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Warren A, Kemp PS, Coussa RG, Cheng L, Boldt HC, Russell SR, Johnson AT, Oetting TA, Sohn EH. Comparative long-term outcomes of vitrectomy combined with anterior chamber intraocular lens to intra-scleral haptic fixation of posterior chamber intraocular lens. Int J Retina Vitreous 2024; 10:59. [PMID: 39187860 PMCID: PMC11346030 DOI: 10.1186/s40942-024-00572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
PURPOSE To evaluate the long-term clinical outcomes in patients with combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) to intrascleral haptic fixation (ISHF) using the Agarwal technique with fibrin glue to secure the scleral flap of a posterior chamber intraocular lens. METHODS Retrospective, consecutive, single-center, comparative case series. 83 eyes were studied. Patients with < 8 months of follow-up were excluded. Detailed pre-, intra-, and post-operative complications were analyzed using mixed model univariate analysis and t-test. Pre- and post-operative best corrected visual acuity (BCVA) was analyzed. RESULTS Twenty-five subjects met entry criteria. Mean age at time of surgery was 70.4 ± 17.7 years in the ACIOL group (n = 12) and 54.6 ± 21.1 years in the ISHF group (n = 13; p = 0.03). Mean follow-up was 38.2 months. Incidence of corneal decompensation was similar in the ACIOL and ISHF lens group (p = 0.93). There was no difference in the BCVA mean change or cystoid macular edema (CME) at the final visit between the groups (p = 0.47; p = 0.08), but there was a trend toward increased CME in the ACIOL group. CONCLUSIONS PPV with concomitant placement of either ACIOL or ISHF lens result in improvement in BCVA. Both procedures are well tolerated and result in favorable outcomes with long-term follow-up though varying patient populations do not allow precise comparison between the two groups.
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Affiliation(s)
- Alexis Warren
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Pavlina S Kemp
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Razek G Coussa
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Liang Cheng
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - H Culver Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Stephen R Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - A Tim Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Thomas A Oetting
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, University of Iowa Healthcare, Iowa City, IA, USA.
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Five Years Follow-Up of Acrysof Cachet® Angle-Supported Phakic Intraocular Lens Implantation for Myopia Correction. J Ophthalmol 2022; 2022:5362020. [PMID: 35378887 PMCID: PMC8976641 DOI: 10.1155/2022/5362020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/04/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up. J Cataract Refract Surg 2021; 47:211-220. [PMID: 32925647 DOI: 10.1097/j.jcrs.0000000000000419] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up. SETTING Ophthalmology Department, Hospital Braga, Portugal. DESIGN Retrospective cohort study. METHODS Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed. RESULTS A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from -9.50 ± 2.93 diopters (D) to -0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD. CONCLUSIONS The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.
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Mahapatra SK, Mannem N. Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens. Indian J Ophthalmol 2021; 69:1404-1408. [PMID: 34011709 PMCID: PMC8302310 DOI: 10.4103/ijo.ijo_2192_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods: In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results: Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion: Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.
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Affiliation(s)
- Santosh K Mahapatra
- Chief Medical Officer and Vitreoretinal Surgeon, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
| | - Navya Mannem
- Opthalmology Resident, Department of Vitreoretina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack, Odisha, India
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Yildirim TM, Khoramnia R, Son HS, Mayer CS, Łabuz G, Munro DJ, Auffarth GU. Reasons for explantation of phakic intraocular lenses and associated perioperative complications: cross-sectional explant registry analysis. BMC Ophthalmol 2021; 21:80. [PMID: 33579238 PMCID: PMC7879667 DOI: 10.1186/s12886-021-01847-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background We discuss the safety, since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications. Methods This retrospective, cross-sectional study included 69 pIOLs, explanted at a single tertiary center between July 2005 and March 2020: 34 angle-supported (G1), 28 iris-fixated (G2) and seven posterior chamber (G3) pIOLs. Case data including the reason for explantation was taken from the patient records. Intra- and postoperative complications were evaluated for an association with the pIOL. Results The mean duration in the eye was 10.4 (0.2–28) years. Cataractogenesis and subsequent surgery that required pIOL explantation was the reason in 42% of all cases. In 22%, cataract in combination with endothelial damage prompted explantation, with 26, 18 and 14% for G1, G2 and G3 respectively. The second most common reasons were corneal damage alone in the angle-supported group (26%), IOL subluxation in the iris-fixated group (18%), and photopic disturbance in the posterior chamber group (29%). In 68% of all explantations, the surgical course was unremarkable, while in the remaining cases perioperative complications were associated with the lens in 45.7%. Conclusion Overall, the need for cataract surgery was the most common reason for pIOL explantation. Corneal complications were more frequent in the angle-supported pIOLs and their removal was associated with higher rates of complication compared to the other groups.
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Affiliation(s)
- Timur M Yildirim
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian S Mayer
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Grzegorz Łabuz
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Donald J Munro
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Descemet membrane endothelial keratoplasty for corneal decompensation caused by a phakic anterior chamber intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol 2020; 258:2761-2766. [PMID: 32944818 DOI: 10.1007/s00417-020-04928-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To describe the clinical outcomes of Descemet membrane endothelial keratoplasty combined with phacoemulsification/posterior chamber intraocular lens implantation (triple procedure) for treatment of corneal decompensation induced by a phakic anterior chamber intraocular lens (AC IOL) implantation. METHODS Ten patients (10 eyes) with corneal decompensation due to phakic AC IOL implantation that had undergone the triple procedure were included in this study. Among the 10 eyes, 5 eyes underwent explantation of AC IOL prior to the transplantation, and then underwent the triple procedure. The remaining 5 eyes with a phakic AC IOL in situ underwent the triple procedure with concurrent explantation of AC IOL. Corrected distance visual acuity (CDVA), subjective refraction, endothelial cell density (ECD), and complications were documented. RESULTS The triple procedure was performed across all eyes without any adverse events. The average CDVA improved from 1.32 ± 0.24 preoperatively to 0.15 ± 0.05 logarithm of the minimum angle of resolution (logMAR), which represents an improvement in Snellen equivalent from 20/400 (0.05) preoperatively to 20/28 (0.71) at 12 months after surgery. At 12 months, all eyes reached a CDVA of 20/32 (0.63) or better, and 50% of eyes reached a CDVA of 20/25 (0.8) or better. The mean donor ECD±SD was 2868.7 ± 67.9 cells/mm2, which decreased to 1724.1 ± 84.6 cells/mm2 at 12 months, representing 39.9% of endothelial cell loss. Patients did not experience any severe adverse events. CONCLUSION The triple procedure is a safe and effective option for corneal decompensation induced by a phakic AC IOL implantation, helping achieve a satisfactory visual rehabilitation with few complications.
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Martínez-Plaza E, López-Miguel A, Holgueras A, Barraquer RI, Alió JL, Maldonado MJ. Phakic intraocular lenses: Recent advances and innovations. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:178-187. [PMID: 32156485 DOI: 10.1016/j.oftal.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.
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Affiliation(s)
- E Martínez-Plaza
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - A López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - A Holgueras
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España
| | - R I Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - J L Alió
- Vissum Instituto Oftalmológico de Alicante, Alicante, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - M J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España.
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Galvis V, Villamil JF, Acuña MF, Camacho PA, Merayo-Lloves J, Tello A, Zambrano SL, Rey JJ, Espinoza JV, Prada AM. Long-term endothelial cell loss with the iris-claw intraocular phakic lenses (Artisan®). Graefes Arch Clin Exp Ophthalmol 2019; 257:2775-2787. [DOI: 10.1007/s00417-019-04506-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/19/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022] Open
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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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Galvis V, Tello A, Carreño NI, Berrospi RD, Niño CA, Cuadros MO. Endothelial loss with AcrySof ® Cachet ® angle-supported phakic lens. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:e53-e54. [PMID: 28162830 DOI: 10.1016/j.oftal.2016.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 06/06/2023]
Affiliation(s)
- V Galvis
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia; Universidad Autónoma de Bucaramanga, Facultad de Salud, Bucaramanga, Colombia
| | - A Tello
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia; Universidad Autónoma de Bucaramanga, Facultad de Salud, Bucaramanga, Colombia.
| | - N I Carreño
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia; Universidad Autónoma de Bucaramanga, Facultad de Salud, Bucaramanga, Colombia
| | - R D Berrospi
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
| | - C A Niño
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
| | - M O Cuadros
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia; Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
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Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation. Am J Ophthalmol 2016; 168:177-182. [PMID: 27189930 DOI: 10.1016/j.ajo.2016.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare visual outcomes among eyes that underwent pars plana vitrectomy (PPV) in combination with either anterior chamber intraocular lens implantation (ACIOL) or scleral suturing of posterior chamber lens (PCIOL). DESIGN Retrospective comparative case series. METHODS All eyes presented with aphakia or luxated or subluxated posterior chamber intraocular lens (IOL) following complicated cataract surgery, trauma, or spontaneous dislocation. Eyes involving visually significant macular pathology, past retinal detachment, follow-up of less than 6 months, and surgeries requiring the removal of an ACIOL were excluded. The main outcomes measured were final best-corrected visual acuity (BCVA) and surgical complication rates. RESULTS Fifty-seven eyes met inclusion criteria; median follow-up was 13.2 months. Initial median BCVA for ACIOL patients was logMAR 1.301 (Snellen equivalent 20/400, range 20/20 to light perception); final median BCVA was logMAR 0.477 (Snellen equivalent 20/60, range 20/20 to light perception, P < .001). Initial median BCVA for PCIOL patients was logMAR 1.239 (Snellen equivalent 20/347, range 20/60 to light perception); final median BCVA was logMAR 0.301 (Snellen equivalent 20/40, range 20/20 to hand motions, P < .001). The change in BCVA between the 2 groups over the course of the study was similar (P > .05). More epiretinal membrane (ERM) formations occurred postoperatively in the ACIOL group (P = .011). Other complication rates were similar between both groups. CONCLUSIONS PPV with secondary IOL placement is safe and effective, resulting in improved visual outcomes regardless of the technique used. Patients undergoing ACIOL placement have a higher incidence of ERM formation.
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Gimbel HV, Norton NR, Amritanand A. Angle-supported phakic intraocular lenses for the correction of myopia: Three-year follow-up. J Cataract Refract Surg 2015; 41:2179-89. [PMID: 26703294 DOI: 10.1016/j.jcrs.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Howard V Gimbel
- From the Gimbel Eye Centre (Gimbel, Amritanand), Calgary, Alberta, Canada; Loma Linda University (Gimbel, Norton), Loma Linda, California, USA.
| | - Nicholas R Norton
- From the Gimbel Eye Centre (Gimbel, Amritanand), Calgary, Alberta, Canada; Loma Linda University (Gimbel, Norton), Loma Linda, California, USA
| | - Anika Amritanand
- From the Gimbel Eye Centre (Gimbel, Amritanand), Calgary, Alberta, Canada; Loma Linda University (Gimbel, Norton), Loma Linda, California, USA
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Galvis V, Tello A, Cuadros MO, Carreño NI, Berrospi RD, Niño CA. Causes of Explantation of Phakic Intraocular Lenses. J Refract Surg 2015; 31:566-7. [PMID: 26248352 DOI: 10.3928/1081597x-20150728-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wissiak E, Lackner EM, Vidic B, Ardjomand N. Phakic intraocular lenses: past and present. SPEKTRUM DER AUGENHEILKUNDE 2013. [DOI: 10.1007/s00717-013-0190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Higueras-Esteban A, Ortiz-Gomariz A, Gutiérrez-Ortega R, Villa-Collar C, Abad-Montes JP, Fernandes P, González-Méijome JM. Intraocular pressure after implantation of the Visian Implantable Collamer Lens With CentraFLOW without iridotomy. Am J Ophthalmol 2013; 156:800-5. [PMID: 23876870 DOI: 10.1016/j.ajo.2013.05.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE To compare the intraocular pressure (IOP) values during a 3-month period after implantation of the new Visian Implantable Collamer Lens (ICL; STAAR Surgical Company, Nidau, Switzerland) V4c design with CentraFLOW technology without iridotomy using a standard procedure followed by implantation of the conventional ICL V4b model. DESIGN Retrospective cohort study. METHODS This study included 17 eyes implanted with the ICL V4b model and 18 eyes implanted with the ICL V4c model. The mean preoperative spherical equivalent refractions were -7.48 ± 5.00 diopters and -8.66 ± 4.2 diopters, respectively. We compared the best-corrected distance visual acuity before surgery with the uncorrected distance visual acuity after surgery. The intraocular pressure (IOP) was measured 1 week, 1 month, and 3 months after surgery. The central vault at 3 months was measured using optical coherence tomography. RESULTS Three months after surgery, the mean uncorrected distance visual acuities were -0.09 ± 0.12 logarithm of the minimal angle of resolution units with the V4b and -0.07 ± 0.11 logarithm of the minimal angle of resolution units with the V4c. The mean distances between the ICL and the anterior crystalline lens surface were 557 ± 224 μm and 528 ± 268 μm for the V4b and V4c, respectively (P = .73). After 1 week and 1 month, the mean IOPs were 13.7 and 13.3 mm Hg and 14.7 and 15.1 mm Hg, respectively. There were no significant differences in IOP within or between groups during the follow-up period (P > .05, for all comparisons). CONCLUSIONS The new ICL with the CentraFLOW design seems to provide similar results as its predecessors for the correction of moderate to high myopia and maintenance of safe IOP levels without iridotomy.
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Wang L, Moss H, Ventura BV, Padilha H, Hester C, Koch DD. Advances in Refractive Surgery. Asia Pac J Ophthalmol (Phila) 2013; 2:317-27. [PMID: 26107036 DOI: 10.1097/apo.0b013e3182a90647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to review advances in the field of refractive surgery as reported in the peer-reviewed literature over the previous year. DESIGN This was a literature review. METHODS We conducted a PubMed search for terms related to refractive surgery and reviewed prominent international ophthalmic journals published from May 2012 through April 2013. All pertinent articles were reviewed, and selected articles with the greatest relevance were included. RESULTS Many studies over the previous year have highlighted progress in the field of refractive surgery; topics included keratoconus screening, photorefractive keratectomy and laser in situ keratomileusis, corneal cross-linking, small-incision lenticule extraction, phakic intraocular lenses, corneal inlays, presbyopic corneal treatments, and femtosecond laser-assisted astigmatic keratotomy. CONCLUSIONS The field of refractive surgery continues to provide exciting developments. Improvements in established procedures and promising new surgical options make the current climate an appealing one for refractive surgeons and patients.
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Affiliation(s)
- Li Wang
- From the *Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX; and †Altino Ventura Foundation, Recife; and ‡Hospital de Olhos do Paraná, Curitiba, Brazil
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Krueger RR. What's New and Important in Refractive Surgery? A Year in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:279-81. [PMID: 26107028 DOI: 10.1097/apo.0000000000000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ronald R Krueger
- From the Cole Eye Institute, Cleveland Clinic 9500 Euclid Avenue, Cleveland, OH 44195
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Dynamic Positional Change and Defocus Curve of a Phakic Foldable Anterior-Chamber Angle-Supported Intraocular Lens during Accommodation. Ophthalmology 2013; 120:1373-9. [DOI: 10.1016/j.ophtha.2012.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 12/04/2012] [Accepted: 12/07/2012] [Indexed: 11/18/2022] Open
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Kermani O, Oberheide U, Gerten G. Rotation stability of the cachet angle-supported phakic intraocular lens. J Refract Surg 2013; 29:390-4. [PMID: 23739831 DOI: 10.3928/1081597x-20130515-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/05/2013] [Indexed: 11/20/2022]
Abstract
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.
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