteria were progressive keratoconus (Amsler-Krumeich classification grades I and II) with no corneal opacities, corneal thickness >450 μm, endothelial cell count >2500 cells/mm(2), anterior chamber depth >3.2 mm, spherical equivalent refraction >4.50 diopters (D) (with a cylinder component <2.00 D), and no other treatment for keratoconus other than contact lens. Each patient underwent CXL in the keratoconic eye with implantation of the Artiflex IOL 6 months thereafter. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction and topographic profiles were examined at 1, 6, and 12 months after the CXL procedure. RESULTS All eyes achieved UDVA of 0.3 logMAR or better. Final spherical and cylindrical error ranged from 0 to -1.50 D and 0 to -1.75 D, respectively. No eyes lost lines of preoperative CDVA. Statistically significant reductions in mean maximum (2.14 D, P<.001) and minimum (1.17 D, P=.02) keratometry values were present 12 months after the CXL procedure. No complications were observed. CONCLUSIONS Combined CXL and Artiflex implantation was a safe and effective treatment in this subset of eyes with progressive keratoconus. Good results in terms of visual acuity, postoperative residual refractive error, and keratometry values were identified.
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Affiliation(s)
- Luis Izquierdo
- Research Department, Instituto de Ojos Oftalmosalud Lima, Peru
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Park DH, Lane SS. Phakic Myopic Intraocular Lenses. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kohnen T, Kook D, Morral M, Güell JL. Phakic intraocular lenses. J Cataract Refract Surg 2010; 36:2168-94. [DOI: 10.1016/j.jcrs.2010.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 11/29/2022]
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Liu A, Manche EE. Late onset secondary cataract following implantation of an iris-fixated phakic intraocular lens. J Refract Surg 2010; 27:305-8. [PMID: 20795584 DOI: 10.3928/1081597x-20100812-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 07/30/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of bilateral late onset anterior cortical cataract following implantation of an iris-fixated phakic intraocular lens (pIOL). METHODS Single observational case report. RESULTS Three and a half years following uncomplicated consecutive implantation of iris-fixated pIOL in both eyes, anterior cortical cataract changes inferiorly emanating from the site of enclavation of the lens in the right eye were noted. By 7 years after implantation, anterior cortical cataract changes were seen emanating from the enclavation sites superiorly and inferiorly in both eyes. These cataracts did not cause any loss of corrected distance visual acuity. CONCLUSIONS This case demonstrates that a potential complication of an iris-fixated pIOL is late onset secondary cataract formation.
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Affiliation(s)
- Anthony Liu
- Department of Ophthalmology, Stanford University School of Medicine, California 94305, USA
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Liu A, Manche EE. Late-onset nontraumatic dislocation of anterior chamber phakic intraocular lens. J Cataract Refract Surg 2010; 36:854-6. [PMID: 20457382 DOI: 10.1016/j.jcrs.2010.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 11/11/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
Long-term stability of the position of phakic intraocular lenses (pIOLs) is important in maintaining visual acuity as well as avoiding injury to the local tissues. We report a case of late nontraumatic dislocation of an iris-fixated pIOL, with subsequent successful repositioning.
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Affiliation(s)
- Anthony Liu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California 94305, USA
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Secondary iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy. Retina 2010; 30:131-9. [PMID: 19834354 DOI: 10.1097/iae.0b013e3181b32eef] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support. METHODS This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications. RESULTS Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was -1.68 +/- 063 D, and the spheric equivalent was within +/-2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes. CONCLUSION Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.
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Ambrósio R. Percentage Thickness Increase and Absolute Difference from Thinnest to Describe Thickness Profile. J Refract Surg 2010; 26:84-6; author reply 86-7. [DOI: 10.3928/1081597x-20100121-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Georgoudis P, Tappin M. Artisan Phakic IOL for the Correction of Ametropia After Deep Anterior Lamellar Keratoplasty. J Refract Surg 2010; 26:87. [DOI: 10.3928/1081597x-20100121-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang KJ, Zhu SQ. Spontaneous dislocation of a Verisyse phakic intraocular lens with severe corneal endothelial cell loss. Eur J Ophthalmol 2009; 20:601-3. [PMID: 19967673 DOI: 10.1177/112067211002000311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of spontaneous dislocation of a Verisyse phakic intraocular lens (PIOL) with severe corneal endothelial cell loss. METHODS A 29-year-old woman with no history of trauma presented with complaint of blurred vision in the right eye of 5 months' duration. History included uneventful implantation of a PIOL bilaterally to correct high myopia in January 2007. RESULTS Visual acuity was 20/100, central endothelial cell density had decreased to 592/mm(2), central corneal pachymetry was 634 microm. The PIOL dislocated temporally and was removed without any lens implanted again. Three months postoperatively, her best-corrected visual acuity was 20/60. CONCLUSIONS A correct fixation with sufficient folded iris inside the claw and long-term follow-up are important for patients with implanted PIOL, and the long-term effects on endothelial cell density in this patient remain to be seen.
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Affiliation(s)
- Kai-Jie Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing - China
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Doors M, Eggink FA, Webers CAB, Nuijts RMMA. Late-onset decentration of iris-fixated phakic intraocular lenses: a case series. Am J Ophthalmol 2009; 147:997-1003, 1003.e1-2. [PMID: 19327741 DOI: 10.1016/j.ajo.2009.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 01/15/2009] [Accepted: 01/15/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate late-onset downward decentration of iris-fixated phakic intraocular lenses (pIOL) resulting from progressive shifting of the haptics through the iris and its influence on the position of the pIOL and the amount of enclavated iris tissue. DESIGN Institutional, prospective, observational case series. METHODS Six patients (9 eyes) from among 368 eyes had 1 shifted haptic during long-term follow-up. Anterior segment optical coherence tomography (AS-OCT) was used to measure the distance between the edges of the pIOL and the corneal endothelium. Slit-lamp photography imaged the pIOL after implantation and after decentration. The images were analyzed to determine decentration and amount of iris tissue at the enclavation sites. RESULTS Shifting of the haptics occurred in 2.4% and was discovered at a mean follow-up of 4.8 years (range, 3 to 7 years). Mean downward decentration was 0.28 +/- 0.15 mm. Mean edge-distances on the nasal, temporal, superior, and inferior side were 1.71 +/- 0.30 mm, 1.86 +/- 0.31 mm, 1.86 +/- 0.31 mm, and 1.58 +/- 0.34 mm, respectively. Mean enclavated iris tissue on the nasal and temporal side was smaller after decentration when compared with that directly after surgery (P = .033 and P = .017, respectively). Shifting of the haptics did not result in a decreased uncorrected and best-corrected visual acuity. CONCLUSIONS Late-onset downward decentration resulting from progressive shifting of the haptics occurred in 2.4% and was associated with a decrease in enclavated iris tissue. AS-OCT showed a mean distance between the edge of the pIOL and the endothelium greater than the advised safety distance of 1.5 mm.
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Affiliation(s)
- Muriël Doors
- Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands.
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de Vries NE, Tahzib NG, Budo CJ, Webers CA, de Boer R, Hendrikse F, Nuijts RM. Results of cataract surgery after implantation of an iris-fixated phakic intraocular lens. J Cataract Refract Surg 2009; 35:121-6. [DOI: 10.1016/j.jcrs.2008.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 10/09/2008] [Accepted: 10/10/2008] [Indexed: 11/29/2022]
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Vilaseca M, Padilla A, Pujol J, Ondategui JC, Artal P, Güell JL. Optical Quality One Month After Verisyse and Veriflex Phakic IOL Implantation and Zeiss MEL 80 LASIK for Myopia from 5.00 to 16.50 Diopters. J Refract Surg 2009; 25:689-98. [PMID: 19714793 DOI: 10.3928/1081597x-20090707-03] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Meritxell Vilaseca
- Centre de Desenvolupament de Sensors, Instrumentació i Sistemes (CD6), Universitat Politècnica de Catalunya, Rambla Sant Nebridi 10, 08222 Terrassa, Barcelona, Spain.
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Boxer Wachler BS, Scruggs RT, Yuen LH, Jalali S. Comparison of the Visian ICL and Verisyse Phakic Intraocular Lenses for Myopia from 6.00 to 20.00 Diopters. J Refract Surg 2009; 25:765-70. [DOI: 10.3928/1081597x-20090813-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 09/23/2008] [Indexed: 11/20/2022]
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Tahzib NG, MacRae SM, Yoon G, Berendschot TTJM, Eggink FAGJ, Hendrikse F, Nuijts RMMA. Higher-order aberrations after implantation of iris-fixated rigid or foldable phakic intraocular lenses. J Cataract Refract Surg 2008; 34:1913-20. [PMID: 19006738 DOI: 10.1016/j.jcrs.2008.07.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 07/25/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate higher-order aberrations (HOAs) after implantation of Artiflex phakic intraocular lenses (pIOLs). SETTING Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands. METHODS This retrospective comparative case series comprised 27 eyes (14 patients) that had Artiflex pIOL implantation and 22 eyes (13 patients) that had Artisan pIOL implantation. Refractive data, pupil size, IOL decentration, and HOA values were recorded and compared. Laboratory analysis was performed. Follow-up was 1 year. RESULTS In the Artiflex group, the mean spherical equivalent (SE) changed from -9.95 diopters (D) +/- 1.43 (SD) (range -6.75 to -12.13 D) to -0.30 +/- 0.53 D (range -1.94 to 0.56 D). Postoperatively, trefoil-y increased (increase factor 1.73) and spherical aberration decreased (increase factor 0.55). The mean pIOL decentration was 0.24 +/- 0.12 mm; 96.3% were decentered 0.5 mm or less. There was a significant correlation between pIOL decentration and postoperative spherical aberration and coma-y. In the Artisan group, the mean SE changed from -9.90 +/- 2.74 D (range -4.00 to -14.50 D) to -0.20 +/- 0.42 D (range -0.75 to 0.50 D). Postoperatively, trefoil-y and spherical aberration increased (increase factors 3.32 and 6.84, respectively). Laboratory analysis confirmed the negative and positive spherical aberration profile of the Artiflex pIOL and Artisan pIOL, respectively. CONCLUSIONS Artiflex pIOL implantation decreased spherical aberration, while Artisan pIOL implantation increased spherical aberration. Trefoil-y increased in both groups. These changes might be explained by incision size differences in relation to trefoil and differences in optic design in relation to spherical aberration.
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Affiliation(s)
- Nayyirih G Tahzib
- Department of Ophthalmology, Academic Hospital Maastricht, Maastricht, The Netherlands.
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Bibliography. Current world literature. Corneal and external disorders. Curr Opin Ophthalmol 2008; 19:363-6. [PMID: 18545022 DOI: 10.1097/icu.0b013e328308161d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kohnen T, Strenger A, Klaproth OK. Basic knowledge of refractive surgery: correction of refractive errors using modern surgical procedures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:163-70; quiz 170-2. [PMID: 19633786 DOI: 10.3238/arztebl.2008.0163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 10/19/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Refractive ophthalmic surgery allows refractive errors to be corrected permanently in a safe, effective, and reliable way with few complications. METHODS Selective literature review with special reference to the guidelines of the German Commission for Refractive Surgery. RESULTS With a total of almost 18 million treatments performed to date, laser in-situ keratomileusis (LASIK) is the most commonly used refractive surgical procedure worldwide. Alternatives to LASIK include surface ablation procedures (PRK, LASEK, Epi-LASIK) and phakic intraocular lens implantation. If ocular accommodation is lost, removal of the crystalline lens and implantation of modern multifocal intraocular lenses (refractive lens exchange) provide an alternative means of correcting myopia, hyperopia and presbyopia. DISCUSSION The treatment effect is maximized and complications kept to a minimum if strict inclusion criteria are applied and a high technical standard maintained during the procedure.
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Affiliation(s)
- Thomas Kohnen
- Klinik für Augenheilkunde der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany.
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