The Barraquer experience with intraocular lenses. 20 years later

Pseudophakic corneal edema: A review of mechanisms and treatments

PURPOSE

To review the pathological mechanisms and treatments for pseudophakic corneal edema (PCE), one of the most common indications for penetrating keratoplasty.

METHODS

The literature was examined for the molecular biology associated with PCE and for the surgical and medical treatments for this disorder.

RESULTS

The incidence of PCE has recently been decreasing because of improved surgical instrumentation, including improvements in intraocular lens designs that cause less trauma to the corneal endothelium. Extracellular matrix and growth factor abnormalities occur in PCE corneas and recently, the role of aquaporins, which are involved in the regulation of fluid movement across cells, has been investigated.

CONCLUSIONS

Although newer treatment options have been suggested, penetrating keratoplasty still remains the most definitive treatment and has the highest success rate.

ZB5M Anterior Chamber and Fyodorov's Posterior Chamber Phakic Intraocular Lenses: Long-term Follow-up

PURPOSE

To compare the long-term complications of two outdated phakic intraocular lenses (PIOL) implanted in eyes with high myopia to aid development of better PIOL designs.

METHODS

Sixty-two eyes of 37 patients implanted with the ZB5M anterior chamber PIOL (anterior chamber group) and 22 eyes of 14 patients implanted with Fyodorov's posterior chamber PIOL (posterior chamber group) were examined. Complications were compared after a mean follow-up of 71.15 +/- 32.17 months (range: 24 to 145 months) in the anterior chamber group and 84.14 +/- 26.43 months (range: 24 to 132 months) in the posterior chamber group (P = .07).

RESULTS

At last follow-up, pupil ovalization was present in 32 (51.6%) eyes in the anterior chamber group and 1 (4.5%) eye in the posterior chamber group (P < .001), and cataract in 5 (8.1%) eyes in the anterior chamber group and 7 (31.8%) eyes in the posterior chamber group (P = .007). Phakic intraocular lens decentration, glaucoma, retinal detachment, corneal decomposition, and monocular diplopia were additional complications encountered in both groups, with no statistically significant difference.

CONCLUSIONS

Proper understanding of these outdated PIOLs may be helpful in developing better PIOL designs.

Advances in refractive surgery: 1975 to the present

PURPOSE

To review the major advances in the field of refractive surgery occurring over the past 25 years.

METHODS

Literature review.

RESULTS

The major developments in refractive surgery over the past 25 years are reviewed.

CONCLUSIONS

The past 25 years have witnessed great changes in refractive surgery. As a result of advancements in technology, instrumentation, and technique, we have seen improvements in the treatment of all types of ametropias. In this article, we review some of the successes and failures of the past quarter-century.

Harold Ridley and the invention of the intraocular lens

On November 29, 1949, Harold Ridley implanted the first intraocular lens (IOL). This marked the beginning of a major change in the practice of ophthalmology and, for Ridley, the beginning of an era of inspiration, reward and challenge, unfortunately marred by the disdain and discourteous actions of many colleagues within the academic establishment in Europe and the United States. By the late 1970s IOLs and implantation procedures had undergone many improvements, and Ridley's invention had become an accepted option for the optical correction of aphakia. Since that time Ridley has been accorded the recognition due him for his unique contribution to ophthalmology through the conferring of numerous awards and honors. This colorful biographical account is based on published history, statements from Ridley's colleagues, and recent interviews with Ridley himself.

Long-term results of surgical treatment of high myopia with Worst-Fechner intraocular lenses

This retrospective study evaluated the results in 90 eyes that had a minuspower anterior chamber intraocular lens implanted to correct high myopia. Preoperative myopia ranged from -7.00 to -24.00 D. Postoperative spherical equivalent was -0.50 D; 80.5% of eyes were within 1.00 D of emmetropia. Two years postoperatively, no cataract formation, retinal detachment, glaucoma, or significant endothelial damage had occurred. We conclude that minus-power lenses can rapidly, safely, and predictably correct high myopia in phakic patients.

Negative implant. A retrospective study

Implantation of a negative power intraocular lens is one of the options for surgical correction of high myopia. We studied 36 eyes with a Fechner Worst Claw Lens, implanted in Groningen between March 1987 and November 1991. The preoperative myopia ranged from -7.00 to -30.00 diopters. Twenty one eyes had a follow up period of more than 12 months. The IOL power was calculated with the van der Heyde method. Correction within 1 diopters of emmetropia has been achieved in 55.5% of the cases. Deviation of more than 2 diopters occurred in 25%. In 24 eyes the best corrected postoperative visual acuity improved. Due to the IOL the retinal image increases in size as compared to spectacle correction. In none of the cases complications were encountered during surgery. In the postoperative period one IOL had to be replaced because of an error made in the calculation of the lens power. In one case endothelial decompensation occurred, probably due to a combination of compulsive eye rubbing and a preexisting cornea guttata. The rim of the IOL optic is the part which is the closet to the endothelium. Our recommendation is that one should avoid indentation of the cornea. No other serious complications occurred in this study.

Cataract surgery and IOL implantation. More than 40 years of personal experience. My present criteria and considerations

The author refers his personal experience with different types of IOL since 1950. After an initial period of enthusiasm (1950 to 1961) the author abandoned the techniques of Ridley, Strampelli and Dannheim, because of the considerable incidence of severe complications directly related to the IOL. Over many years he emphasized the serious postoperative complications which appeared in the course of the years, even with the different new types of IOL which acquired a certain prestige. With the new posterior chamber lenses placed in the capsular bag, the results became more encouraging and the author resumed IOL implantation with this type of lenses after an adequate period of observation and experimentation. The present criteria, technique and results of the author are discussed together with some considerations on future research work to develop new techniques for substitution of the opacified lens and also to attempt to restore accommodation.

Refractive surgery for high myopia. The Worst-Fechner biconcave iris claw lens

Surgical correction of high myopia is indicated in a limited number of cases. Techniques include (epi)keratophakia, keratomileusis and implantation of a negative-power IOL. The iris claw lens, fixed to the midperiphery of the iris, has proved its safety in aphakic eyes. The model has been adapted by giving it a vault in order to make it suitable for implantation in high myopic phakic eyes. The implantation technique and short-term results of patients operated by Worst are presented.

The correction of myopia by lens implantation into phakic eyes

We corrected myopia in 62 phakic eyes by fixing a concave intraocular lens to the midperiphery of the iris in the anterior chamber. No inflammation, glaucoma, corneal edema, or intraocular lens induced-cataract has occurred. The lens did not touch the corneal endothelium. The achieved correction was within 10% in 47 of the 62 eyes (76%) and within 20% of the expected correction in all eyes.

Dislocated intraocular lens after biodegradation of fixation loops. A case report

A boy aged 3 years had a Worst Medallion intraocular lens with loops made of nylon 6 implanted in his right eye after aspiration of traumatic cataract. Post-operatively, the eye was irritated and showed increased tendency to secondary membrane formation. The patient was lost to follow-up 3 months post-operatively. He returned 5 years later because of 4 days of pain and redness in his right eye. On examination, the optic part of the intraocular lens was seen to lie free in the anterior chamber. The loops were broken near their insertions in the lens body. The distal ends of the broken loops could not be detected in the pupillary region. No traces of the iris fixation suture were to be seen. The lens was removed and subjected to scanning electron microscopy which revealed extensive biodegradative changes in the 3 loop stumps, the 4th being totally dissolved. The young age of the patient and the chronic inflammation may have had an accelerating effect on the nylon degradation. We conclude that children with eyes implanted with nylon-loop lenses should stay under regular ophthalmological control.

Intraocular lenses: a histopathologic study of eyes, ocular tissues, and intraocular lenses obtained surgically

Eyes, ocular tissues, and intraocular lenses obtained surgically from 179 eyes of 177 patients were studied to determine the histopathologic features of complications related to anterior chamber, iris-fixation, iridocapsular, and posterior chamber lens implantation.

Complications of intraocular lenses. A historical and histopathological review

Recent improvements in intraocular lens (IOL) design, manufacturing techniques, and surgical techniques have greatly reduced the incidence of complications following implantation, and many authors now consider IOL implantation to be among the most safe and effective major surgical procedures. However, adverse reactions are still seen--some as late sequelae of earlier IOL designs and implantation techniques and some as sequelae of more recent implantations using "state-of-the-art" lenses and surgical techniques. Complications may be due to various factors, including surgical technique, IOL design, or the inability of some eyes with preexisting disease to tolerate an implant. The authors trace the evolution of IOLs since Ridley's first implant, summarizing the modifications in lenses and surgical techniques that were made as complications were recognized. They then review the clinical and histopathological features of selected cases from more than 200 IOLs and/or globes removed due to IOL-related complications and studied in the University of Utah Ocular Pathology Laboratory. It is hoped that this review will provide insights into the pathogenesis of IOL complications, enhancing the current success of implant procedures and stimulating further basic and clinical research in this area.

Pathology of intraocular lenses in 33 eyes examined postmortem

Thirty-three pseudophakic eyes from 29 patients were examined postmortem. Clinically, 25 of the eyes had had visual acuities of 20/50 or better. In general the intraocular lenses (IOLs) were quite well tolerated. Iris atrophy and erosion were prominent features of eyes containing an anterior chamber, iris fixation, or iridocapsular lens. Angle recession and ciliary-body erosion were found in some eyes with anterior chamber lenses. Ciliary-body erosion by haptics was seen with posterior chamber lenses. Pupillary membranes were present in eight eyes. Granulomatous reaction to IOL material was present in 13 eyes. Usually this was localized to the site of the lens haptic, and was consistent with good visual acuity. One eye with a posterior chamber lens had been successfully treated for Staphylococcus epidermidis endophthalmitis after capsulotomy, shortly before death. Central corneal endothelial cell loss seemed to be of similar amount for the anterior chamber, iris fixation, and iridocapsular lenses, but was less severe in eyes with posterior chamber lenses. Cystoid macular edema was present in five eyes, retinal phlebitis in two eyes, and retinal detachments in four eyes.

Quality control, and changing indications for lens implantation. The Seventh Binkhorst Medal Lecture-1982

A total of 776 specimens yielded significant data on quality control and manufacturing defects in lens implants and on the biodegradation of lens implant and suture materials. Improved quality and an understanding of durability of materials in vivo has permitted wider safe use of intraocular lenses.

Scanning electron microscopy of removed intraocular lenses

During a six-year period, 27 intraocular lenses (2%) were removed from a population of 1,794 implanted eyes. The frequency of and reasons for removal of the lenses, as well as patient information, dates of insertion and removal, types of surgery, and lens manufacturers, were recorded. Twelve of 15 lenses obtained for study were examined by scanning electron microscopy. These revealed poor finish quality, molding defects, and loop degradation. In the first four years the incidence of lens removal was approximately 3.8%. During the following three years, there was a dramatic reduction in the number of lenses removed, suggesting that increased experience and better lens design led to fewer lens removals.