Three-year stability of an angle-supported foldable hydrophobic acrylic phakic intraocular lens evaluated by Scheimpflug photography

Five Years Follow-Up of Acrysof Cachet® Angle-Supported Phakic Intraocular Lens Implantation for Myopia Correction

Purpose

The Acrysof Cachet® angle-supported phakic intraocular lens (pIOL) (Alcon Laboratories, Inc., Fort Worth, TX) is designed to correct high refractive errors in human eyes. The aim of this study was to evaluate the outcome of AcrySof Cachet® angle-supported pIOL implantation with particular regard to efficacy and safety of the implant over a 60-month follow-up period.

Design

Retrospective consecutive clinical case study.

Methods

Prior to pIOL implantation, patients had a complete ophthalmologic examination including objective and subjective refraction, uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA), endothelial cells density (ECD), slit lamp photography, optical coherence tomography (OCT), Scheimpflug digital videokeratoscopy, optical biometry, slit lamp examination, intraocular pressure (IOP) measurement, and pupillometry. Postoperatively, patients received yearly a complete eye examination.

Results

Thirty-one eyes of 16 patients were included in this study. The mean age was 36.2 ± 8.1 years. UCVA (logMAR) improved from 1.33 ± 0.20 before surgery to 0.08 ± 0.14 one year after surgery and was 0.20 ± 0.20 five years after surgery. CDVA (logMAR) improved from 0.10 ± 0.10 before surgery to 0.05 ± 0.13 one year after surgery and was 0.04 ± 0.14 five years postoperatively. The mean percentage of endothelial cells loss (ECL) was 11.51% over the first year and 15.95% five years after surgery. There were no intraoperative complications in any of the eyes.

Conclusions

Our results up to five years after implantation of the AcrySof Cachet® angle-supported pIOL demonstrated very good outcomes in all above shown measurements, including CDVA, UCVA, and ECD. However, since major endothelial cell loss may occur in some patients with this type of pIOL, regular follow-up visits are required.

Phakic intraocular lens: Two-year results and comparison of endothelial cell loss with iris-fixated intraocular lenses

PURPOSE

To evaluate the efficacy, safety, and stability of a foldable angle-supported Acrysof Cachet phakic intraocular lens (pIOL) to correct moderate to high myopia and compare endothelial cell loss after iris-fixated Artisan and Artiflex pIOL implantation.

SETTING

University Eye Clinic Maastricht, the Netherlands.

DESIGN

Retrospective observational study.

METHODS

Foldable angle-supported pIOL implantation for myopia ranging from -6.0 to -16.5 diopters (D) was done. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), and adverse events were documented preoperatively and 6 months and 1 and 2 years postoperatively. Endothelial cell loss after implantation of the foldable angle-supported pIOL and iris-fixated pIOLs was compared 6 months and 1 and 2 years postoperatively.

RESULTS

There were 158 eyes. The UDVA was equal to or more than 20/25 in 95% of eyes at 1 and 2 years postoperatively. The mean SE was -0.17 D ± 0.43 (SD) 2 years postoperatively. One patient developed pupil ovalization, resulting in explantation of the pIOL from both eyes. Acute endothelial cell loss in the foldable angle-supported pIOL group was -3.2% ± 0.7%, significantly higher than after iris-fixated pIOL implantation. Chronic endothelial cell loss from 6 to 24 months after surgery was -3.8% ± 0.7%. At the 2-year follow-up, the chronic endothelial cell loss in the foldable angle-supported pIOL group was not different than with iris-fixated pIOLs (P > .05).

CONCLUSIONS

The foldable angle-supported pIOL effectively corrected moderate to high myopia. However, acute surgical endothelial cell loss was significantly higher than with iris-fixated pIOLs.

FINANCIAL DISCLOSURE

Dr. Nuijts is a consultant to Alcon Laboratories, Inc., Théa Pharma GmbH, and ASICO LLC; he has received study grants from Acufocus, Inc., Alcon Laboratories, Inc., Carl Zeiss Meditec AG, Ophtec BV, and Physiol S.A. No other author has a financial or proprietary interest in any material or method mentioned.

Angle-supported phakic intraocular lenses for the correction of myopia: Three-year follow-up

PURPOSE

To evaluate patient safety and refractive outcomes in eyes with an angle-supported phakic intraocular lens (pIOL), and to assess the correlation between rotation and corneal endothelial cell damage.

SETTING

Gimbel Eye Centres, Calgary and Edmonton, Alberta, Canada.

DESIGN

Retrospective cohort study.

METHODS

This study included patients with moderate to high myopia (range -6.50 to -19.50 diopters [D]) who received the Acrysof Cachet pIOL. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity, manifest refraction spherical equivalent (MRSE), endothelial cell density (ECD), and IOL rotation.

RESULTS

This study evaluated 119 eyes of 61 patients. The mean ECD decrease from preoperative measurements was 3.11% (n = 46), with a mean IOL rotation of 10.6 degrees (n = 35) at the 3-year postoperative visit. Of the 49 eyes at the 3-year visit measured for UDVA, 98.0% were 20/40 or better and 77.6% were 20/20 or better. The MRSE improved from a preoperative mean of -9.26 diopters (D) ± 2.43 (SD) (range -19.50 to -5.63 D) to -0.33 ± 0.61 D (range -3.12 to +0.71 D) at the 3-year visit. The residual refractive error was within ±0.50 D of the target refraction for 78.4% and within ±1.00 D for 92.2% of the 51 eyes. The study included one bilateral pIOL removal due to endothelial cell loss, one case of synechia, and one case of subtle pupil ovalization.

CONCLUSIONS

No correlation between IOL rotation and ECD decrease was found (R(2) = 0.0143); the pIOL provided promising refractive outcomes and acceptable safety in patients with moderate to high myopia.

FINANCIAL DISCLOSURE

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

[Scheimpflug photography for the examination of phakic intraocular lenses]

BACKGROUND

High myopia phakic intraocular lenses (IOL) have become an established means of surgical correction for high ametropia. Scheimpflug photography is one of the methods which are frequently applied for postoperative examination of the implants.

MATERIAL AND METHODS

Results from published studies employing Scheimpflug photography for examination of anterior chamber angle-fixated, iris-fixated and sulcus-fixated phakic IOLs were evaluated.

RESULTS

In several published studies Scheimpflug photography was used to examine the position of the implant and opacification of the crystalline lens. The results provided valuable evidence for the improvement of phakic IOL design.

CONCLUSION

Scheimpflug photography offers an easy to use, rapid non-contact examination of phakic IOLs.

Stability of cachet phakic intraocular lens position during 6-months follow-up

Purpose:

To evaluate the position stability of a phakic intraocular lens (Cachet pIOL; Alcon, Laboratories, Inc., Fort Worth, TX) in the anterior chamber (AC) during a 6-months follow-up.

Methods:

Thirty eyes of 16 subjects underwent a Cachet pIOL implantation for the correction of high myopia from -6.50 to -16.00 D with plano targeted refraction. The position stability of the Cachet pIOL was evaluated using an Anterior Segment-OCT (AS-OCT, Carl Zeiss AG, Oberkochen, Germany) at 1- and 6-months postoperatively. Three measurements have been taken into account: 1) the minimum distance between the anterior surface of the Cachet pIOL optic disk and the central corneal endothelium; 2) the minimum distance between the optic disk’s edges of the pIOL and the endothelium; 3) the minimum distance between the posterior surface of the pIOL optic disk and the anterior surface of the crystalline lens. The endothelial cell density (ECD) was also recorded.

Results:

No statistically significant changes of the Cachet pIOL position in the AC were found during follow-up. The average changes were ≤0.1 mm between 1- and 6-months postoperatively (P>0.05). At the end of follow-up, The mean ECD loss was 0.7 % (from 2794 ± 337 cell/mm² to 2776 ± 388 cell/mm²; P>0.05).

Conclusion:

A high position stability of the Cachet pIOL in the anterior chamber was shown during a 6-months follow-up.

Rotation stability of the cachet angle-supported phakic intraocular lens

PURPOSE

To evaluate the rotational stability of an acrylic angle-supported phakic intraocular lens (PIOL) 12 months after implantation in myopic eyes.

METHODS

Patients with a history of moderate to high myopia underwent unilateral or bilateral implantation of an acrylic angle-supported PIOL (AcrySof Cachet; Alcon Laboratories, Inc., Fort Worth, TX). All were followed up for 12 months. IOL rotation was assessed using digital overlay of ocular photographs captured within 2 weeks of implantation and at postoperative month 12. The secondary outcomes of refractive power (spherical equivalent, refractive sphere, and cylinder) and uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were assessed preoperatively and again at 3 months after implantation.

RESULTS

Fifty eyes of 28 patients with a mean age of 32 years were included in this retrospective cohort study. All underwent successful IOL implantation and follow-up. A mean 12-month rotation of 11° was observed (standard deviation: 15.1°, range: 0 to 60°). All preoperative measures (mean) of refractive power improved by 3 months postoperatively (spherical equivalent = -0.35 ± 0.79 diopters [D], spherical refraction = 0.04 ± 0.82 D, and cylindrical refraction = -0.77 ± 0.91 D). Two percent of eyes requiring additional laser adjustment by postoperative month 12, primarily due to corneal astigmatism.

CONCLUSION

The study findings suggest that AcrySof Cachet angle-supported PIOLs offer moderate 1-year rotational stability. Because this type of IOL also corrects myopia effectively, it appears to be a good treatment option for myopic eyes. However, the rotation that occurs makes it unsuitable for cylinder corrections.

Corneal decompensation and angle-closure glaucoma after upside-down implantation of an angle-supported anterior chamber phakic intraocular lens

We present the case of a 27-year-old man with severe pain, loss of visual acuity, corneal edema, and high intraocular pressure (IOP) in 1 eye after bilateral Acrysof Cachet phakic intraocular lens (pIOL) implantation. Slitlamp examination was limited due to severe corneal edema, but anterior segment optical coherence tomography indicated upside-down implantation of the pIOL. The pIOL was explanted, which confirmed that the haptic indicator had been implanted counterclockwise. Postoperative treatment included antiinflammatory and antiglaucoma topical therapy. Follow-up monitoring showed decreasing corneal edema and normalized IOP. At 6 weeks, the corrected distance visual acuity was +0.1 logMAR, the IOP was within normal limits, and the cornea showed no signs of edema, but there was endothelial cell density loss. This case presents the preoperative and postoperative management of high IOP after pIOL implantation and illustrates the pitfalls of incorrect implantation of angle-supported anterior chamber IOLs with haptic angulation.

Severe endothelial cell loss with anterior chamber phakic intraocular lenses

We report the case of a highly myopic patient who developed severe bilateral endothelial cell loss following implantation of 2 angle-supported anterior chamber pIOL models, the Acrysof Cachet and the GBR (currently off the market).

FINANCIAL DISCLOSURE

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

Visual and aberrometric outcomes in eyes with an angle-supported phakic intraocular lens

PURPOSE

To evaluate the postoperative changes in spherical aberration and the point-spread function (PSF) induced by the implantation of a new angle-supported phakic intraocular lens (pIOL).

SETTING

Department of Ophthalmology, St. Bassiano Hospital, Bassano del Grappa, Italy.

DESIGN

Prospective nonrandomized cohort study.

METHODS

Eyes with high myopia had implantation of an Acrysof Cachet angle-supported pIOL. Preoperative and postoperative total spherical aberration and PSF were measured using a Luneau 80 Wave+ wavefront aberrometer (high-resolution Hartmann-Shack technology) at a fixed entrance pupil scan size of 5.0 mm under pharmacologic mydriasis. Preoperative and postoperative data were analyzed and compared using the Student t test.

RESULTS

Thirty-five eyes of 18 patients were included in the statistical analysis. The Student t test for paired data (95% confidence interval) showed a statistically significant difference between preoperative data and postoperative data. The mean preoperative total spherical aberration Z(4,0) was -0.001 μm ± 0.076 (SD) preoperatively and -0.13 ± 0.11 μm postoperatively (P≤.05). The mean PSF was 0.28 ± 0.15 preoperatively and 0.34 ± 0.16 postoperatively (P<.05).

CONCLUSION

Implantation of the angle-supported pIOL in eyes with high myopia improved the quality of vision, inducing negative spherical aberration and increasing the PSF under mesopic conditions.

Pediatric refractive surgery: corneal and intraocular techniques and beyond

Refractive surgery has now been used successfully to treat severe anisometropia and isoametropia associated with amblyopia in children who cannot wear standard spectacles or contact lenses. Extraocular techniques include photorefractive keratectomy, laser-assisted subepithelial keratomileusis, and laser-assisted in situ keratomileusis. Intraocular techniques include refractive lensectomy and phakic intraocular lenses and are still being investigated in children for refractive errors outside the treatment dose capabilities of the excimer laser. This workshop discusses the various techniques, how and when to use each, and their risks and benefits. Newer techniques currently being used in adults that may someday be used in children are also introduced.

AcrySof cachet phakic intraocular lens in myopic patients: visual performance, wavefront error, and lens position

PURPOSE

To evaluate visual and aberrometric outcomes and position of the AcrySof Cachet (Alcon Laboratories Inc) angle-supported phakic intraocular lens (PIOL) for correction of myopia in adults.

METHODS

This prospective study included 36 consecutive eyes with moderate to high myopia in which an AcrySof Cachet PIOL was implanted to minimize refractive error. Follow-up was up to 1 year.

RESULTS

Mean manifest spherical equivalent refraction reduced significantly from -14.90 ± 0.90 diopters (D) to -0.29 ± 0.30 D at 1 month and remained stable at 1 year (P<.001). Mean uncorrected distance visual acuity was >0.1 logMAR (20/20 Snellen) in 56% of patients and >0.3 logMAR (20/25 Snellen) in 100% of patients. Corrected distance visual acuity was >0.1 logMAR (20/20 Snellen) in 78% of patients and >0.3 logMAR (20/25 Snellen) in 100% of patients. Mean endothelium-PIOL distance and mean PIOL-crystalline distance were within recommended values at all postoperative evaluations. Statistically significant variations for these variables were not observed. Anterior chamber depth, safety center distance, and vault center distance showed significant reduction after accommodation (P<.01). Anterior chamber depth and safety center distance significantly increased after pupil dilation (P<.01). Mean percentage of endothelial cell loss was 4.04% at 1 year. The root-mean-square of total higher order aberrations and spherical, coma, and trefoil aberrations did not change significantly from pre- to postoperatively.

CONCLUSIONS

The AcrySof Cachet PIOL was effective in the correction of moderate to high myopia and provided excellent visual performance with no modification of physiologic ocular wavefront error. Adequate distance from the cornea and crystalline lens was maintained with no significant change during follow-up and under different environmental conditions.

Anterior chamber intraocular lens, sutured posterior chamber intraocular lens, or glued intraocular lens: where do we stand?

PURPOSE OF REVIEW

To review the recent literature addressing the surgical approaches to intraocular lens (IOL) fixation in the setting of inadequate capsular support.

RECENT FINDINGS

Lack of capsular support is a commonly encountered problem facing the anterior segment surgeon. Recent reports suggest that visual outcomes are generally good with modern IOLs and surgical approaches. More recently described techniques include sutureless scleral fixation and intraocular endoscopy-guided suture placement.

SUMMARY

Many clinical circumstances require extracapsular IOL fixation and multiple options exist in the setting of inadequate capsular support. Ultimately, there are many factors that must be considered in selecting an appropriate surgical approach. These include ocular history as well as the skill, experience, and comfort level of the individual surgeon. The myriad of options that now exist for IOL fixation increases the likelihood that patients with a wide variety of pathologic states will attain their best possible visual outcome.

Refractive lens exchange versus phakic intraocular lenses

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.