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Alshehri M, Bin Helayel H, Vargas JM, Almutlak M, Fairaq R. Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia. Int Ophthalmol 2023; 43:3539-3547. [PMID: 37356032 DOI: 10.1007/s10792-023-02761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/21/2023] [Indexed: 06/27/2023]
Abstract
AIM To identify the current surgical management of aphakia and the outcomes and complications of each technique. METHODS This cross-sectional study included ophthalmic surgeons with at least one-year experience in surgery for aphakia. A study questionnaire was formulated to collect data in Saudi Arabia and other regional countries. The questionnaire included 22 questions on demographics, preferred surgical techniques, complications and the factors related to surgeon decision and the choice for managing aphakia. RESULTS The study included 145 participants (111; 76.6% were males) with mean age of 46.7 ± 11.5 years. The mean duration of cataract surgery experience was 17.6 ± 11.1 years. Most participants (86.2%) were trained in cataract surgery. Scleral fixation of intraocular lens (SFIOL) was the most commonly preferred technique, followed by iris fixation IOL, and anterior chamber IOL (75.2%, 9%, and 15.9%, respectively). The main determinants for selection of a surgical technique were simplicity (56.6%), surgical instrument availability (48.3%), and training on the technique (47.6%). The most frequent postoperative complications were pupil distortion, high intraocular pressure (IOP), pupillary capture of the IOL, and IOL decentration. CONCLUSIONS SFIOL is the preferred surgical technique for managing aphakia. The decision to choose one technique over another is complex and is based on several factors, including technical difficulty, previous training, anatomical variations, ocular comorbidities, and the potential complications. The most frequent complications after surgical correction of aphakia are pupil distortion, high IOP, pupillary capture of the IOL, and decentered IOLs.
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Affiliation(s)
- Mohammed Alshehri
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
- Anterior Segment Division, King Faisal Medical City, Abha, Saudi Arabia
| | - Halah Bin Helayel
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
| | - José Manuel Vargas
- Ophthalmology Division, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Mohammed Almutlak
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia
| | - Rafah Fairaq
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Uruba Road, 11462, Riyadh, Saudi Arabia.
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Zaleski M, Stahel M, Eberhard R, Alexander Blum R, Barthelmes D. OUTCOMES OF RETROPUPILLARY IRIS CLAW INTRAOCULAR LENS IMPLANTATION COMBINED WITH PARS PLANA VITRECTOMY. Retina 2022; 42:1284-1291. [PMID: 35174810 PMCID: PMC9200228 DOI: 10.1097/iae.0000000000003443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report 12-month visual outcomes, incidence of intraocular pressure (IOP) changes and postoperative complications after pars plana vitrectomy with retropupillary implantation of an iris claw intraocular lens (IOL) in aphakic eyes after complicated cataract surgery and eyes with a dislocation of the IOL. METHODS This is a retrospective analysis of eyes undergoing implantation of an iris claw IOL combined with pars plana vitrectomy from 1st of January 2009 until 30th of June 2018 after complicated cataract extraction with capsular loss (Group A) or dislocation of an IOL (Group B). Corrected distance visual acuity was analyzed in logarithm of the minimum angle of resolution (logMAR) units, IOP was recorded in mmHg. RESULTS Eyes in Group A (n = 49) improved from a preoperative median visual acuity of 0.523 logMAR (Snellen 20/65) to 0.201 logMAR (Snellen 20/30), P < 0.01. Eyes in Group B (n = 126) showed stable median visual acuity, preoperative 0.301 logMAR (Snellen 20/40) versus postoperative 0.222 logMAR (Snellen 20/30), P > 0.05. During 12 months in Group A, IOP >21 mmHg occurred in 9 (18.4%) eyes; no eye had an IOP <6 mmHg. In Group B, IOP >21 mmHg occurred in 15 (11.9%) eyes, IOP <6 mmHg in 5 (4%) cases. None of the eyes in Group A and B had IOP >21 mmHg or <6 mmHg at 12 months follow-up. CONCLUSION The retropupillary implantation of an iris claw IOL with pars plana vitrectomy provides adequate visual rehabilitation and seems to be safe in IOP changes.
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Affiliation(s)
- Marta Zaleski
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marc Stahel
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roman Eberhard
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Alexander Blum
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
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João MD, Costa JV, Sousa K, Monteiro T, Lopes N, Calvão-Santos G, Cruz C, Vaz F. Visual and refractive outcomes following secondary intraocular lens implantation. Semin Ophthalmol 2022; 37:619-625. [PMID: 35245158 DOI: 10.1080/08820538.2022.2046805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the visual and refractive results after secondary IOL implantation using different surgical techniques - iris-claw aphakic IOL through a corneal incision or scleral tunnel, and 3-piece IOL into the ciliary sulcus. PATIENTS AND METHODS Retrospective study including patients that were submitted to secondary IOL implantation from January 2017 to December 2019 at the Department of Ophthalmology of Hospital de Braga, Portugal. We collected demographic data (age, surgical indication, comorbidities, surgical technique, IOL implanted, and intra and postoperative complications) and visual and refractive data [preoperative and 3-month, 6-month, and 12-month postoperative corrected-distance visual acuity (CDVA), spherical equivalent (SE), manifest cylinder, and intraocular pressure]. RESULTS 128 eyes from 123 patients were included. The most frequent surgical indications were IOL subluxation/luxation (62.5%) and intraoperative posterior capsular rupture (23.4%). CDVA improved from 1.26 ± 0.51 to 0.47 ± 0.49 logMar (p < .001). CDVA was significantly better in the 3-piece into the ciliary sulcus IOL group than both other groups. The final SE was -0.68 ± 0.94 diopters. The mean manifest refractive cylinder remained stable until the 6th month after the surgery (p = .454) and improved in the last 6 months of follow-up (p = .015). In the postoperative period, the cylinder was higher in the corneal incision iris-claw aphakic IOL group and lower in the 3-piece IOL into the ciliary sulcus group (p < 0,05). The corneal incision iris-claw aphakic IOL group presented the most postoperative complications. CONCLUSION All techniques showed satisfying results. The 3-piece IOL into the ciliary sulcus group showed the best visual and refractive performance, followed by the scleral tunnel iris-claw IOL group and the corneal incision iris-claw IOL group.
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Affiliation(s)
| | | | - Keissy Sousa
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Tiago Monteiro
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Nuno Lopes
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | | | - Carlos Cruz
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - Fernando Vaz
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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Anterior Versus Retropupillary Iris-Claw Intraocular Lens: Indications, Visual Outcome and Postoperative Complications. Ophthalmol Ther 2022; 11:771-784. [PMID: 35149965 PMCID: PMC8927565 DOI: 10.1007/s40123-022-00474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/26/2022] [Indexed: 11/03/2022] Open
Abstract
Introduction In cases of inadequate capsular support for intraocular lens (IOL) implantation, iris-claw IOL is a practical option. Iris-claw IOL can be implanted anteriorly or retropupillary. In this study, we compare the outcome of implantation of iris-claw IOL between anterior and retropupillary locations.
Methods We retrospectively examined the characteristics and outcomes of patients who underwent iris-claw “Artisan®” intraocular lens implantation (IOL) during the period of January 2014 to July 2020. The study population included all patients who underwent iris-claw IOL implantation, whether as a primary or secondary implantation, regardless of the causative indication. The study population was categorized by location of implantation and indication. The outcome was compared by visual acuity and postoperative complications. Results In this study, 171 eyes of 151 patients were included. Iris-claw IOL was implanted anteriorly in 110 (64.3%) eyes. The most common indication for iris-claw IOL was complicated cataract surgery, followed by ectopia lentis and by trauma. Patients with retropupillary position achieved better visual outcome whatever the causative indication. Anterior iris-claw IOL patients had more high intraocular pressure readings and macular edema. Conclusions This study revealed that retropupillary iris-claw IOL may achieve better visual outcome without significant postoperative complications. Further prospective studies and trials on larger sample sizes are needed.
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Singhal A, Kaushik J, Singh A, Shetty R. Descemet Stripping Endothelial Keratoplasty in Microcornea for Pseudophakic Bullous Keratopathy With Anterior Chamber Intraocular Lens. Cureus 2021; 13:e19262. [PMID: 34900458 PMCID: PMC8648131 DOI: 10.7759/cureus.19262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/05/2022] Open
Abstract
To report a case of bilateral pseudophakic bullous keratopathy (PBK) in a patient having bilateral microcornea with pre-existing anterior chamber intraocular lens (ACIOL) who underwent Descemet stripping endothelial keratoplasty (DSEK) with a successful postoperative visual outcome. A 36-year-old female, diagnosed with microcornea and congenital cataract in both eyes underwent lens aspiration sequentially followed by ACIOL implantation in both eyes. The patient reported to our centre and was diagnosed with bilateral PBK with ACIOL with microcornea. She also had associated secondary glaucoma, postoperative chronic uveitis, and hyphaema, which were controlled with medical management first and taken into consideration while planning DSEK. The patient underwent manual DSEK without intraocular lens exchange under local anaesthesia in both eyes sequentially with a good visual recovery postoperatively in both eyes. Descemet stripping automated endothelial keratoplasty (DSAEK)/DSEK seems a viable option in patients with microcornea who develop PBK following cataract surgery with retained ACIOL where there is absence of capsular support as well as deficiency of iris tissue.
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Affiliation(s)
| | - Jaya Kaushik
- Ophthalmology, Armed Forces Medical College, Pune, IND
| | - Ankita Singh
- Ophthalmology, Armed Forces Medical College, Pune, IND
| | - Rakesh Shetty
- Ophthalmology, Armed Forces Medical College, Pune, IND
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Supporting IOL'S in a Deficient Capsular Environment: The Tale of No "Tails". J Ophthalmol 2021; 2021:9933486. [PMID: 34557313 PMCID: PMC8455193 DOI: 10.1155/2021/9933486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of the following three distinct surgical procedures for secondary IOL implantation without capsular support: Iris-claw lens, flanged transscleral fixated IOLs (Yamane technique), and sutureless transscleral hook IOL fixation (Carlevale IOL). Materials and Methods In this retrospective comparative study, three different sutureless IOL implantation techniques were compared in patients without any capsular support. Visual acuity and outcomes were analyzed in 24 eyes of 23 patients (14 male and 9 female). Study included 13 iris-claw lenses (Artisan Ophtec), 6 flanged transscleral fixated IOLs (Yamane technique using a MA60MA Alcon Inc IOL), and 5 transscleral Carlevale IOLS (Carlevale IOL, Soleko, Italy). Results logMAR mean best-corrected visual acuity (BCVA) improved from 0.49 ± 0.19 to 0.19 ± 0.10 at three months after surgery (p < 0.05). Postoperative BCVA was similar in all three groups, and no intergroup difference was noted. Three eyes (12.5%) had a raised IOP >25 mmHg, 2 eyes (8%) presented a subluxated/dislocated IOL, 4 eyes (16%) had corneal edema longer than 7 days, 3 eyes (12.5%) had irregular pupil profile, 2 eyes (8%) had vitreous hemorrhage, 7 eyes had (29%) corneal astigmatism over 3 diopters, and one patient (4%) developed cystoid macular edema (CME). Conclusions All three surgical procedures can be considered adequate to correct aphakia in patients without capsular support with significant improvement in visual acuity and low complication.
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Glued intraocular lens in eyes with deficient capsules: retrospective analysis of long-term effects. J Cataract Refract Surg 2021; 47:496-503. [PMID: 32925654 DOI: 10.1097/j.jcrs.0000000000000416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the long-term (6-12 years) results and complications of glued transscleral-fixated intraocular lens (IOL). SETTING Dr. Agarwal's Eye Center, Chennai, India. DESIGN Retrospective case series. METHODS Eyes with glued IOL of more than 5-year follow-up were evaluated. Visual acuity (logarithm of the minimum angle of resolution [logMAR]), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness, central foveal thickness, and ocular residual astigmatism (ORA) were evaluated. RESULTS Overall, 91 eyes (63 patients) with mean postoperative 8.2 ± 2.3 years were analyzed. The duration was 10 to 12 years in 31 eyes (34%), 9 years in 14 eyes (15.3%), and 6 to 9 years in 46 eyes (50.5%). No subscleral haptic was visible in 50% eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The corrected distance visual acuity (CDVA) was 0.50 ± 0.50 logMAR. Clinically, no tilt was seen in 87 eyes (95.6%), whereas detectable tilt was seen in 4 eyes (4.3%). The optical coherence tomography microtilt was 0.8 ± 1.7 and 0.4 ± 1.2 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.10 ± 1.00 diopter. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%), and uveitis-glaucoma-hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%) keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries performed. CONCLUSIONS Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long-term.
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Thulasidas M. Retropupillary Iris-Claw Intraocular Lenses: A Literature Review. Clin Ophthalmol 2021; 15:2727-2739. [PMID: 34211261 PMCID: PMC8240859 DOI: 10.2147/opth.s321344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 01/02/2023] Open
Abstract
Retropupillary iris-claw intraocular lenses (ICIOLs) have been increasingly chosen by surgeons nowadays as a primary or secondary procedure of IOL implantation in eyes with insufficient capsular or zonular support. They have gained popularity due to their simple fast technique, favourable functional outcomes, and safety. The transition in the ICIOL fixation from prepupillary to a more biologically appropriate retropupillary position and change in the optic design from biconvex to convex-concave have provided better visual outcomes and improved safety. A peer-reviewed literature search was conducted in Medline (PubMed), Embase, and Cochrane Library using the keywords "retropupillary iris claw" and "iris claw". The search yielded 310 articles that were screened. Forty-three articles on retropupillary ICIOLs were finally found to be relevant and reviewed in full-text versions. The functional outcomes following retropupillary implantation of ICIOLs have been acceptable in eyes with no ocular co-morbidities otherwise. However, the indications for surgery may affect the outcomes. The major postoperative complications directly associated with ICIOLs include pupil ovalization and redislocation. Nevertheless, the rate of disenclavation depends on the experience and skill of the surgeon. This review is based on a literature review, and it focuses on the preoperative evaluation, surgical technique, postoperative outcomes, and associated complications. Prospective randomized trials with a larger sample size and longer follow-up are needed for comparison with other techniques of IOL fixation and confirmation of long-term safety profile.
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Affiliation(s)
- Mithun Thulasidas
- Cataract and Glaucoma services, Sankara Eye Hospital, Coimbatore, Tamil Nadu, 641035, India
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Caporossi T, Tartaro R, Albani G, Barca F, Giansanti F, Rizzo S. Via pars plana anterior iris enclavation IOL fixation. Int J Ophthalmol 2021; 14:774-776. [PMID: 34012895 DOI: 10.18240/ijo.2021.05.20] [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: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To describe a via pars plana anterior iris enclavation intraocular lens (IOL) fixation technique. METHODS A total of 35 consecutive aphakic vitrectomised patients (average age 71.12±10.12y) underwent pars plana vitrectomy (PPV) and via pars plana anterior iris enclavation IOL fixation. RESULTS The mean preoperative best corrected visual acuity (BCVA) was 0.11±0.14 logMAR, the mean postoperative BCVA was 0.07±0.11 logMAR. The preoperative mean spherical equivalent was 7.22±4.21 D. The final mean spherical equivalent was -0.25±0.15 D. No eyes had hypotony, retinal or choroidal detachment or endophthalmitis. CONCLUSION This technique may be a safe and useful in the case of aphakia, and a prospective study would be useful to confirm this findings.
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Affiliation(s)
- Tomaso Caporossi
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy
| | - Ruggero Tartaro
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy
| | - Giancarlo Albani
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy
| | - Francesco Barca
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy
| | - Fabrizio Giansanti
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy
| | - Stanislao Rizzo
- Department of Surgical and Translational Medicine, Eye Clinic, University of Florence, Azienda Ospedaliera Universitaria Careggi, Florence 50139, Italy.,Department of Ophthalmology, Catholic University of Sacred-Heart Foundation "Policlinico Universitario A. Gemelli" IRCCS, Rome 00168, Italy
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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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Iris-Claw Intraocular Lens Implantation in Various Clinical Indications: A 4-Year Study. J Clin Med 2021; 10:jcm10061199. [PMID: 33805747 PMCID: PMC7998776 DOI: 10.3390/jcm10061199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups both before and after the surgery, but 4 years after the surgery IOP values in group IV were higher than in group III. The cECC decreased every year after the surgery in all groups, but four years after the IOL implantation, the lowest cECC values were observed in group IV. At the same time, all groups of patients showed improved BCVA, stable refraction, and a low percentage of postoperative complications.
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Sankarananthan R, Prasad RS, Dheera MS, Shekhar M, Sen S, Janani R. Retrospective analysis of visual outcomes in retropupillary iris-suture-fixated rigid intraocular lens in a tertiary eye center in southern India. Int Ophthalmol 2020; 41:973-980. [PMID: 33179206 DOI: 10.1007/s10792-020-01651-7] [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: 08/01/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report clinical outcomes of retropupillary iris-suture-fixated rigid intraocular lens (IFIOL) SETTING: Tertiary care ophthalmic hospital DESIGN: Retrospective study METHODS: This study included all eyes undergoing IFIOL with a minimum follow-up of 6 months between April 2017 and January 2019. Patients with preexisting anterior or posterior segment pathologies causing defective vision, uveitis or history of previous intraocular surgeries with exception of cataract surgery were excluded from the study. Data were retrieved from electronic medical records, and we documented demographics, history, position of cataractous lens or IOL, primary/secondary surgery and its complications. Postoperative visual acuity, pupillary response, diplopia, centration of IOL, inflammation were also recorded at the baseline visit and at 1 month, 3 months and 6 months postoperatively. RESULTS One hundred and ten eyes of 110 patients that underwent IFIOL were evaluated. Twenty-two patients (20%) underwent primary IFIOL, whereas 67 (60.9%) patients had secondary IFIOL. In 18 patients (16.36%), IFIOL was done to reposition decentered/dislocated IOLs. At the final follow-up, there was a significant improvement in corrected distance visual acuity (CDVA) with 87 patients (79.09%) achieving CDVA of 6/12 or better. IFIOL was stable and centered in 101 eyes (91.81%). Two patients (1.81%) had intraoperative complications. Postoperative iritis was seen in 7 patients (6.36%), and 4 patients (3.63%) had rise in IOP. CONCLUSION This is a safe, reliable, reproducible technique for aphakia rehabilitation and decentered IOL stabilization with good clinical outcome, especially in a limited resource setting.
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Affiliation(s)
- R Sankarananthan
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - R Senthil Prasad
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | | | - Madhu Shekhar
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India.
| | - Sagnik Sen
- Department of Retina and Vitreous, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - R Janani
- Department of Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
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Abela-Formanek C, Reumüller A. Sekundäre Linsenimplantation: chirurgische Techniken und Ergebnisse. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEs stehen verschiedene alternative chirurgische Optionen zur Verfügung, um eine sekundäre Intraokularlinse (IOL) in Augen mit unzureichender Kapselunterstützung zu implantieren. Erfolgreiche Techniken umfassen die Implantation einer irisfixierten IOL (IFIOL), einer kammerwinkelgestützten Vorderkammerlinse (ACIOL) oder verschiedene Variationen zur Sklerafixierung (SFIOL). Jede dieser Methoden hat sich als sicher und effektiv erwiesen, weist jedoch verfahrensspezifische Einschränkungen auf. Jüngste Studien zeigen, dass die Entwicklung neuer chirurgischer Techniken diesen Patienten weiterhin sichere und reproduzierbare Behandlungsmöglichkeiten bietet. Obwohl die Implantation von sekundären IOLs ohne Kapselunterstützung von vielen Faktoren, einschließlich der Präferenz des Chirurgen, abhängt, sind nahtlose sklerafixierende Techniken für die chirurgische Gemeinschaft von wachsendem Interesse. Das Bestreben nach kürzeren und weniger traumatischen Operationen sowie nach reproduzierbaren und funktionell guten Ergebnissen, fördert dabei die Entwicklung von neuen Operationstechniken, Intraokularlinsen und Instrumenten. Diese Übersichtsarbeit gibt einen Einblick in alte und neue Behandlungsmethoden zur Korrektur von Aphakie mit sekundären Intraokularlinsen
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Artisan iris-claw intraocular lens implantation in vitrectomised eyes. Eye (Lond) 2020; 35:1393-1397. [PMID: 32555519 DOI: 10.1038/s41433-020-1022-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To present the visual acuity (VA) results and complication rates following Artisan intraocular lens (IOL) insertion in vitrectomised eyes. METHODS Outcome data were collected for all vitrectomised patients who had undergone Artisan IOL insertion between January 2014 and May 2019 at Moorfields Eye Hospital. All those with follow-up greater than 2 months were included in the analysis. RESULTS Sixty-nine eyes from 61 patients were included. Average follow up was 2 years. Fifty-five (80%) eyes had at least one ocular comorbidity prior to Artisan IOL insertion. At final follow up 46 (67%) eyes had best-corrected VA better than 6/12. Sixty-three eyes (91%) either gained or maintained VA. Mean post-operative spherical equivalent was -0.2D. Two (3%) lenses became de-enclavated requiring further surgery. Two (3%) eyes developed acute post-operative cystoid macular oedema. Two (3%) required additional topical IOP-lowering therapy to their pre-operative glaucoma regimen. One eye had mild corneal oedema, which persisted for 1 year following surgery and subsequently resolved. CONCLUSIONS Artisan IOL insertion is a safe and effective option for the surgical correction of aphakia in vitrectomised eyes lacking capsular support. Refractive results comparable to posterior chamber IOL placement can be achieved with these lenses.
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The Influence of Decentration on Higher-Order Aberrations in Artisan Aphakic Intraocular Lens Implantation Eyes. J Ophthalmol 2020; 2020:7601524. [PMID: 32351725 PMCID: PMC7171672 DOI: 10.1155/2020/7601524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To characterize the influence of decentration on higher-order aberrations of Artisan aphakic intraocular lens implantation eyes. Setting. Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China. Design Retrospective case series. Methods Twenty-three eyes of 18 patients were retrospectively examined. Location of the IOL was imaged using a slit-lamp, and decentration (the distance from the center of a pupil to the geometric center of the IOL) was measured using the AutoCAD 2007 software. Ocular and internal higher-order aberrations were measured using the wavefront analyzer KR-1W (Topcon) and their correlation with decentration were analyzed. Coma, spherical, 3rd-, 4th-order, trefoil, tetrafoil aberrations, ocular, and internal higher-order aberrations were calculated for a 4.0 mm pupil diameter. Results The mean age of patients was 33.6 ± 21.4 years (ranging from 7 to 72 years). The mean follow-up period was 28.2 ± 10.5 months (ranging from 12 to 52 months). The mean postoperative best-corrected visual acuity (BCVA) was 0.19 ± 0.19 logMAR (range −0.18–0.52). The mean decentration was 0.57 ± 0.28 mm (range 0.15–1.21 mm). There was no correlation between Artisan IOL decentration and ocular higher-order aberrations, internal higher-order aberrations, coma, spherical, 3rd-, 4th-order, trefoil, and tetrafoil aberrations, respectively. There was a positive correlation between Artisan IOL decentration and 2nd-astig aberrations when 2nd-astig aberrations were less than 0.1. Conclusions The position of Artisan IOLs showed slight decentration and the amounts of decentration were not large enough to influence higher-order aberrations.
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Castaldelli GB, Firmino GDC, Castaldelli VA, Costa RDS, Ribeiro JC. Use of Techniques for Scleral and Iris Fixation in Secondary Implantation of Intraocular Lenses. Ophthalmic Res 2020; 64:1-9. [PMID: 32163944 DOI: 10.1159/000507120] [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: 12/11/2019] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients' visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient's eye and the improvement of the surgeon's learning curve.
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Affiliation(s)
| | | | | | - Rafael de Souza Costa
- Department of Ophthalmology, Instituto Cearense de Oftalmologia (ICO), Fortaleza, Brazil
| | - João Crispim Ribeiro
- Department of Ophthalmology, Christus University Center (Unichristus), Fortaleza, Brazil.,Department of Ophthalmology, Instituto Cearense de Oftalmologia (ICO), Fortaleza, Brazil
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Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2019; 43:369-376. [PMID: 28410720 DOI: 10.1016/j.jcrs.2016.12.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/09/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN Retrospective case series. METHODS All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. RESULTS The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. CONCLUSIONS When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.
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Affiliation(s)
- Greg Brunin
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmar Sajjad
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Kim
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ildamaris Montes de Oca
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Mitchell P Weikert
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Douglas D Koch
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina Al-Mohtaseb
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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Touriño Peralba R, Lamas-Francis D, Sarandeses-Diez T, Martínez-Pérez L, Rodríguez-Ares T. Iris-claw intraocular lens for aphakia: Can location influence the final outcomes? J Cataract Refract Surg 2019; 44:818-826. [PMID: 30055690 DOI: 10.1016/j.jcrs.2018.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). SETTING Complejo Hospitalario Universitario de Santiago de Compostela, Spain. DESIGN Retrospective case series. METHODS Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. RESULTS The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. CONCLUSIONS Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME.
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Affiliation(s)
- Rosario Touriño Peralba
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain.
| | - David Lamas-Francis
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Sarandeses-Diez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Laura Martínez-Pérez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Rodríguez-Ares
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
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Kansal V, Onasanya O, Colleaux K, Rawlings N. Outcomes of Using Sutureless, Scleral-Fixated Posterior Chamber Intraocular Lenses. Semin Ophthalmol 2019; 34:488-496. [DOI: 10.1080/08820538.2019.1652761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vinay Kansal
- Department of Ophthalmology, University of Saskatchewan, Saskatoon, Canada
| | | | - Kevin Colleaux
- Saskatoon Retinal Consultants, Department of Ophthalmology, University of Saskatchewan, Saskatoon, Canada
| | - Nigel Rawlings
- Saskatoon Retinal Consultants, Department of Ophthalmology, University of Saskatchewan, Saskatoon, Canada
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Toro MD, Longo A, Avitabile T, Nowomiejska K, Gagliano C, Tripodi S, Choragiewicz T, Kaminska A, Figus M, Posarelli C, Forlini M, Jünemann AGM, Reibaldi M, Rejdak R. Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation. PLoS One 2019; 14:e0214140. [PMID: 30970023 PMCID: PMC6457484 DOI: 10.1371/journal.pone.0214140] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support. METHODS AND FINDINGS Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). CONCLUSIONS Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.
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Affiliation(s)
- Mario Damiano Toro
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- Institute for Ophthalmic Research, University Eye Hospital, Tuebingen, Germany
| | | | - Sarah Tripodi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Tomasz Choragiewicz
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kaminska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Matteo Forlini
- Institute of Ophthalmology, University of Parma, Parma, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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Verisyse versus Veriflex Phakic Intraocular Lenses: Refractive Outcomes and Endothelial Cell Density 5 Years after Surgery. J Ophthalmol 2018; 2018:4210460. [PMID: 30363928 PMCID: PMC6186327 DOI: 10.1155/2018/4210460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/11/2018] [Accepted: 08/26/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years. Methods We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively. Results The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (−0.25 ± 0.30 D and −0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group, p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed. Conclusion Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile.
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Martínez AH, González CVA. Iris-claw intraocular lens implantation: Efficiency and safety according to technique. J Cataract Refract Surg 2018; 44:1186-1191. [DOI: 10.1016/j.jcrs.2018.06.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/06/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022]
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Lajoie J, Glimois V, Petit T, Amelie R, Varenne F, Fournie P, Pagot Mathis V, Malecaze F, Wargny M, Gallini A, Soler V. [Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. J Fr Ophtalmol 2018; 41:696-707. [PMID: 30217610 DOI: 10.1016/j.jfo.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.
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Affiliation(s)
- J Lajoie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France.
| | - V Glimois
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - T Petit
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - R Amelie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Varenne
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - P Fournie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Pagot Mathis
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Malecaze
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - M Wargny
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - A Gallini
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Soler
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
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Mani A, Moulick P, Sati A, Gupta S. Glued intraocular lens with descemet stripping endothelial keratoplasty in aphakic bullous keratopathy. Med J Armed Forces India 2018; 74:183-186. [DOI: 10.1016/j.mjafi.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022] Open
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Abstract
The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in a video in the online version of this article. A complete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of a trained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.
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De Novelli FJ, Neto TLG, de Sena Rabelo G, Blumer ME, Suzuki R, Ghanem RC. Net technique for intraocular lens support in aphakia without capsular support. Int J Retina Vitreous 2017; 3:32. [PMID: 28856011 PMCID: PMC5572154 DOI: 10.1186/s40942-017-0085-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background This paper describes a modified surgical technique for intraocular lens implantation in aphakic eyes with no capsular support. Methods Retrospective case series. Seventeen eyes of 17 aphakic patients with no capsule support underwent intraocular lens (IOL) implantation using a standardized technique in which a net was created at the ciliary sulcus plane with two threads forming a net pattern. The net was used as support for the IOL. Follow-up ranged from 6 to 38 months, with an average of 23 months. Results In all cases, the IOL was safely implanted and remained stable during the follow-up. In 16 eyes, the IOL remained well centered; in one eye, slight decentration was observed. Distance-corrected visual acuity improved by a mean of 4 lines, from 1.13 (LogMAR) to 0.52 (P = 0.01). Conclusion This technique might be especially useful in cases of insufficient capsular support associated with tissue loss or iris atrophy. In these cases, iris fixation is not feasible; thus, the only surgical alternative is IOL scleral fixation. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0085-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Marcel Eduardo Blumer
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
| | - Ricardo Suzuki
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
| | - Ramon Coral Ghanem
- Sadalla Amin Ghanem Eye Hospital, 35 Camboriu Street, Joinville, SC 89216-222 Brazil
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Jare NM, Kesari AG, Gadkari SS, Deshpande MD. The posterior iris-claw lens outcome study: 6-month follow-up. Indian J Ophthalmol 2017; 64:878-883. [PMID: 28112126 PMCID: PMC5322700 DOI: 10.4103/0301-4738.198843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate functional and anatomical outcomes of posterior iris-claw intraocular lens (IOL) implant for correction of aphakia in eyes with inadequate capsular support. Materials and Methods: Prospective case series of 108 aphakic eyes with inadequate capsular support which underwent posterior iris-claw IOL with a 6-month follow-up period was conducted. The cases belonged to two clinical settings: elective secondary implantation and those with intraoperative posterior dislocation of cataractous lens or IOL. Main outcome measures were visual acuity, anterior chamber reaction, stability of IOL, endothelial cell count, intraocular pressure (IOP), and cystoid macular edema (CME). Results: The mean best-corrected visual acuity was LogMAR 0.25. None had chronic anterior chamber inflammation. The mean difference in central endothelial counts before surgery and 1 month after surgery was 104.21 cell/mm2 (4.92%). There was no statistically significant difference in central endothelial cell count at 1 and 6 months (P = 0.91) and also in the central macular thickness at preoperative and after 6 months suggestive of CME (P = 0.078). Three eyes had raised IOP which were managed with neodymium-doped yttrium aluminum garnet laser peripheral iridotomy. There were no IOL dislocations or other adverse events in our series. Conclusion: Posterior chamber iris-claw lenses are a good option in eyes with inadequate posterior capsular support. Chronic inflammation, poor lens stability, or significant central endothelial cell loss was not observed during the 6-month follow-up period.
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Affiliation(s)
- Nana Madhukar Jare
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Ashwini Ganesh Kesari
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Salil S Gadkari
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan D Deshpande
- Department of Cataract and Refractive Surgery, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Huerva V, Ascaso FJ, Caral I, Grzybowski A. Calculation of iris-claw IOL power for correction of late in-the-bag IOL complex dislocation. BMC Ophthalmol 2017; 17:122. [PMID: 28693457 PMCID: PMC5504750 DOI: 10.1186/s12886-017-0516-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
Background To assess the constants and formula for aphakia correction with iris-claw IOLs to achieve the best refractive status in cases of late in-the-bag IOL complex dislocation. Methods A literature search was performed. The following data were obtained: Iris-claw IOL model, Iridal or retroiridal enclavation, A-constant, ultrasound or optical biometry, formula employed and refractive outcomes. Acceptable emmetropia was considered if the resulting spherical equivalent (SE) was within ±1.00 D. Results The majority of the studies used SRK/T formula (66.6%). The 88.9% of the reports obtained a SE within ±1.00 D. Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, the emmetropia (±1.00 D) of SE, was able to get near 100% of reported cases over the pupil implantation. However, the emmetropia decreased to 80% when the enclavation is retropupilar using the same formula. The A-constant can vary from 116.7 to 117.5 for retropupilar enclavation. Conclusions Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, ±1.00 D of SE, is able to get near 100% of cases. Nevertheless, ±1.00 D of SE decreased to 80% of the cases when the enclavation is retropupilar.
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Affiliation(s)
- Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain. .,IRB Lleida, Lleida, Spain.
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Isabel Caral
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain.,IRB Lleida, Lleida, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, Poznań, Poland.,University of Warmia and Mazury, Olsztyn, Poland
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Secondary Intraocular Lenses by the Retinal Surgeon: from Sclerotomies to Sutures. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0136-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Outcomes of Sutureless Iris-Claw Lens Implantation. J Ophthalmol 2016; 2016:7013709. [PMID: 27642519 PMCID: PMC5013207 DOI: 10.1155/2016/7013709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose. To evaluate the indications, refraction, and visual and safety outcomes of iris-claw intraocular lens implanted retropupillary with sutureless technique during primary or secondary operation. Methods. Retrospective study of case series. The Haigis formula was used to calculate intraocular lens power. In all cases the wound was closed without suturing. Results. The study comprised 47 eyes. The mean follow-up time was 15.9 months (SD 12.2). The mean preoperative CDVA was 0.25 (SD 0.21). The final mean CDVA was 0.46 (SD 0.27). No hypotony or need for wound suturing was observed postoperatively. Mean postoperative refractive error was −0.27 Dsph (−3.87 Dsph to +2.85 Dsph; median 0.0, SD 1.28). The mean postoperative astigmatism was −1.82 Dcyl (min −0.25, max −5.5; median −1.25, SD 1.07). Postoperative complications were observed in 10 eyes. The most common complication was ovalization of the iris, which was observed in 8 eyes. The mean operation time was 35.9 min (min 11 min, max 79 min; median 34, SD 15.4). Conclusion. Retropupilary iris-claw intraocular lens (IOL) implantation with sutureless wound closing is an easy and fast method, ensuring good refractive outcome and a low risk of complication. The Haigis formula proved to be predictable in postoperative refraction.
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Teichman JC, Compan J, Conlon R, Baig K. Use of a security suture during retropupillary implantation of an iris-claw IOL. J Cataract Refract Surg 2015; 41:2019. [PMID: 26475412 DOI: 10.1016/j.jcrs.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 11/16/2022]
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Scleral Fixation of Posteriorly Dislocated Intraocular Lenses by 23-Gauge Vitrectomy without Anterior Segment Approach. J Ophthalmol 2015; 2015:391619. [PMID: 26294964 PMCID: PMC4532867 DOI: 10.1155/2015/391619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022] Open
Abstract
Background. To evaluate visual outcomes, corneal changes, intraocular lens (IOL) stability, and complications after repositioning posteriorly dislocated IOLs and sulcus fixation with polyester sutures. Design. Prospective consecutive case series. Setting. Institut Universitari Barraquer. Participants. 25 eyes of 25 patients with posteriorly dislocated IOL.
Methods. The patients underwent 23-gauge vitrectomy via the sulcus to rescue dislocated IOLs and fix them to the scleral wall with a previously looped nonabsorbable polyester suture. Main Outcome Measures. Best corrected visual acuity (BCVA) LogMAR, corneal astigmatism, endothelial cell count, IOL stability, and postoperative complications. Results. Mean follow-up time was 18.8 ± 10.9 months. Mean surgery time was 33 ± 2 minutes. Mean BCVA improved from 0.30 ± 0.48 before surgery to 0.18 ± 0.60 (p = 0.015) at 1 month, which persisted to 12 months (0.18 ± 0.60). Neither corneal astigmatism nor endothelial cell count showed alterations 1 year after surgery. Complications included IOL subluxation in 1 eye (4%), vitreous hemorrhage in 2 eyes (8%), transient hypotony in 2 eyes (8%), and cystic macular edema in 1 eye (4%). No patients presented retinal detachment. Conclusion. This surgical technique proved successful in the management of dislocated IOL. Functional results were good and the complications were easily resolved.
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Yaşa D, Ağca A, Alkın Z, Çankaya Kİ, Karaküçük Y, Coşar MG, Yılmaz İ, Yıldırım Y, Demirok A. Two-Year Follow-Up of Artisan Iris-Supported Phakic Anterior Chamber Intraocular Lens for Correction of High Myopia. Semin Ophthalmol 2014; 31:280-4. [PMID: 25412329 DOI: 10.3109/08820538.2014.962164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the results of Artisan iris-supported phakic anterior chamber intraocular lens (pIOL) implantation in patients with high myopia. METHODS Medical records of patients who underwent Artisan pIOL implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a two- year follow-up were included. Spherical equivalent of manifest refractive error (SE), uncorrected visual acuity (UDVA), distance corrected visual acuity (CDVA), and endothelial cell density (ECD) were analyzed at six months, one year, and two years after surgery. RESULTS Sixty-two eyes of 42 patients were included in the study. All patients had a minimum anterior chamber depth of 3.0 mm from the endothelium. At two years, 68% of the patients were within ±0.50 D. Mean ECD was 2723 ± 311 cells/mm(2) preoperatively and 2630 ± 291 cells/mm(2) at six months postoperatively (3.4% loss, p = 0.001). ECD loss from six months postoperatively to two years postoperatively was not statistically significantly different. In three eyes (4.8%) of two patients, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected. CONCLUSION Artisan pIOL implantation is a safe and highly effective procedure for surgical correction of high myopia. ECD loss stabilizes in the early postoperative period.
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Affiliation(s)
- Dilek Yaşa
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | - Alper Ağca
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | - Zeynep Alkın
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | | | - Yalçin Karaküçük
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | | | - İhsan Yılmaz
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | - Yusuf Yıldırım
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and
| | - Ahmet Demirok
- a Beyoglu Eye Research and Training Hospital , Istanbul , Turkey and.,b Istanbul Medeniyet University, Department of Ophthalmology , Istanbul , Turkey
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Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study. Eur J Ophthalmol 2014; 25:208-13. [PMID: 25363856 DOI: 10.5301/ejo.5000527] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support. METHODS In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion. RESULTS All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred. CONCLUSIONS Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.
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Abstract
The intraocular correction of aphakia in the anterior chamber currently consists of two options: an angle supported intraocular lens (IOL, Kelman Multiflex) and an iris fixated IOL (Artisan/Verisyse). The angle supported IOL is fixated with four haptic points in the anterior chamber and the iris fixated IOL is enclavated to the anterior iris surface. Acceptable results of both IOLs are reported in the literature; however both IOLs show some long-term complications in some eyes. Alternatives to these anterior chamber IOLs to correct aphakia are the retropupillary fixated Artisan and sclera fixated IOLs.
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Affiliation(s)
- T Kohnen
- Klinik für Augenheilkunde, Klinikum der Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland,
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Xue K, Hildebrand GD. Retropupillary Artisan intraocular lens implantation in very young children with aphakia following penetrating eye injuries. J AAPOS 2013; 17:428-31. [PMID: 23993721 DOI: 10.1016/j.jaapos.2013.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 11/29/2022]
Abstract
Visual rehabilitation of children with penetrating eye injuries often carries a poor prognosis. When capsular support is insufficient, implantation of the aphakic Artisan (Ophtec, The Netherlands) iris-claw intraocular lens (IOL) in front of the iris is an accepted alternative to anterior chamber or scleral-fixated implantation. With anterior chamber lens implantation, however, there is concern about long-term endothelial loss. Posterior iris (or retropupillary) fixation of an Artisan IOL theoretically reduces this risk. We present three consecutive cases of penetrating eye injury resulting in aphakia successfully repaired by retropupillary implantation of the Artisan IOL. The patients achieved best-corrected visual acuities of 20/25 to 20/30 (0.10-0.15 logarithm of the minimum angle of resolution) at 8, 13, and 22 months' follow-up, respectively.
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Affiliation(s)
- Kanmin Xue
- Pediatric Ophthalmology Service, King Edward VII Hospital, Windsor, United Kingdom
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Abstract
PURPOSE Implantation of a scleral-fixated intraocular lens (SFIOL) for the surgical management of aphakia in the absence of capsular support is a safe procedure with a low risk of complications in the early postoperative period. However, data on long-term functional outcome are limited. The purpose of this study is to assess the long-term outcome and complication profile of SFIOL implantation in a cohort of Chinese patients. METHODS All patients who had undergone primary or secondary SFIOL implantation between 1997 and 2008 were retrospectively reviewed for visual outcomes and complications. Patients' demographic data and information on baseline preoperative visual acuity, indication for surgery, postoperative complications, latest postoperative visual acuity and indication for any subsequent surgical procedures were collected and analysed. RESULTS 104 eyes of 99 patients (51 males and 48 females) were identified. Mean age at surgery was 67.1 ± 13 years (range 32-88 years), with a mean follow-up of 73.4 ± 43 months (range 12-180 months). 72% of patients had unchanged or improved final postoperative visual acuity. 25 of 104 eyes (24.0%) had postoperative complications, with suture-related complications being the most common. 13 eyes (12.5%) required further procedures for postoperative complications. Suture breakage leading to lens subluxation occurred in two eyes (1.9%). CONCLUSIONS SFIOL implantation is valuable for the management of aphakia in the absence of capsular support, and our visual outcomes and complication rates are comparable to other case series. The long-term outcomes and safety profile are favourable, but potential long-term suture-related problems should be discussed with the patients before surgery.
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Affiliation(s)
- Abbie S W Luk
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, , Shatin, Hong Kong
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Kozomara B. Treatment of bilateral postoperative aphakia in a young patient with Still-Chauffard syndrome. SCRIPTA MEDICA 2012. [DOI: 10.5937/scriptamed1202111k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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