[Study of pupillary motility after implantation of an iris claw lens (Artisan) in a phakic population with severe myopia]

Light- and drug-induced pupillary dynamics in eyes with a retropupillary iris-claw intraocular lens

PURPOSE

We evaluated the pupillary characteristics and response to light and drugs in eyes with posterior chamber (PC) placement of iris-claw intraocular lens (IC-IOL).

METHODS

In this cross-sectional, comparative study, we included adults with an IC-IOL implanted in the PC of a single eye. We excluded patients with ocular trauma, postoperative IC-IOL displacement or complications, and extended iris atrophy. We used anterior segment optical coherence tomography to perform light-controlled pupillography, measure the pupil diameter (PD), and estimated the pupil circularity under mesopic conditions. PD was also assessed under photopic, scotopic, pharmacological mydriasis, and miosis conditions. The results were compared to those of the fellow eye, phakic, or regular pseudophakic.

RESULTS

The IC-IOL and control groups included 30 eyes each. The most frequent reasons for IC-IOL implantation were complicated cataract (37%) and dislocated/luxated prior IOL (33%). Compared to the control group, the IC-IOL group had lower visual acuity, a smaller PD under scotopic conditions (p = 0.0010) and after pharmacological mydriasis (p < 0.0001), and a larger PD after pharmacological miosis (p < 0.0001). Mesopic pupil circularity was comparable between the groups. We also considered ongoing extraocular treatments with possible effects on iris motility.

CONCLUSIONS

The pupillary size and profile were similar between the groups in mesopic light. Reduced mydriasis was noted in response to light and drugs, while the degree of miosis was reduced in response to inducing drugs in the IC-IOL compared to the control group. This study complements previous results concerning the PC placement of IC-IOLs by adding original observations on drug-induced pupil motility.

Sutureless Intrascleral Posterior Chamber Intraocular Lens Fixation: Analysis of Clinical Outcomes and Postoperative Complications

PURPOSE

To report a technique for performing sutureless intrascleral fixation of a posterior chamber intraocular lens (PC-IOL) and analyzing the clinical outcomes and postoperative complications. Study Design. 68 eyes of 66 patients who received the technique were studied retrospectively.

METHODS

The best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), IOL tilt and decentration, corneal topography (K1 and K2), and postoperative complications were determined at 3 months.

RESULTS

The mean preoperative BCVA was 1.63 ± 1.24 logMAR units, and the mean postoperative BCVA was 0.74 ± 0.59 logMAR units at 3 months (P < 0.05). The mean preoperative IOP was 21.9 ± 12.6 mmHg, and the mean postoperative IOP was 16.9 ± 4.5 mmHg at 3 months (P = 0.001). The mean preoperative corneal topography (K1 and K2) was K1 = 42.14 ± 1.91 and K2 = 43.54 ± 1.51; the mean postoperative corneal topography (K1 and K2) was K1 = 43.03 ± 2.18 and K2 = 43.40 ± 1.71 at 3 months (P = 0.678 and 0.468, respectively). The mean preoperative spherical equivalent was +11.00 ± 13.19 diopters (D), and the mean postoperative spherical equivalent was +0.06 ± 0.86 D (P < 0.005). The mean IOL tilt was 2.4 ± 1.7°, and the mean decentration was 0.35 ± 0.21 mm. The mean ACD was 4.31 ± 0.29 mm.

CONCLUSIONS

The 27-gauge sutureless intrascleral PC-IOL implantation technique minimizes intraoperative injury, simplifies procedure, and provides good PC-IOL fixation with few postoperative complications.

[Long-term changes in pupil size after implantation of an Artisan phakic intraocular lens for correction of high myopia]

PURPOSE

To evaluate the long-term changes in pupil size after implantation of an Artisan phakic intraocular lens for correction of high myopia.

PATIENTS AND METHODS

Fourteen myopic eyes of seven patients were included in the study. Pupil size was measured under photopic conditions, under scotopic conditions after 10 min of dark adaptation, and after topical medical mydriasis. The pupil size was measured using the eye image of the OPD scan (Nidek).

RESULTS

The mean follow-up was 46 months after surgery. The mean photopic pupil diameter was 2.94+/-0.33 mm (range, 2.54-3.6 mm). The diameter of the scotopic pupil remained less than 6.0 mm in all patients (4.68+/-0.59 mm, with maximal pupil diameter of 5.67 mm). The mean pupil diameter after pharmacological dilation was also reduced (5.39+/-1.08 mm; range, 4.19-7.59 mm), with pupil dilation more than 7 mm in only one patient.

CONCLUSION

The iris-fixated intraocular lens mechanically limited pupil dilation in our patients. The long-term reduction in pupil size after Artisan phakic intraocular lens implantation may contribute to the maintenance of the quality of vision in scotopic conditions.