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

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

Purpose

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

Design

Retrospective consecutive clinical case study.

Methods

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

Results

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

Conclusions

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

[Long-term clinical and functional outcomes of high myopia correction by femtosecond laser-assisted implantation of an intrastromal ring]

OBJECTIVE

To analyze remote clinical and functional outcomes of correcting high myopia in patients with thin cornea by the method of femtosecond laser-assisted implantation of intracorneal implant MyoRing.

MATERIAL AND METHODS

The study included 22 patients (22 eyes; the mean age of study patients was 30.2±5.37 years). Mean spherical equivalent (SE) of refraction was -11.52±1.96 D, cylindrical component (cyl) of refraction was -2.04±1.64 D, minimal pachymetry index in the center was 491.6±20 µm, corneal hysteresis (CH) amounted to 8.6±1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.6±0.23 mm. All patients had a history of mild amblyopia. The follow-up period lasted 2 years.

RESULTS

Two years after the surgery uncorrected visual acuity was 0.6±1.22, corrected visual acuity 0.7±0.20. Mean spherical equivalent (SE) of refraction was 0.61±1.43 D, cylindrical component of refraction was -0.13±0.5 D. Predictability of SE within ±0.5 D was recorded in 84% of cases, ±1.0 - also in 84% of cases. Index of safety was 1.16, index of efficacy - 1.0. CH was 9.5±0.03 mm Hg. Mean pachymetry at the center did not change statistically significantly after the surgery in comparison to the initial data (p=1.00).

CONCLUSION

MyoRing implantation is an effective and safe method, which ensures correction of the spherical component of refraction, as well as correction of astigmatism, improvement of biomechanical properties of the cornea, and an increase in corneal hysteresis (p=0.01).

Ocular higher-order aberrations changes after implantable collamer lens implantation for high myopic astigmatism

Purpose

To investigate the changes in higher-order aberrations (HOAs) induced by the implantation of implantable collamer lenses (ICLs) and Toric ICL (TICL) in eyes with high myopia and high myopic astigmatism.

Methods

We investigated 33 eyes of 18 consecutive patients (in a prospective, interventional case series study), with spherical equivalent errors of -6.00 to -21.09 diopters (D) and cylindrical errors of -0.5 to -4.75 D, who underwent ICL and TICL implantation. Before and after 5 days, 2 and 6 months of surgery, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), defocus and adverse events of the surgery were assessed. Ocular HOAs were also evaluated by Hartmann-Shack aberrometry (Technolas PV, Rochester, New York, USA) before and after 6 months of surgery.

Results

At 6.0 months after surgery, the UCVA and BCVA in 40% and 66.7% of eyes were 20/20, respectively. Mean defocus refraction and astigmatism was reduced to -0.66 and 0.65 D from -12.79 and 2.18 at baseline, respectively. For a 6 mm pupil, HOAs were not significantly changed, merely from 0.417 ± 0.162 μ before surgery to 0.393 ± 0.119 μ after surgery (P = 0.45). Spherical aberration (Z400) increased significantly (P = 00.0). Surgical induced astigmatism was lower than 0.25 D, and there were no changes in trefoils and coma aberration. No vision-threatening complications occurred during the observation period.

Conclusion

This study shows that the ICL and TICL performed well in correcting high myopic astigmatism without significant changes in HOAs during a 6-month observation period, although the spherical aberration (Z400) increased significantly.

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

PURPOSE

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

SETTING

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

DESIGN

Retrospective cohort study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

FINANCIAL DISCLOSURE

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

Comparison of the visual outcomes between PRK-MMC and phakic IOL implantation in high myopic patients

PURPOSE

To compare the visual outcomes between PRK-MMC and phakic IOL in patients with more than 8 diopter (D) of myopia.

METHODS

This comparative study was performed on 23 eyes under treatment with Artiflex (group A) and 23 eyes under treatment with PRK-MMC (group B). Artiflex phakic IOL (Ophtec BV) was used in group A, and the VISX STAR S4 Excimer Laser (Abbott) was used for PRK-MMC in group B.

RESULTS

The safety index was 1.11 ± 0.23 and 1.05 ± 0.25 (P = 0.100) and the efficacy index was 1.02 ± 0.11 and 0.98 ± 0.10 (P = 0.266) in group A and B, respectively. At 1 year after surgery, the manifest refraction spherical equivalent was -0.17 ± 1.18 and -0.25 ± 0.18 D in group A and B, respectively (P = 0.471). Mesopic CS showed no significant difference between the two groups in any spatial frequency. Total coma was 0.24 ± 0.17 and 0.67 ± 0.40 μm (P < 0.001), spherical aberration was -0.11 ± 0.11 and 0.41 ± 0.18 μm (P < 0.001), and RMS HOAT was 0.50 ± 0.20 and 0.96 ± 0.45 μm (P<0.001) in group A and B, respectively.

CONCLUSION

Phakic IOL implantation was better than PRK-MMC in the correction of high myopia in terms of visual quality, but the two methods had no difference with regard to visual acuity. Therefore, PRK-MMC can be used when the anterior chamber depth is a limiting factor in the implantation of phakic IOLs.

Visian implantable contact lens versus AcrySof Cachet phakic intraocular lenses: comparison of aberrmetric profiles

Purpose

To evaluate the in vivo aberrometric performance of two phakic intraocular lenses (PIOLs); the Visian implantable contact lens (ICL) and the AcrySof Cachet PIOL.

Methods

Thirty eight eyes from 29 patients with an age range of 23–32 years and more than 9 D of myopia were divided into two groups; one group of 20 eyes received a Visian ICL model V4c, another group of 18 eyes received an AcrySof Cachet PIOL. Total higher order aberrations (HOAs) root mean square, total coma, and total spherical aberrations were recorded pre and 6 weeks postoperatively to evaluate and compare the aberrometric performance of the Visian ICL and the AcrySof Cachet PIOL implanted in highly myopic patients.

Results

Preoperatively, there were no significant differences in any studied parameters, except for preoperative spherical equivalent. Postoperatively, there were no statistically significant differences in the induction of HOAs between both PIOLs. The reduction in spherical aberrations was statistically significant in each group as well as in all study patients.

Conclusion

Both AcrySof Cachet PIOL and ICLs are effective phakic implants to correct high refractive errors. They both induce small amounts of negative spherical aberration that do not affect the total HOAs, yet reduce the positive ocular spherical aberration. This result is expected to improve the quality of vision in such patients.

Rotation stability of the cachet angle-supported phakic intraocular lens

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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