Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia

Comparison of the Biometric Characteristics After Long-term Implantation of Iris-fixated Phakic Intraocular Lens in Explanted and Nonexplanted Groups of Eyes

PURPOSE

To evaluate and compare the biometric characteristics of the anterior chamber of a group of patients with significant endothelial cell loss (ECL) who required phakic intraocular lens (pIOL) explantation and a group of patients who did not fulfill the explantation criteria related to corneal decompensation.

DESIGN

Retrospective, consecutive, interventional case series.

METHODS

The study included all consecutive patients receiving a pIOL implantation at Oftalmosalud Instituto de Ojos, Lima, Peru, between 2001 and 2012. The explanted group (E group) consisted of eyes in which the pIOLs were explanted due to ECL, and the nonexplanted group (NE group) consisted of eyes randomly selected in which the pIOL was not explanted with a minimum follow-up time of 8 years. Slit-lamp biomicroscopy, visual acuity, refraction, endothelial cell count, and anterior segment optical coherence tomography were assessed at the preoperative evaluation for both groups and before explantation in the E group and 8 years post-implantation in the NE group.

RESULTS

pIOLs were implanted in 265 eyes. The annual percentage of ECL was 1.47% and 5.55% in the NE group and E group, respectively (P < .001). The mean minimum endothelial lens distance (ELD) was 1.44 ± 0.22 mm and 1.05 ± 0.23 mm in the NE group and E group, respectively (P < 0.001). The mean time for explantation was 12.58 ± 3.79 years for the E group. Annual ECL could accurately discriminate between the NE group and E group; a cutoff point of 3.5 (%/year) or 86.5 (cells/years) had a 100% sensitivity and specificity. A cutoff of 1.21 mm in the minimum ELD has a 91% sensitivity and 79% specificity to discriminate between the E group and NE group.

CONCLUSIONS

pIOL explantation due to ECL occurs in eyes with a significantly postoperative lower minimum ELD. Annual ECL and minimum ELC can effectively discriminate between the E and NE groups.

Endothelial Cell Loss in Patients with Phakic Intraocular Lenses

Although the safety of phakic intraocular lenses (pIOLs) has been continuously improved over 70-years of development, high endothelial cell losses can occur even with current pIOL models. Numerous studies have demonstrated that the distance of a pIOL to the corneal endothelium plays a crucial role in the extent of endothelial cell loss. For this reason alone, higher endothelial cell loss tends to be observed with anterior chamber lenses than with posterior chamber lenses. Adequate preoperative anterior chamber depth is essential, at least for iris-fixed pIOLs, in order to ensure a safe distance from the endothelium. However, the anterior chamber becomes shallower with age and therefore it may be useful to consider patient age in the safety criteria. Although endothelial cell loss is generally low with current pIOL models, regular monitoring of the endothelial cell density remains essential due to large interindividual differences in patients with pIOLs. If the endothelial cell loss is greater than expected and the follow-up visits confirm the trend, the pIOL should be explanted without delay. The endothelial reserve should be considered on an individual basis by taking into account patient age, physiological endothelial cell loss, and loss due to further surgery. With careful indication and long-term patient care, pIOLs remain a safe treatment option.

Diagnostic Techniques to Increase the Safety of Phakic Intraocular Lenses

Preoperative and postoperative diagnostics play an important role in ensuring the safety of patients with phakic intraocular lenses (pIOLs). The risk of endothelial cell loss can be addressed by regularly measuring the endothelial cell density using specular microscopy and considering the endothelial cell loss rate and the endothelial reserve in accordance with the patient's age when deciding whether to explant a pIOL. The anterior chamber morphometrics, including the anterior chamber depth and the distance between the pIOL and the endothelium, measured using Scheimpflug tomography and anterior segment optical coherence tomography (AS-OCT), can help to assess the risk of the endothelial cell loss. In patients undergoing posterior chamber pIOL implantation, accurate prediction of the vault and its postoperative measurements using AS-OCT or Scheimpflug tomography are important when assessing the risk of anterior subcapsular cataract and secondary glaucoma. Novel approaches based on ultrasound biomicroscopy and AS-OCT have been proposed to increase the vault prediction accuracy and to identify eyes in which prediction errors are more likely. Careful patient selection and regular postoperative follow-up visits can reduce the complication risk and enable early intervention if a complication occurs.

Five-year clinical outcomes of rigid iris-fixated phakic intraocular lens in northern Chinese

PURPOSE

To investigate the 5-year clinic outcomes of rigid iris-fixated pIOL on the visual performance, complications and intraocular light scattering in northern Chinese.

METHODS

Thirty eyes implanted with iris-fixated phakic IOLs (pIOLs group) and 34 eyes with high myopia (myopia group) were involved in this study. At preoperatively, 6 months, 1, 3, and 5 years postoperatively, the uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD), and intraocular pressure (IOP) were measured in pIOLs group. The objective scatter index (OSI), modulation transfer function cut off (MTF cut off), and Strehl ratio were measured by Optical Quality Analysis System and a pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects' satisfaction in pIOLs and myopia groups.

RESULTS

At 5 years postoperatively, an UCVA of 20/20 or better was found in 43.33% of eyes in pIOLs group. At 6 months, 1, 3, and 5 years postoperatively, the mean ECD decrease were 1.29% ± 0.45%, 2.59% ± 1.30%, 6.67% ± 2.26%, and 10.80% ± 3.48%. The value of OSI in pIOLs group was significantly higher than that in myopia group (P < 0.001). The PDQ results showed that the subjects in myopia group complained less with intolerance of bright lights than those in pIOLs group. The values of Strehl ratio and MTF cut off in pIOLs group were significantly lower than that in myopia group (P < 0.001).

CONCLUSIONS

Iris-fixated pIOL induce more intraocular light scattering. A significant decrease in ECD was observed at 5 years postoperatively. An annual evaluation of ECD is necessary for patients undergoing pIOL implantation.

Long-term results in patients with iris-fixated foldable phakic intraocular lens for myopia and astigmatism

PURPOSE

To evaluate the long-term results of iris-fixated foldable phakic intraocular lenses (pIOLs) implantation for the management of myopia and astigmatism.

SETTING

Centro Hospitalar Universitário do Porto, Oporto, Portugal.

DESIGN

Prospective, clinical study.

METHODS

Patients who underwent Artiflex Myopia or Artiflex Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixed pIOLs implantation for the treatment of myopia or astigmatism between 2003 and 2011 were included. Refractive stability, refractive predictability, safety, efficacy, and cumulative probability of success were evaluated at five, 10, and 15 years of follow-up.

RESULTS

Five-, 10- and 15-year follow-ups were completed by 199 of 217 (91.7%), 187 of 217 (86.2%), and 43 of 45 (95.6%) eyes implanted with pIOLs, respectively. The mean spherical equivalent was -8.36±2.75, -0.11±0.31, -0.33±0.62, and -0.80±1.32 dioptres (D) preoperatively and after five, 10 and 15 years after surgery. At 5, 10, and 15 years after surgery, 100%, 95.6%, and 81.6% were within ±1.00D. The safety and efficacy indexes were 1.07 and 1.06 at five, 1.04 and 0.99 at 10, and 1.05 and 1.00 at 15 years of follow-up, respectively. Kaplan-Meier analysis showed survival rates of 97% at five years, 73% at 10 years, and 43% at 15 years of follow-up.

CONCLUSION

Long-term results demonstrate that the implantation of Artiflex pIOLs is a stable, predictable, and effective procedure at five, 10, and 15 years of follow-up. We recommend annual follow-up visits to evaluate endothelium cell density and anterior chamber depth decrease, alerting patients to this need in the preoperative evaluation.

Two-year results after combined phacoemulsification and iris-fixated phakic intraocular lens removal

PURPOSE

To describe and present results after a technique for cataract surgery combined with explantation of an iris-fixated phakic intraocular lens (IF-pIOL).

METHODS

The medical records of all patients, who had undergone cataract surgery combined with IF-pIOL explantation and subsequent implantation of a posterior chamber IOL by the Single Incision Technique (SIT), were reviewed. Data collection included preoperative and postoperative corrected distance visual acuity (CDVA), manifest refraction, and endothelial cell density (ECD) up to a follow-up time of 24 months.

RESULTS

Fifty myopic eyes (34 patients) and 9 hyperopic eyes (6 patients) had undergone a SIT procedure mainly because of cataract (67%). Postoperative CDVA improved in both the myopic eyes to 0.16 ± 0.37 logMAR, as in the hyperopic eyes to - 0.10 ± 0.55 logMAR with no eyes having loss of Snellen lines. Mean postoperative spherical equivalent was - 0.34 ± 0.72 D and - 0.10 ± 0.55 D, respectively. ECD loss 6 months after surgery was 5% and remained stable thereafter.

CONCLUSION

SIT for combined phacoemulsification and IF-pIOL removal yields good visual and refractive results and is a safe procedure in regard to ECD loss. The technique has advantages over the conventional procedure and is easy to perform.

Long term efficacy and safety profiles following posterior chamber phakic intraocular lens implantation in eyes with ≥ 10-year follow-up

PURPOSE

Evaluate long-term efficacy, safety, predictability and stability of a posterior chamber phakic intraocular lens (Visian ICL) in eyes with ≥10-year follow-up.

SETTING

Instituto de Microcirugía Ocular, Barcelona, Spain.

DESIGN

Retrospective study.

METHODS

Eyes undergoing ICL implantation from 2008-2011 with ≥10-year follow-up were included. Variables analyzed were: preoperative, 1-month, 1-year, 5-years and last follow-up uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE), endothelial cell count (ECC) and intraocular pressure (IOP). Descriptive statistics were performed and results reported following the Standard for Reporting Refractive Surgery Outcomes.

RESULTS

45 eyes (26 patients) were analyzed, mean follow-up 11.35 ± 1.30 years. Mean preoperative SE was -10.06 ± 3.40D and mean preoperative cylinder -1.55 ± 1.45D. At last follow-up, efficacy and safety indices were 0.79 and 1.12, respectively. In total, 32 (71%) eyes achieved an UDVA of ≥20/40. 22 (49%) eyes gained ≥1 line of CDVA, and 2 (4%) eyes lost ≥2 lines of CDVA. At final follow-up, 19 (42%) and 29 (64%) eyes were within ±0.50D and ±1.00D of attempted SE correction, respectively. 31 (69%) eyes had ≤1.00D of postoperative astigmatism and 29 (74%) eyes were within ±15° from the intended correction axis. At the last visit, a statistically significant myopic progression of -0.75 ± 1.20D was observed (p=0.01). ECC loss at last follow-up was 9.85 ± 11.35%. IOP remained stable. There were no intraoperative complications. 3 eyes (7%) developed cataract after 10 years.

CONCLUSIONS

Long-term results demonstrate that ICL is effective, predictable, stable and safe.

Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results

PURPOSE

To evaluate a 12-year follow-up of myopic patients after iris-fixated phakic intraocular lenses (IF pIOLs) implantation. Setting. Ophthalmology Department, Military University Hospital in Prague (Czech Republic).

DESIGN

Single-center retrospective cohort study.

METHODS

We describe the results of a cohort study that included 85 eyes of 46 myopic patients who underwent implantation of Verisyse myopia, Veriflex, and Verisyse myopia toric (all Abbott Medical Optics, Inc.) intraocular lenses. Refractive functions and adverse events were assessed preoperatively, at 6 months, and 1, 2, 5, and 12 years after IF pIOL implantation.

RESULTS

Mean spherical equivalent was measured as -9.37 ± 2.87 D, 0.14 ± 0.61 D, and -0.42 ± 1.08 D, preoperatively, at 6 months and 12 years postoperatively, respectively. There was a significant reduction in the cylinder after surgery. At 12 years postoperatively, 90% of eyes had uncorrected distance visual acuity (UDVA) of 20/40 and 64% of 20/20. The safety index was 1.10 for the whole postoperative follow-up period. We found cataract formation in 3 eyes (3.5%). The endothelial cells loss (EC loss) directly caused by IF pIOL implantation was 6.0%, 8.10%, 12.8%, and 11.9%, at 1, 2, 5, and 12 years, respectively. In our cohort, 95% of eyes lost a higher percentage of EC than would be expected from a physiological loss at 12 years postoperatively. We found a significant negative interaction between preoperative pachymetry and EC loss, indicating that the lower pachymetry leads to a faster decline in endothelial cells density (ECD). IF pIOL re-enclavation was found in 28% of eyes. 7% of subluxations were caused by trauma. The mean time of nontraumatic re-enclavation was 6 years postoperatively.

CONCLUSIONS

The study confirmed the advantages of IF pIOL implantation due to rapid visual recovery and stable visual function over the 12-year follow-up and also showed the influence of lower corneal pachymetry regarding EC loss.

Short-Term Efficacy and Safety of Cataract Surgery Combined with Iris-Fixated Phakic Intraocular Lens Explantation: A Multicentre Study

The purpose of this study was to evaluate the short-term efficacy and safety of cataract surgery for patients with iris-fixated phakic intraocular lenses (pIOLs). This study included 96 eyes of 91 patients. The changes in the logMAR uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), subjective spherical equivalent (SE), astigmatism, and endothelial cell density (ECD) were collected retrospectively. The intraoperative and postoperative complications also were investigated to assess the surgical safety. The preoperative UCVA and BCVA improved significantly at month 1 postoperatively, respectively (p < 0.001 for both comparisons). The efficacy and safety index at month 1 postoperatively were 1.02 ± 0.56 and 1.31 ± 0.64, respectively. The SE at month 1 postoperatively was significantly (p < 0.001) higher compared to preoperatively, whereas the subjective astigmatism did not differ significantly (p = 0.078). The ECD significantly decreased at month 1 (p < 0.001). The most common postoperative complication was intraocular pressure elevation exceeding 25 mmHg in 10.4% of eyes, which was controlled with medications in all cases until month 1 postoperatively. No intraoperative complications developed. Cataract surgeries for patients with iris-fixated pIOLs were performed safely with good visual outcomes.

Changes in visual outcomes and ocular morphometrics after foldable myopic and toric intraocular lens implantation: 5 year results

PURPOSE

To evaluate the refractive, visual, and morphometric changes after implantation with a foldable iris-fixated phakic intraocular lens (pIOL) to correct myopia or astigmatism.

SETTING

University Eye Clinic Maastricht, the Netherlands.

DESIGN

Prospective case series.

METHODS

We evaluated patients implanted with the Artiflex Myopia (Toric) iris-fixated pIOL as of January 2004. Measurements were performed annually and reported after 1 and 5 years.

RESULTS

The study included 481 eyes (277 patients; age 39.8±10.9 years [SD]). Five years postoperatively 91% of eyes were within ±1.0 D of target, and the mean myopisation over a 5 year period was 0.22 diopters (p<0.001). The logMAR CDVA increased by a mean 0.015 (p=0.015) over 5 years; 88% of eyes had a CDVA of 20/20 or better and 5.5% lost 2 or more lines of CDVA. Mean UDVA increased by 0.045 logMAR over 5 years (p<0.001); 96% reached an UDVA of 20/40 or more. Anterior chamber depth (ACD) decreased by 0.04 mm (p<0.001), and axial length (AXL) increased by 0.23 mm (p<0.001) over 5 years. Chronic endothelial cell loss showed a 5-year decline of 320 cells/mm2 in the myopic and 310 cells/mm2 in the toric subgroups (p<0.001). Cataract resulted in pIOL explantation in 4.0% of eyes (mean survival 59.0±40.0 months); higher preoperative age (hazard ratio [HR], 1.13; p<0.001) and smaller ACD (HR, 6.80; p= 0.035) were risk factors for shorter survival due to cataract formation.

CONCLUSION

Over 5 years logMAR CDVA and UDVA decreased significantly due to myopisation caused by lenticular changes and AXL elongation.

Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up

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.

Implantation of an iris-fixated phakic intraocular lens for the correction of hyperopia: 15-year follow-up

PURPOSE

To assess the predictability, efficacy, stability, and safety of implantation of an Artisan iris-fixated phakic intraocular lens (IF-pIOL) for the correction of hyperopia with a follow-up of up to 15 years.

SETTING

Leiden University Medical Center, the Netherlands.

METHODS

Patients operated by a single surgeon up to 2007 were identified, and data on refraction, corrected distance visual acuity (CDVA), uncorrected distance visual acuity, endothelial cell (EC) density, and complications were collected.

RESULTS

A total of 61 eyes (32 patients) were analysed. The mean spherical equivalent decreased from +6.43 ± 1.78 diopters (D) preimplantation to -0.22 ± 0.57 D at 1 year postimplantation and remained stable throughout follow-up. A stable CDVA with safety indices ranging from 0.91 to 1.10 and efficacy indices between 0.43 and 0.86 were observed. Follow-up time had a significant effect on EC density with an estimated annual decline of 58 cells/mm2 after IF-pIOL implantation. IF-pIOL explantation was performed in a 10 eyes (16.4%) after 8.13 ± 5.11 years. The main reason for IF-pIOL explantation was EC loss (4 eyes [6.6%]). Pigment dispersion was the most encountered complication, observed in 9 eyes (14.8%).

CONCLUSIONS

Visual and refractive results after implantation of an IF-pIOL to correct hyperopia show favorable and stable results with long-term follow-up. Lifelong monitoring of EC counts is mandatory. Pigment dispersion might be a problem in hyperopic eyes implanted with an IF-pIOL; a shallower anterior chamber depth and a convex iris configuration might be predisposing factors.

Efficacy and safety of iris-supported phakic lenses (Verisyse) for the treatment of high myopia: 5-year results

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.

Middle- and long-term results after iris-fixated phakic intraocular lens implantation in myopic and hyperopic patients: a meta-analysis

The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects. The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects of iris-fixated pIOLs on myopic and hyperopic eyes with a follow-up of at least 2 to 4 years. Visual and refractive results after implantation for correction of myopia are positive and the complication rate is low. Endothelial cell loss appears to be at an acceptable rate, although the range of endothelial cell change is too wide to draw firm conclusions. Care should be taken when considering an iris-fixated pIOL for hyperopic eyes because complication rates, particularly pigment dispersion, might be higher than those in myopic eyes. More well-designed, long-term studies are needed, especially in hyperopic eyes. The authors advocate for standardized reporting of refractive surgery data. Initiatives proposed by journal authors and editors to achieve uniformity should be supported.

Long-Term Destiny of Corneal Endothelial Cells in Anterior Chamber Intraocular Lens-Implanted Eyes

Purpose

To investigate the long-term changes of corneal endothelial cells (EC) in anterior chamber intraocular lens- (AC-IOL-) implanted eyes.

Methods

Retrospective study. We included 37 eyes (25 patients) that received AC-IOL implantation previously in the Eye and ENT Hospital of Fudan University between 1995 and 2016. Follow-up outcomes included the best-corrected visual acuity (BCVA), endothelial cell density, hexagonality, coefficient of variance, and central corneal thickness.

Results

In total, 23 eyes (62.16%) with phakic and 14 eyes (37.84%) with aphakic AC-IOLs were included. Among these, 3 eyes (8.11%) were angle-supported AC-IOLs and 34 eyes (91.89%) were Artisan iris-fixated AC-IOLs. The mean age of patients was 41.40 ± 17.17 years, and the mean follow-up time was 12.12 ± 4.71 years in our study. At the follow-up time, corneal decompensation existed in 3 angle-supported AC-IOL eyes with a rate of 100% and 15 iris-fixated AC-IOL eyes with a rate of 44.12%. AC-IOL displacement occurred in 14 (41.18%) iris-fixated AC-IOL eyes. In the 19 iris-fixated AC-IOL eyes without corneal decompensation, significant changes also took place in corneal endothelial cells. The endothelial cell density decreased from 2843.26 ± 300.76 to 2015.58 ± 567.99 cells/mm² (29.1% loss, P < 0.001) and hexagonality decreased from 51.21 ± 7.83 to 42.53 ± 9.17 (%) (16.9% loss, P < 0.001). The Kaplan–Meier survival curve also demonstrated the accumulated expectation rates of corneal endothelial cell decomposition for AC-IOLs with a median survival time of 12 years.

Conclusion

We reported a significant chronic loss and long-term decompensation destiny of corneal endothelial cells in AC-IOL eyes. Semiannual or annual follow-up and evaluation of endothelial cells should be conducted in AC-IOL-implanted patients.

Phakic intraocular lenses: An overview

Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.

Long-term changes in visual outcomes and ocular morphometrics after myopic and toric phakic intraocular lens implantation: Five- and 10-year results

PURPOSE

To evaluate the long-term refractive and visual, anterior chamber depth, and axial length (AL) changes and complications after rigid iris-fixated phakic intraocular lens (pIOL) implantation to treat myopia or astigmatism.

SETTING

University Eye Clinic Maastricht, Maastricht UMC+, the Netherlands.

DESIGN

Prospective case series.

METHODS

The study evaluated patients who had implantation of an Artisan myopic or toric iris-fixated pIOL as of January 1998. Changes were measured annually and reported after 1, 5, and 10 years postoperatively.

RESULTS

The study comprised 460 eyes (250 patients; mean age 41.1 years ± 10.7 [SD]). Over 10 years, the mean myopization was -0.79 diopters (D) (P < .001), with 52% of eyes within ±1.0 D of target. The mean increase in the logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over 10 years was 0.05 (P < .001); 95% of eyes had a CDVA of 20/40 or more and 7% lost 2 or more lines of CDVA. The mean logMAR uncorrected visual acuity (UDVA) increased by 0.14 over 10 years (P < .001); 96% had a UDVA 20/40 or better. The AL increased by 1.14 mm over 10 years (P = .009). Ten percent of pIOLs were explanted because of cataract formation after a mean of 97.9 ± 34.9 months. A higher preoperative age (hazard ratio [HR], 1.08; P < .001) and longer AL (HR, 1.34; P < .001) were risk factors for shorter survival because of cataract formation.

CONCLUSION

Ten years after rigid iris-fixated pIOL implantation, the CDVA and UDVA decreased significantly as a result of significant myopization caused by an increased AL unrelated to the pIOL.

Ten-year safety follow-up and post-explant analysis of an anterior chamber phakic IOL

PURPOSE

To assess endothelial cell loss (ECL) rate and collect safety data in patients with AcrySof L-series Cachet phakic intraocular lens (pIOL) up to 10 years post-implantation.

SETTING

Clinical settings in the United States, European Union, and Canada.

DESIGN

Nonrandomized, observational, open-label safety study.

METHODS

Central and peripheral endothelial cell density was evaluated and compared with 6-month post-implantation baseline. Nonlinear analysis was performed to identify factors affecting post-explantation ECL. Additional evaluations included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), adverse device effects (ADEs), and serious adverse events (SAEs).

RESULTS

The study included 1123 implanted eyes (mean age, 37.5 years). At 10 years, mean central and peripheral ECL was 16% (1.7% annualized). Explantations were performed in 10% of eyes (n = 136/1323). For eyes with pIOL explantation because of ECL (7%), annualized ECL rate post-explantation was numerically lower compared with the overall rate in eyes that underwent explantation for any reason (annualized rate, -1.65% vs -2.03%, respectively; n = 96) and compared with pre-explantation ECL. Mean ± SD CDVA and UCVA were -0.12 ± 0.11 and 0.03 ± 0.22 logarithm of the minimum angle of resolution, respectively. Common ocular ADEs included ECL (10%), pIOL extraction (9%), iris adhesion (7%), and pupillary deformity (2%). Common SAEs included pIOL extraction (11%), ECL (9%), and iris adhesions (8%).

CONCLUSIONS

Cachet pIOLs were associated with long-term ECL in some cases. Overall, only 10% of all implanted eyes underwent explantation during 10-year follow-up. In patients requiring explantation because of ECL, the annualized ECL rates decreased post-explantation in some eyes. Continued monitoring of patients regardless of explantation is recommended.

Explantation of phakic intraocular lenses: causes and outcomes

PURPOSE

To describe reasons for explantation of anterior and posterior chamber phakic intraocular lenses (pIOLs), as well as outcomes of the surgery.

METHODS

The medical files of patients who underwent pIOL explantation due to complications were reviewed. All patients were divided into three groups based on the type of explanted pIOL: anterior chamber angle-supported (AS pIOL), anterior chamber iris-fixated (IF pIOL), and posterior chamber (PC pIOL).

RESULTS

Sixty-two eyes of 41 patients were evaluated. There were 26 (41.9%), 16 (25.8%), and 20 (32.2%) eyes in the AS pIOL, IF pIOL, and PC pIOL groups, respectively. The mean interval between the implantation and removal of the pIOL (i.e., survival time) was 13.6 ± 8.1 years (range 0.01-21.22 years). The mean follow-up after the explantation was 22.5 ± 4.0 months (range 11.3-28.7 months). The main causes of explantation were cataract in the PC pIOL group (60%) and chronic endothelial cell loss in the AS pIOL group (53.8%) and IF pIOL group (56.2%). Overall, the procedure most often combined with pIOL explantation was phacoemulsification and implantation of a posterior chamber IOL (40.3%), followed by keratoplasty (9.6%). Intraoperative complications were significantly more common in the AS pIOL group than the other groups (p < 0.001).

CONCLUSIONS

Explantation of anterior chamber pIOLs due to severe endothelial cell loss and the proportion of keratoplasty was more common in patients with a relatively long survival time. Therefore, patients with pIOL implantation should be monitored regularly after surgery.

Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses

PURPOSE

To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL).

METHODS

Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications.

RESULTS

Patients' mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up (p < 0.001), remaining stable over the entire follow-up period (p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm². During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months).

CONCLUSION

Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.

Safety and visual outcomes following Iris-claw phakic intraocular lens bilensectomy

PURPOSE

To evaluate the visual outcomes, safety, efficacy, and causes of bilensectomy for iris fixated phakic intraocular lenses (pIOLs).

METHODS

This was a two center consecutive retrospective study that included 43 eyes that underwent iris-claw pIOL bilensectomy. Patients with follow up less than 4 months were excluded from the study. Uncorrected, corrected visual acuity (UCVA, CDVA), refractive outcomes, efficacy, safety (number of eyes in which the postoperative CDVA was worse than the preoperative CDVA), endothelial cell density (ECD), causes of bilensectomy, the time between the implantation of the pIOL and bilensectomy, intra and postoperative complications were analyzed.

RESULTS

There was a statistically significant improvement in UCVA and CDVA after surgery (p = 0.001). The efficacy index was 0.7, four eyes had a postoperative CDVA worse than the preoperative CDVA. The mean spherical equivalent 1 year after bilensectomy was -0.78 ± 1.70 D. There was a statistically significant endothelial cell loss after iris claw lens bilensectomy (p = .003). Cataract development and endothelial cell loss were the only reasons for bilensectomy. The mean time between pIOL implantation and bilensectomy was 12.2 ± 5.5 years. One patient had corneal edema 8 months after surgery and one had a retinal detachment 11 months after surgery.

CONCLUSION

Bilensectomy was successful in improving UCVA and CDVA with an acceptable refractive outcome. Significant loss of ECD was found after surgery. The results recommend a larger ACD as selection criteria when choosing to implant an Artisan lens, and a close postoperative monitoring of the endothelial cell count.

A Novel Concept of Correcting Presbyopia: First Clinical Results with a Phakic Diffractive Intraocular Lens

Purpose

To evaluate the effect of a novel technique to correct presbyopia. A phakic IOL (presbyopic IPCL; implantable phakic contact lens) with a diffractive optic is implanted and its impact on visual acuity, refraction, patient satisfaction in patients striving for spectacle-independence is evaluated.

Design

Retrospective noncomparative open-label clinical trial.

Methods

Sixteen eyes of 8 patients (average age 47 years) had a presbyopic IPCL implanted in the posterior chamber. The visual acuity on different distances, refractive status, corneal topography, endothelial cell density, anterior chamber depth, white-to-white, mesopic pupil size and intraocular pressure (IOP) were measured before implantation of this novel phakic IOL with diffractive optic and four weeks after surgery.

Results

At follow-up four weeks after surgery, 9 of the 16 eyes were emmetropic and uncorrected distance visual acuity was at least 0.8. Near vision was excellent in all patients without the need to wear reading glasses. There was neither a significant change in IOP nor a significant surgical impact on endothelial cells. Patient satisfaction was high. There was no major complaint of halos or glare.

Conclusion

The presbyopic IPCL can provide the presbyopic patient with good visual acuity and spectacle-independence for far and near distance. We found this novel technique to have a good safety profile during the surgical procedure and our short follow-up period. Further long-term follow-up is mandatory.

Phakic intraocular lenses: Recent advances and innovations

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.

Three-Year Effect of Phakic Intraocular Lenses on the Corneal Endothelial Cell Density

Purpose

To compare the effect of three different phakic intraocular lenses (pIOLs) on the corneal endothelial cell density (ECD).

Patients and Methods

This was a prospective observational cohort study that included 60 eyes (30 patients) with axial myopia of −6.50 to −22.00 diopters (D). The Verisyse anterior chamber (AC) rigid iris fixated pIOL, the Veriflex (AC) flexible iris fixated pIOL, and the Visian posterior chamber (PC) implantable collamer lens (ICL) were implanted in three equal groups of patients. The effect of the three pIOLs on the ECD was compared over a follow-up period of one week, and one, three, and six months, and one, two, and three years. Specular microscopy was done to evaluate the cornea before the surgery and throughout the study. Changes were statistically analyzed and compared.

Results

In the first three postoperative months, Verisyse and Veriflex pIOLs induced almost the same amount of endothelial cells loss of 10.3% and 10.6%, respectively, while ICLs showed endothelial cells loss of 3.5%. At the end of the three-year study, Veriflex pIOLs induced the highest rate of endothelial cell loss of 25%, while Verisyse and ICL lenses showed endothelial cells loss of 15.7% and 13.4%, respectively. The main effect of time and type of lens was statistically significant (p<0.001).

Conclusion

All pIOLs cause a decrease in ECD. The AC pIOLs tend to be associated with more cell loss than PC pIOLs. Surgical insult is the important factor responsible for the early endothelial cell loss, while the material from which the pIOL is made may be an important factor for the continuous corneal endothelial cell loss over a long time.

Changes in Endothelial Cell Count Up to Three Years After Implantation of Toric Implantable Collamer Lenses

PURPOSE

To determine the temporal effect of toric implantable collamer lens (TICL) implantation and location on corneal endothelial cell density (ECD) over a period of 36 months after surgery.

METHODS

ECD [number of cells per square millimeter estimated using the Specular Microscope SP-1P (Topcon Europe Medical B.V., Netherlands)] data were collected from cases deemed suitable for the TICL (VTICMO, VTICM5; STAAR Surgical, Nidau, Switzerland). The preoperative refractive error (sphere and cylinder) ranged from -1.00 to -22.25 diopter sphere and from -0.50 to -5.50 diopter cylinder. ECD was evaluated at preoperative and all postoperative sessions.

RESULTS

Key findings were as follows: the mean ECD (±SD, 95% confidence interval) was 2720 cells/mm (±272, 2620-2820 cells/mm) preoperatively, which was reduced to 2372 cells/mm (±325, 2250-2490 cells/mm) at 36 months postoperatively (P < 0.001). Linear regression revealed the following significant correlations between the (1) log of the change in ECD (y1) and log of preoperative ECD (x1) at 2 years postoperatively, y1 = 2.513x1-6.2816 (n = 62, r= 0.3503, P = 0.005); (2) mean ECD (y2) and log time (in months, x2), y2= 2543.7-36.997x2-38.99x2 (r=-0.9654, n = 7, P = 0.0004); and (3) mean axial distance between the front surface of the crystalline lens and the TICL back surface (y3) and time postoperatively (in months, x3), y3 = 0.1035x3-5.2808x3 +473.18 (r = 0.8512, n = 7, P = 0.015).

CONCLUSIONS

Expected ECD loss after TICL implantation by 2 years postoperatively is predictable. On average, over 3 years after implantation, there is (1) an initial rapid decline in ECD, followed by a gradual fall in the rate of cell loss, and (2) a gradual fall in the distance between the TICL and the crystalline lens by 2 years postoperatively, followed by a reversal by the third year.

Refractive surgery

Refractive surgery has evolved beyond laser refractive techniques over the past decade. Laser refractive surgery procedures (such as laser in-situ keratomileusis), surface ablation techniques (such as laser epithelial keratomileusis), and photorefractive keratectomy have now been established as fairly safe procedures that produce excellent visual outcomes for patients with low-to-moderate amounts of ametropia. Additionally, a broader selection of options are now available to treat a wider range of refractive errors. Small incision lenticule extraction uses a femtosecond laser to shape a refractive lenticule, which is removed through a small wound. The potential advantages of this procedure include greater tectonic strength and less dry eye. In the future, intracorneal implants could be used to treat hyperopia or presbyopia. Phakic intraocular implants and refractive lens exchange might be useful options in carefully selected patients for correcting high degrees of ametropia. Thus, physicians are now able to provide patients with the appropriate refractive corrective option based on the individual's risk-benefit profile.

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

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.

Five-Year Endothelial Cell Loss After Implantation With Artiflex Myopia and Artiflex Toric Phakic Intraocular Lenses

PURPOSE

To evaluate the long-term changes in endothelial cell density (ECD) after the implantation of 2 types of foldable iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism.

DESIGN

Prospective clinical cohort study.

METHODS

Two-hundred and ninety-three and 188 eyes implanted with, respectively, the Artiflex Myopia and Artiflex Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January 2004. One-hundred and forty-six eyes from the myopic and 64 eyes from the toric groups completed a 5-year follow-up. Main outcome measures were chronic endothelial cell (EC) loss, percentage of eyes with a ≥25% decrease in ECD, and the percentage of eyes with an ECD < 1500 cells/mm².

RESULTS

Chronic EC loss showed an annual decline of 64 cells/mm² in the myopic (P < .001, standard error 3.58) and 62 cells/mm² in the toric (P < .001, standard error 3.77) groups. Total chronic EC loss from 6 months to 5 years postoperatively was 10.5% in the myopic and 10.2% in the toric groups. After 5 years, an ECD decrease of ≥25% occurred in 4.4% and 4.3% of eyes, and an ECD < 1500 cells/mm² was reported in 3.0% and 0.0% of eyes, respectively. Explantation of a pIOL owing to EC loss was required in 3.1% and 0% of eyes.

CONCLUSION

Chronic EC loss was around 10% over a 5-year period in eyes implanted with the foldable myopic (toric) pIOL. In up to 3.1% of eyes significant EC loss resulted in subsequent pIOL explantation.

Short and long-term outcomes of angle supported phakic intraocular lens implantation in high myopic eyes

This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens (pIOL). Endothelial cell density (ECD) at baseline, 6mo and 3y were 3017±296, 2775±265 and 2558±299 cells/mm2 respectively. ECD loss at 6mo was 7.2% and annual ECD loss was 3% over 36mo. Corrected distance visual acuity at 36mo was 0.4 logMAR or better in 32 (88.9%) eyes. Intraocular pressure did not change (P=0.9). No eyes developed cataract, retinal detachment or pupillary distortion. Angle supported pIOL gives good visual outcome. Endothelial cell loss should be monitored.

Visual acuity, endothelial cell density and polymegathism after iris-fixated lens implantation

PURPOSE

The purpose of this study was to evaluate the visual acuity as well as endothelial cell density (ECD) and polymegathism after iris-fixated lens (Artiflex® AC 401) implantation for correction of moderate to high myopia.

PATIENTS AND METHODS

In this retrospective cross-sectional study, 55 eyes from 29 patients undergoing iris-fixated lens implantation for correction of myopia (-5.00 to -15.00 D) from 2007 to 2014 were evaluated. Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, ECD and polymegathism (coefficient of variation [CV] in the sizes of endothelial cells) were measured preoperatively and 6 months postoperatively.

RESULTS

In the sixth month of follow-up, the uncorrected vision acuity was 20/25 or better in 81.5% of the eyes. The best-corrected visual acuity was 20/30 or better in 96.3% of the eyes, and more than 92% of the eyes had a refraction score of ±1 D from the target refraction. The mean corneal ECD of patients before surgery was 2,803±339 cells/mm2, which changed to 2,744±369 cells/mm2 six months after surgery (p=0.142). CV in the sizes of endothelial cells before the surgery was 25.7%±7.1% and six months after surgery it was 25.9%±5.4% (p=0.857).

CONCLUSION

Artiflex iris-fixated lens implantation is a suitable and predictable method for correction of moderate to high myopia. There was no statistically significant change in ECD and polymegathism (CV in the sizes of endothelial cells) after 6 months of follow-up.

Severe pigment dispersion after iris-claw phakic intraocular lens implantation

A 23-year-old female patient presented 3 months after the implantation of an Artisan^® phakic intraocular lens with a severe depigmentation of the iris and peripheral anterior synechiae. Explantation of the intraocular lens and goniosynechialysis were performed. Eleven months after the explantation appearance of the iris significantly improved. There was no loss of lines of corrected distance visual acuity. Severe pigment dispersion after the implantation of an Artisan^® phakic intraocular lens may happen and may require explantation of the lens. Iris depigmentation may improve with time.

Violet Light Transmission is Related to Myopia Progression in Adult High Myopia

Myopia is increasing worldwide. Although the exact etiology of myopia is unknown, outdoor activity is one of the most important environmental factors for myopia control. We previously reported that violet light (VL, 360-400 nm wavelength), which is abundant in the outdoor environment, suppressed myopia progression for individuals under 20 years of age. However, whether VL is also effective for adult high myopia, which can be sight-threatening, has remained unknown. To investigate the influence of VL for adult myopia, we retrospectively compared the myopic progression and the axial length elongation over five years in adult high myopic patients over 25 years of age after two types (non-VL transmitting and VL transmitting) of phakic intraocular lens (pIOL) implantation. We found that high myopic patients with the non-VL transmitting pIOLs implanted are almost two times more myopic in the change of refraction and four times longer in the change of axial length, compared to those implanted with the VL transmitting pIOLs. This result indicated that the VL transmitting pIOL suppressed myopia progression and axial length elongation compared with the non-VL transmitting one. In conclusion, our study showed the VL possibly has an anti-myopia effect for human adults with high myopia.

Long-Term Endothelial Cell Loss in Patients with Artisan Myopia and Artisan Toric Phakic Intraocular Lenses: 5- and 10-Year Results

PURPOSE

To evaluate the long-term change in endothelial cell density (ECD) after the implantation of 2 types of rigid iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism.

DESIGN

Prospective, clinical cohort study.

PARTICIPANTS

A total of 507 eyes of 289 patients receiving the Artisan Myopia or Artisan Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January 1998.

METHODS

A total of 381 myopic and 126 toric pIOLs were implanted. Five- and 10-year follow-ups were completed by 193 and 127 eyes implanted with the myopic pIOL and by 40 and 20 eyes implanted with the toric pIOL, respectively.

MAIN OUTCOME MEASURES

Chronic endothelial cell (EC) loss, percentage of eyes with a decrease of ≥25% in ECD, and percentage of eyes with an ECD <1500 cells/mm².

RESULTS

Chronic EC loss was calculated from 6 months postoperatively to the end of follow-up and showed an annual ECD decline of 48 cells/mm² (standard error, 3.14) and 61 cells/mm² (standard error, 6.30) in the myopic (P < 0.001) and toric (P < 0.001) groups, respectively, resulting in a total EC loss of 16.6% and 21.5% from 6 months to 10 years postoperatively, respectively. Ten years after implantation, ECD had decreased by ≥25% in 7.9% and 6.3%, whereas ECD was <1500 cells/mm² in 3.9% and 4.0% in the myopic and toric groups, respectively. Explantation of the pIOL occurred in 6.0% in the myopic group and 4.8% in the toric group. Risk factors for increased EC loss were a shallow anterior chamber depth (ACD) (P ≤ 0.005) and a smaller distance between the central and peripheral pIOL edge to the endothelium (P ≤ 0.005).

CONCLUSIONS

A significant linear chronic EC loss was reported after implantation with myopic or toric iris-fixated pIOLs. A smaller ACD and smaller distance between pIOL edge and endothelium were risk factors for EC loss. Modification of preoperative age-related ECD thresholds is indicated to maintain an ECD that warrants safe future combined pIOL explantation and cataract surgery.

Wavefront aberration and contrast sensitivity after implantation of foldable and rigid iris claw phakic intraocular lenses: Artiflex versus artisan

Aim of study:

The aim of this study is to assess wavefront aberration and contrast sensitivity (CS) after implantation of foldable iris claw – artiflex- and rigid iris claw – artisan- phakic intraocular lenses (pIOLs).

Materials and Methods:

A nonrandomized prospective comparative case study was performed on 57 eyes; of which, 54 were myopia and 3 were hyperopia. Twenty-four patients had artisan pIOL implantation and 33 had artiflex pIOL implantation. Higher-order aberration (HOA) and CS were obtained 1 year after surgery.

Results:

Total HOA in artisan group was greater than artiflex group (P = 0.044) with a mean HOA of 0.44 ± 0.15 root mean square (RMS) for artisan and 0.35 ± 0.15 RMS for artiflex. Although, there were no significant differences in the vertical trefoil, vertical coma, horizontal trefoil, horizontal coma, secondary astigmatism, quatrefoil, and fourth order spherical aberration in two groups. CS in mesopic conditions was better in artiflex-treated eyes at three spatial frequencies of 6, 12, and 18 cycles per degree (cpd) (P = 0.003, P = 0.007, and P = 0.00, respectively), and no significant difference was seen between two lenses at 3 cpd.

Conclusion:

Although the components of HOA were not significantly different between two groups, total HOA was higher in artisan group, which may be due to the slight differences in each component, increasing the HOA as a total. CS was significantly better in artiflex group.

Iris reconstruction combined with iris-claw intraocular lens implantation for the management of iris-lens injured patients

Aim:

To study the efficiency and safety of iris reconstruction combined with iris-claw intraocular lens (IOL) implantation in the patients with iris-lens injuries.

Settings and Design:

Retrospective, noncomparable consecutive case series study.

Materials and Methods:

Eleven patients (11 eyes) following iris-lens injuries underwent iris reconstructions combined with iris-claw IOL implantations. Clinical data, such as cause and time of injury, visual acuity (VA), iris and lens injuries, surgical intervention, follow-up period, corneal endothelial cell count, and optical coherence tomography, were collected.

Results:

Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or <20/1000. Within a 1.1–4.2-year follow-up period, a significant increase, equal to or better than 20/66, in UCVA was observed in six (55%) cases, and in best-corrected VA (BCVA) was observed in nine (82%) cases. Postoperative BCVA was 20/40 or better in seven cases (64%). After combined surgery, the iris returned to its natural round shape or smaller pupil, and the iris-claw IOLs in the 11 eyes were well-positioned on the anterior surface of reconstructed iris. No complications occurred in those patients.

Conclusions:

Iris reconstruction combined with iris-claw IOL implantation is a safe and efficient procedure for an eye with iris-lens injury in the absence of capsular support.

Long-term Visual and Refractive Outcomes After LASIK for High Myopia and Astigmatism From -8.00 to -14.25 D

PURPOSE

To evaluate outcomes of high myopic LASIK using the MEL 80 excimer laser (Carl Zeiss Meditec, Jena, Germany).

METHODS

Retrospective analysis of 479 consecutive high myopic LASIK procedures (318 patients) using the MEL 80 excimer laser and VisuMax femtosecond laser (Carl Zeiss Meditec) in 77% of cases or zero compression Hansatome microkeratome (Bausch & Lomb, Rochester, NY) in 23% of cases. Inclusion criteria were preoperative spherical equivalent refraction (SEQ) of between -8.00 and -14.25 diopters (D) and corrected distance visual acuity (CDVA) of 20/20 or better. Patients were observed for a minimum of 1 year. Flap thickness was between 80 and 160 µm and optical zone was between 5.75 and 6.50 mm. Standard outcomes analysis was performed.

RESULTS

Mean attempted SEQ was -9.39 ± 1.22 D (range: -8.00 to -14.18 D) and mean cylinder was -1.03 ± 0.84 D (range: 0.00 to -4.50 D). Mean age was 37 ± 9 years (range: 21 to 60 years) with 54% female patients. Postoperative SEQ was ±0.50 D in 55% and ±1.00 D in 83% of eyes after primary treatment. After re-treatment, 69% of eyes were within ±0.50 D and 95% were within ±1.00 D. UDVA was 20/20 or better in 89% of eyes after final treatment. One line of CDVA was lost in 3% of eyes and no eyes lost two or more lines. Statistically significant increases (P < .001) were measured in contrast sensitivity (CSV-1000) at 12 and 18 cycles per degree.

CONCLUSIONS

The MEL 80 excimer laser was found to achieve high efficacy and safety for treatment of high myopia between -8.00 and -14.25 D and up to -4.50 D of cylinder. [J Refract Surg. 2016;32(5):290-297.].

Comparison of Corneal Diameter and Anterior Chamber Depth Measurements Using 4 Different Devices

PURPOSE

To evaluate the reliability and validity of anterior chamber depth (ACD) and corneal diameter [white-to-white (WTW) distance] measurements with 4 devices as well as applicability of these values in predicting the anterior chamber angle diameter evaluated by optical coherence tomography for implantation of lenses in the anterior chamber.

METHODS

In this prospective randomized case series, we measured ACD and WTW distance in one eye of 40 healthy subjects with Pentacam HR, IOL Master 500, LenStar 900, and Visante OCT.

RESULTS

When comparing WTW distance with anterior chamber angle diameter measured by Visante OCT coefficient of repeatability and limits of agreement ranges were 0.5 and 1.1 mm for IOL Master, 0.5 and 1.1 mm for Pentacam HR, and 0.6 and 1.1 mm for LenStar (P < 0.05 in all cases), respectively. Coefficient of repeatability and limits of agreement ranges were 0.3 and 0.6 mm for IOL Master, 0.3 and 0.5 mm for Pentacam HR, and 0.3 and 0.6 mm for LenStar, respectively, compared with ACD measured by Visante OCT; however, P was not significant in any of the cases. P value was also not significant when comparing IOL Master, LenStar, and Pentacam in terms of ACD and WTW distance with each other.

CONCLUSIONS

Unlike previous groups analyzing the ACD and WTW distance we found no significant difference between the measurements by different automatic devices. We consequently expect no difference in clinical outcome when measurements for WTW distance or ACD are performed with any of the devices listed above.

A Multicenter Prospective Cohort Study on Refractive Surgery in 15 011 Eyes

PURPOSE

To assess the clinical outcomes of currently used refractive surgery procedures performed in 2015.

DESIGN

Prospective, multicenter cohort study.

METHODS

This prospective study included 15 011 eyes of 7622 consecutive patients who underwent laser in situ keratomileusis (LASIK), surface ablation, refractive lenticule extraction (ReLEx), or phakic intraocular lens (IOL) implantation at 42 major institutions. We determined the safety, efficacy, predictability, stability, and adverse events of these surgeries preoperatively and at 1 week and 1 and 3 months postoperatively.

RESULTS

Mean logMAR corrected distance visual acuity 3 months after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, or iris-supported phakic IOL implantation was -0.18 ± 0.07, -0.16 ± 0.08, -0.17 ± 0.09, -0.21 ± 0.08, and -0.10 ± 0.12, respectively; the corresponding values for logMAR uncorrected distance visual acuity were -0.15 ± 0.11, -0.12 ± 0.12, -0.12 ± 0.13, -0.15 ± 0.12, and 0.01 ± 0.21, respectively. The percentages within ±1.0 diopter (D) of the attempted correction were 96%, 93%, 97%, 99%, and 84% after LASIK, surface ablation, ReLEx, posterior chamber phakic IOL, and iris-supported phakic IOL implantation, respectively. Refractive change from 1 week to 3 months was -0.08 ± 0.07, 0.21 ± 0.63, -0.04 ± 0.41, 0.01 ± 0.31, and 0.01 ± 0.46 D, respectively. No vision-threatening complications occurred during the observation period.

CONCLUSIONS

Although more prolonged follow-up is still necessary, currently used refractive surgery procedures have good safety and efficacy outcomes, yielding predictable and stable results. Contemporary LASIK, surface ablation, ReLEx, and phakic IOL implantation appear to be feasible options for the treatment of refractive errors.