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Vargas V, Alió JL, Alió Del Barrio JL, Cantó-Cerdán M, Barraquer RI, Duch F, Marinho A. Bilensectomy: Safety and Visual Outcomes in Angle-Supported, Iris-Fixated, and Posterior Chamber Phakic Intraocular Lenses. J Refract Surg 2023; 39:128-134. [PMID: 36779470 DOI: 10.3928/1081597x-20221130-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE To report the visual and refractive outcomes, intraoperative and postoperative complications, and main causes of bilensectomy in the different types of phakic intraocular lenses (pIOLs). METHODS This was a retrospective multicenter study that included 234 eyes of 185 patients that underwent bilensectomy. Patients were divided into three groups depending on the pIOL that was explanted (angle-supported, iris-fixated, or posterior chamber). The main reasons leading to the indication for bilensectomy, time elapsed between pIOL implantation and bilensectomy, intraoperative and postoperative complications, uncorrected and corrected distance visual acuity (UDVA and CDVA), and endothelial cell density loss 1 year after bilensectomy were evaluated. RESULTS There was a statistically significant improvement in UDVA and CDVA after bilensectomy in all groups. Cataract development was the main reason for bilensectomy, followed by significant endothelial cell density loss. Time between pIOL implantation and bilensectomy was significantly greater in eyes with an anterior chamber pIOL. CONCLUSIONS Bilensectomy outcomes in general are good. Iris-fixated lenses, particularly hyperopic, are more prone to intraoperative complications and endothelial cell loss than the other pIOLs models. The results show that bilensectomy is a safe and effective procedure with a relatively low rate of intraoperative and postoperative complications and acceptable refractive predictability. [J Refract Surg. 2023;39(3):128-134.].
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Gaurisankar ZS, van Rijn GA, Cheng YYY, Luyten GPM, Beenakker JWM. Two-year results after combined phacoemulsification and iris-fixated phakic intraocular lens removal. Graefes Arch Clin Exp Ophthalmol 2021; 260:1367-1375. [PMID: 34655334 PMCID: PMC8913490 DOI: 10.1007/s00417-021-05442-3] [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: 05/12/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 10/26/2022] Open
Abstract
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.
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Affiliation(s)
- Zoraida Solaiga Gaurisankar
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Gwyneth A van Rijn
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Yanny Y Y Cheng
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.,Department of Radiology, C.J. Gorter Center for High-Field MRI, Leiden University Medical Center, Leiden, The Netherlands
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Vargas V, Marinho A, El Sayyad F, Alio Del Barrio JL, Alio JL. Safety and visual outcomes following Iris-claw phakic intraocular lens bilensectomy. Eur J Ophthalmol 2020; 31:1795-1801. [PMID: 32715788 DOI: 10.1177/1120672120944033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Veronica Vargas
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain
| | | | - Fouad El Sayyad
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain
| | - Jorge L Alio Del Barrio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain.,Universidad Miguel Hernández, School of Medicine, Alicante, Spain
| | - Jorge L Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Research & Development Department, VISSUM, Alicante, Spain.,Universidad Miguel Hernández, School of Medicine, Alicante, Spain.,IBERIA eye bank, Oftalred, Universidad Miguel Hernández, Alicante, Spain
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Vargas V, Alió JL, Barraquer RI, D' Antin JC, García C, Duch F, Balgos J, Alió Del Barrio JL. Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy. EYE AND VISION 2020; 7:34. [PMID: 32626790 PMCID: PMC7329535 DOI: 10.1186/s40662-020-00200-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/28/2020] [Indexed: 12/13/2022]
Abstract
Background To evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens – pIOL – explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOLs. Methods This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months. The uncorrected and best corrected distance visual acuities (UDVA, CDVA), endothelial cell density before and after bilensectomy were assessed, as well as the cause of bilensectomy and intra or postoperative complications. Results There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy (p = 0.00). The main reason for bilensectomy was cataract development (93.1% of the cases), followed by miscalculation of lens size, and corneal edema. The endothelial cell count remained stable without a statistically significant change after surgery (p = 0.67). The refractive efficacy index was 0.8, none of the patients lost lines of CDVA after surgery, 73% of the patients were within ±1 D (spherical equivalent) of the target refraction. Intraoperative complications were one posterior capsule rupture with the intraocular lens (IOL) implanted in the sulcus, and 3 eyes required the use of pupil expanders for adequate pupil dilation. Postoperatively, one eye developed retinal detachment. The three pIOLs models explanted were the Implantable Collamer Lens (ICL), Implantable Phakic Contact Lens (IPCL) and the Phakic Refractive Lens (PRL). Conclusions Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses (PC pIOLs). There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.
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Affiliation(s)
| | - Jorge L Alió
- Vissum Instituto Oftalmológico de Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Rafael I Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Oftalmología Barraquer, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Justin Christopher D' Antin
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Oftalmología Barraquer, Barcelona, Spain
| | | | - Francisco Duch
- Instituto Catalán de Retina (ICR) unidad de Cirugía Refractiva, Barcelona, Spain
| | - Joan Balgos
- Vissum Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Jorge L Alió Del Barrio
- Vissum Instituto Oftalmológico de Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Martínez-Plaza E, López-Miguel A, Holgueras A, Barraquer RI, Alió JL, Maldonado MJ. Phakic intraocular lenses: Recent advances and innovations. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:178-187. [PMID: 32156485 DOI: 10.1016/j.oftal.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- E Martínez-Plaza
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - A López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - A Holgueras
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España
| | - R I Barraquer
- Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Universitat Internacional de Catalunya, Barcelona, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - J L Alió
- Vissum Instituto Oftalmológico de Alicante, Alicante, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España
| | - M J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España; Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, España.
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Anterior segment optical coherence tomography of long-term phakic angle-supported intraocular lenses. Am J Ophthalmol 2013; 156:894-901.e2. [PMID: 23938126 DOI: 10.1016/j.ajo.2013.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the long-term age-related anterior chamber changes by anterior segment optical coherence tomography (OCT) and the impact of such changes on the stability and behavior of angle-supported phakic intraocular lenses (IOLs). DESIGN A retrospective consecutive observational cohort study. METHODS A total of 23 eyes with high myopia implanted with an angle-supported phakic IOL between 1990 and 1996 at Vissum Corporación Oftalmológica de Alicante were included in the study. Patients were evaluated using OCT. Anterior chamber depth, anterior chamber width, crystalline lens rise, and the distance between phakic IOL and endothelium were measured. RESULTS Fifteen years after implantation, anterior chamber depth was 2.9 ± 0.3 mm, crystalline lens rise 748.18 ± 393.13 μm, and phakic IOL-endothelium distance 2.1 ± 0.30 mm. The predictive model showed that 30 years after implantation, endothelial cell count was less than 600 cells/mm(2) in patients with a preoperative spherical equivalent of -25 diopters (D). Twenty years after implantation, the safety zone of 1.5 mm between endothelium and the lens will not be respected in patients with a preoperative spherical equivalent of -20 D. CONCLUSIONS The findings of this study could have an important influence on the decision about the indication to implant angle-supported phakic IOLs in young patients with a long postoperative life expectancy, as age-related changes in the anatomy of the anterior segment may create a long-term hazard for the implanted eye.
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Abstract
An analytical review of the data available in the field of phakic intraocular lens implantation was conducted. Particular attention was paid to the more critical issues of intraocular lens sizing and safety guidelines. A comprehensive, competitive analysis of different implantation sites, intraocular lens model designs, and safety guidelines has been included. Specialized biometry techniques, such as very high frequency ultrasound and Scheimpflug imaging, have been reviewed, and a critical review of commercial claims regarding intraocular lens technologies has been included. Clinical studies of phakic intraocular lenses demonstrate increasing promise for the correction of refractive errors not amenable to mainstream excimer laser refractive surgery. The main issues currently revolve around adequate lens design (VHF ultrasound study suggests that custom-design and sizing may be the most effective and safest approach for every phakic IOL model), because these devices will be required to remain physiologically inert and anatomically compatible with internal ocular structures and relations for several decades. The possibility of safe removing or exchanging the IOL should remain a feasible option over time. It is of utmost importance that we continue to critically evaluate current encouraging short-term outcomes, which are being extrapolated to the longer term by ongoing high resolution imaging and monitoring of the anatomical and functional relations of implanted phakic IOLs.
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Affiliation(s)
- Carlo F Lovisolo
- Department of Ophthalmology and Visual Sciences, San Raffaele Hospital and QuattroElle Eye Center, Milan, Italy, and Department of Ophthalmology, St. Thomas Hospital-Kings College, London, UK.
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Menezo JL, Peris-Martínez C, Cisneros-Lanuza AL, Martínez-Costa R. Rate of Cataract Formation in 343 Highly Myopic Eyes After Implantation of Three Types of Phakic Intraocular Lenses. J Refract Surg 2004; 20:317-24. [PMID: 15307392 DOI: 10.3928/1081-597x-20040701-03] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the feasibility of using phakic intraocular lenses (PIOL) to treat high myopia, and evaluate the incidence of cataract, comparing three different lens types. METHODS From 1989 to 2002, we implanted three different phakic intraocular lenses (PIOL) in 343 eyes of 232 patients; 231 eyes recieved an Ophtec (Worst-Fechner model, iris-claw), 89 an Adatomed (silicone posterior chamber), and 23 a Staar (posterior chamber, models V2, V3, V4). Average follow-up was 96.2 months for the Ophtec group, 31.5 months for the Adatomed group, and 19.3 months for Staar group. Eyes that subsequently developed cataract were studied for clinical evolution and had PIOL explantation and cataract extraction. RESULTS Nuclear cataract developed in 7 of 231 eyes (3.04 %) with an Ophtec lens. Anterior subcapsular cataract developed with the two types of posterior PIOLs (Adatomed group: 38/89 eyes, 42.69%; Staar group: 3/23 eyes, 13.04%). Anterior subcapsular cataract in the Adatomed group developed more rapidly compared to the Staar group. We explanted 7 lenses in the Ophtec group, 16 lenses in the Adatomed group, and 2 lenses in the Staar group (models V2 and V3 only). Patient age older than 40 years at implantation of PIOLs and axial length greater than 30 mm were factors significantly related to nuclear cataract formation and the Ophtec lens. However, these two factors had a weaker correlation with the posterior phakic lenses (Adatomed, Staar) for high myopia than with the Ophtec lens. Postoperative best spectacle-corrected visual acuity remained stable after explantation, phacoemulsification, and posterior chamber lens implantation. CONCLUSIONS Delayed cataract development and cataract type (nuclear) in patients with an Ophtec lens and the variables of patient age (>40 yr) and axial length (>30 mm) may considered prognostic factors. Other factors such as lens design, material, and placement probably influenced cataract formation in patients with the Adatomed and Staar PIOLs. The lens styles used in this study are no longer manufactured.
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Affiliation(s)
- José L Menezo
- Department of Surgery, University of Valencia, School of Medicine, Valencia, Spain
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Menezo JL, Peris-Martínez C, Cisneros AL, Martínez-Costa R. Phakic intraocular lenses to correct high myopia. J Cataract Refract Surg 2004; 30:33-44. [PMID: 14967266 DOI: 10.1016/j.jcrs.2003.11.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2003] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of using phakic intraocular lenses (IOLs) to correct high myopia by comparing 3 IOL models: Adatomed, Staar, and Artisan. SETTING La Fe University Hospital, Department of Ophthalmology, and the Fundación Oftalmológica del Mediterráneo, Valencia, Spain. METHODS In this prospective comparative study, a phakic IOL was implanted in 217 highly myopic eyes (118 patients). Fifty-nine eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. The mean preoperative spherical equivalent was -15.39 diopters (D) +/- 2.83 (SD), -16.00 +/- 5.05 D, and -16.17 +/- 2.75 D in the Adatomed, Staar, and Artisan groups, respectively. The mean follow-up was 32.4 months (range 19 to 46 months) in the Adatomed group, 18.3 months (range 11 to 21 months) in the Staar group, and 121.4 months (range 38.4 to 154.3 months) in the Artisan group. At the follow-up examinations, intraocular pressure (IOP), IOL pigment deposits, cataract formation, and visual acuity were evaluated. RESULTS The best corrected and uncorrected visual acuities improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. The difference in mean IOP between preoperatively and the last follow-up examination was 1.5 mm Hg in the Staar group, 1.3 mm Hg in the Adatomed group, and 1.7 mm Hg in the Artisan group (P =.36, P =.26, and P =.32, respectively). The incidence of pigment deposits was similar in the Adatomed and Staar groups, with deposits in 32 eyes (54.23%) and 8 eyes (38.1%), respectively. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. CONCLUSIONS There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.
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Affiliation(s)
- José L Menezo
- Department of Surgery, University of Valencia School of Medicine, Valencia, Spain
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Abstract
Since Zaldivar's review of phakic intraocular lenses in these pages in 2000 [1**], further reports of experience with this technology have emerged. Their relative advantages and disadvantages over competing technologies are becoming clearer. Clinical trials, including Food & Drug Administration (FDA) trials, have shown predictability, stability, and efficacy. Safety of these implants over the long term remains a concern, but in some situations, at least, phakic intraocular lenses are becoming the refractive correction of choice. This brief review looks at the most recent data to emerge regarding phakic intraocular lenses.
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Affiliation(s)
- Ian F Comaish
- The Eye Institute, 270 Victoria Avenue, Chatswood, New South Wales, 2067 Australia.
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Werner L, Apple DJ, Pandey SK, Trivedi RH, Izak AM, Macky TA. Phakic posterior chamber intraocular lenses. Int Ophthalmol Clin 2001; 41:153-74. [PMID: 11481545 DOI: 10.1097/00004397-200107000-00012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Werner
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA
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Krueger RR. Will Reversible (Removable) Refractive Surgery Reverse the Way We Do Refractive Surgery? J Refract Surg 2001; 17:296-8. [PMID: 11383759 DOI: 10.3928/1081-597x-20010501-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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