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Iranipour BJ, Rosander JH, Zetterberg M. Visual Improvement and Lowered Intraocular Pressure After Surgical Management of In-The-Bag Intraocular Lens Dislocation and Aphakia Correction; Retrospective Analysis of Scleral Suturing versus Retropupillary Fixated Iris-Claw Intraocular Lens During a 5-Year Period. Clin Ophthalmol 2024; 18:315-324. [PMID: 38332906 PMCID: PMC10849897 DOI: 10.2147/opth.s445244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose We compare and evaluate the visual outcome and complication rate of two different techniques of surgical management of in-the-bag intraocular lens (IOL) dislocation or aphakia correction. In addition, we evaluate possible risk factors for IOL dislocation or aphakia. Patients and Methods This retrospective case series reviewed medical records for all patients who had undergone surgery for IOL dislocation or aphakia during a 5-year period at a single ophthalmic center in Sweden. The two most common procedures, scleral suturing of dislocated in-the-bag IOL and retropupillary fixation of iris-claw IOL, were further analyzed. Main outcome measures were best-corrected visual acuity (BCVA), reoperations, and complications. Results The study comprised 110 eyes, including scleral suturing procedures (n=35) and retropupillary iris-claw IOL (n=75). There was a significantly higher rate of dense cataract (p=0.030) and posterior capsular rupture (PCR), (p=0.016) among iris-claw cases at the primary cataract extraction with pseudoexfoliations in about two-thirds of patients in both groups. All eyes in the scleral suturing group had an IOL dislocation. In the iris-claw group, 23 eyes (30.7%) were aphakic following complicated cataract surgery with PCR. No intraoperative complications occurred in any eyes during the secondary IOL procedure. Both groups showed significant improvement in BCVA, yet there was no significant difference between groups in postoperative BCVA (p=0.263). However, the scleral suturing group experienced a significantly larger improvement in BCVA due to worse BCVA preoperatively (p=0.005). Intraocular pressure decreased significantly after both repositioning and exchange surgery (p=0.002 and 0.010 respectively), but improvement between groups was not significantly different (p=0.264). Conclusion Both surgical methods resulted in significantly improved BCVA and lowering of IOP and can be considered safe with limited complications. The outcome was similar between groups. Pseudoexfoliation prevalence was high in both groups indicating that it may be a risk factor for either aphakia or late IOL dislocation.
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Affiliation(s)
| | - Jonas H Rosander
- Department of Ophthalmology, The NU Hospital Group, Region Västra Götaland, Uddevalla, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience/Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Karjou Z, Karimi S, Yaghoobi M, Nikkhah H, Safi S. Pars plana lensectomy and iris-claw Artisan intraocular lens implantation in patients with Marfan syndrome. Oman J Ophthalmol 2023; 16:64-68. [PMID: 37007247 PMCID: PMC10062075 DOI: 10.4103/ojo.ojo_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/13/2022] [Accepted: 12/02/2022] [Indexed: 02/23/2023] Open
Abstract
RATIONAL The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome. MATERIALS AND METHODS In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019. RESULTS Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery. CONCLUSIONS Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.
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Clinical outcome and endothelial loss following prepupillary and retropupillary implantation of iris claw intraocular lenses. Int Ophthalmol 2021; 41:3961-3969. [PMID: 34324103 DOI: 10.1007/s10792-021-01965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Iris claw intraocular lenses (IOLs) were successfully used for the management of aphakia in patients that lack capsular support. The aim of this study was to compare the clinical outcome of prepupillary and retropupillary implantation of these IOLs. METHODS The files of the 26 patients that had an iris claw IOL implantation between 2010 and 2020 were retrospectively reviewed. Detailed ophthalmological examination findings including corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell counts, slit lamp and dilated fundus examination findings were specifically tabulated. Intraoperative and postoperative complications were also specifically recorded. RESULTS There were 18 patients in the prepupillary implantation group and eight patients in the retropupillary implantation group. Age and gender distribution were similar between the groups. CDVA significantly increased in prepupillary and retropupillary implantation groups (p = 0.001 and p = 0.012, respectively). Median endothelial cell loss was 6.7% in prepupillary group and 7.2% in retropupillary group. The only intraoperative complication was iridodialysis (n = 1). Postoperative complications included retinal detachment (n = 1), cystoid macular edema (n = 2) and IOL tilt (n = 1). All of these complications occurred in the prepupillary implantation group. CONCLUSION Prepupillary and retropupillary implantation of iris claw IOLs resulted with similar visual gain and endothelial loss rates in a follow-up time of 6 months. There was an insignificant trend toward a reduced complication rate following retropupillary implantation.
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Luo W, Tong J, Shen Y. Rigid gas‐permeable contact lens for visual rehabilitation in aphakia following trauma. Clin Exp Optom 2021; 95:499-505. [PMID: 22804911 DOI: 10.1111/j.1444-0938.2012.00764.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 10/25/2011] [Accepted: 01/31/2012] [Indexed: 01/08/2023] Open
Affiliation(s)
- Wei‐ling Luo
- Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Ophthalmology, Jiaxing Traditional Chinese Medical Hospital, Jiaxing, Zhejiang, China
| | - Jian‐ping Tong
- Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ye Shen
- Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Choi EY, Lee CH, Kang HG, Han JY, Byeon SH, Kim SS, Koh HJ, Kim M. Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation. Sci Rep 2021; 11:726. [PMID: 33436860 PMCID: PMC7804091 DOI: 10.1038/s41598-020-80292-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Chul Hee Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea.
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Artisan iris-claw intraocular lens implantation in vitrectomised eyes. Eye (Lond) 2020; 35:1393-1397. [PMID: 32555519 DOI: 10.1038/s41433-020-1022-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To present the visual acuity (VA) results and complication rates following Artisan intraocular lens (IOL) insertion in vitrectomised eyes. METHODS Outcome data were collected for all vitrectomised patients who had undergone Artisan IOL insertion between January 2014 and May 2019 at Moorfields Eye Hospital. All those with follow-up greater than 2 months were included in the analysis. RESULTS Sixty-nine eyes from 61 patients were included. Average follow up was 2 years. Fifty-five (80%) eyes had at least one ocular comorbidity prior to Artisan IOL insertion. At final follow up 46 (67%) eyes had best-corrected VA better than 6/12. Sixty-three eyes (91%) either gained or maintained VA. Mean post-operative spherical equivalent was -0.2D. Two (3%) lenses became de-enclavated requiring further surgery. Two (3%) eyes developed acute post-operative cystoid macular oedema. Two (3%) required additional topical IOP-lowering therapy to their pre-operative glaucoma regimen. One eye had mild corneal oedema, which persisted for 1 year following surgery and subsequently resolved. CONCLUSIONS Artisan IOL insertion is a safe and effective option for the surgical correction of aphakia in vitrectomised eyes lacking capsular support. Refractive results comparable to posterior chamber IOL placement can be achieved with these lenses.
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Touriño Peralba R, Lamas-Francis D, Sarandeses-Diez T, Martínez-Pérez L, Rodríguez-Ares T. Iris-claw intraocular lens for aphakia: Can location influence the final outcomes? J Cataract Refract Surg 2019; 44:818-826. [PMID: 30055690 DOI: 10.1016/j.jcrs.2018.05.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/15/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). SETTING Complejo Hospitalario Universitario de Santiago de Compostela, Spain. DESIGN Retrospective case series. METHODS Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. RESULTS The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. CONCLUSIONS Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME.
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Affiliation(s)
- Rosario Touriño Peralba
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain.
| | - David Lamas-Francis
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Sarandeses-Diez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Laura Martínez-Pérez
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Teresa Rodríguez-Ares
- From the Cornea and Ocular Surface Unit (Touriño Peralba, Lamas-Francis, Sarandeses-Diez, Martínez-Pérez, Rodríguez-Ares), Ophthalmology Department, Complejo Hospitalario Universitario de Santiago de Compostela and the Surgery Department (Touriño Peralba, Rodríguez-Ares), Medical School, Santiago de Compostela University, Santiago de Compostela, Spain
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Ersöz MG, Hocaoğlu M, Sayman Muslubaş IB, Arf S, Karaçorlu M. Dislocated Intraocular Lens Extraction and Iris-Claw Lens Implantation in Vitrectomized and Non-vitrectomized Eyes. Turk J Ophthalmol 2019; 49:277-282. [PMID: 31650810 PMCID: PMC6823582 DOI: 10.4274/tjo.galenos.2019.79735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes. Materials and Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up. Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes. Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.
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Affiliation(s)
| | | | | | - Serra Arf
- İstanbul Retina Institute, İstanbul, Turkey
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Randon M, Queromes P, Pierre-Kahn V. [Long term postural myopic shift assessment after posterior iris-claw aphakic intraocular lens implantation]. J Fr Ophtalmol 2019; 42:968-973. [PMID: 31208908 DOI: 10.1016/j.jfo.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Posterior chamber iris-claw intraocular lens (IOL) is often used in aphakic eyes with inadequate capsular support. Postoperatively, patients may describe better capabilities for near reading in a face-down position. The goal was to evaluate the indications, visual outcomes and complications of this IOL and to compare postoperative spherical equivalent between the prone and the face-down position. MATERIALS AND METHODS Retrospective single-center case series of 31 eyes of 28 patients who underwent surgery between 2007 and 2016. Visual outcomes, early and late complications were analyzed. The refractive measurements were also assessed using a portable refractometer in prone and face-down position for each patient. The spherical equivalents were then compared. RESULTS The mean follow up was 29 months (3-73). The final mean corrected visual acuity (0.17±0.5 SD LogMar) was significantly better than preoperatively (0.5±0.50 SD LogMar) (P<0.05). Postoperative refractive error was within±2 diopters of emmetropia in 95 % of patients. The mean spherical equivalents in prone and face down position were different (P<0.05),-0.44 diopters (-4;+2.75) and-1.38 diopters (-5.25; 1) respectively. A mean myopic shift of-0.95 diopters (-5.25; 1.00) was observed in face down position. Cystoïd macular edema (6 %) and IOL disenclavation (9.6 %) were the main complications. DISCUSSION A posterior iris-claw intraocular lens appears to be an effective and relatively safe IOL to treat aphakia with poor capsular support. When the patient's head is bent forward, a mean myopic shift of 1 diopter is observed. This may support the idea that this IOL could be considered as an accommodative implant. Anterior movement of the iris-IOL complex due to gravity may be responsible for this myopic shift.
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Affiliation(s)
- M Randon
- Service d'ophtalmologie, hôpital Foch, Suresnes, France.
| | - P Queromes
- Service d'ophtalmologie, hôpital Foch, Suresnes, France
| | - V Pierre-Kahn
- Service d'ophtalmologie, hôpital Foch, Suresnes, France
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Toro MD, Longo A, Avitabile T, Nowomiejska K, Gagliano C, Tripodi S, Choragiewicz T, Kaminska A, Figus M, Posarelli C, Forlini M, Jünemann AGM, Reibaldi M, Rejdak R. Five-year follow-up of secondary iris-claw intraocular lens implantation for the treatment of aphakia: Anterior chamber versus retropupillary implantation. PLoS One 2019; 14:e0214140. [PMID: 30970023 PMCID: PMC6457484 DOI: 10.1371/journal.pone.0214140] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Though several procedures of IOL implantation have been described (sutured scleral fixation, intra-scleral fixation, angle-supported anterior chamber, and anterior chamber or retropupillary iris-claw IOLs), there are no randomized trials which are comparing different techniques. Hence, the surgical treatment of aphakia still remains controversial and challenging. The purpose of this study was to compare the long-term efficacy and the rate of complications of anterior versus posterior Iris-claw intraocular lenses (IOL) implantation to correct for the treatment of aphakia without sufficient capsule support. METHODS AND FINDINGS Consecutive eyes having secondary implantation of aphakic iris-fixated IOLs with a follow-up of at least 5 years were considered. Mean correct distance visual acuity (CDVA) changes, percentage of eyes with CDVA improvement, mean corneal endothelial cell density (CECD) loss and the rate of other complications were used for statistical analysis. The study evaluated a total of 180 eyes (Group A: 87 anterior chamber iris-claw fixation, Group B: 93 retropupillary iris-claw implantation) of 180 consecutive different patients, with aphakia of various reasons. CDVA improved significantly in both groups after surgery (P<0.001, ANOVA), and was remarkably higher than baseline in both groups from first week and during the entire follow-up (P<0.001, Tukey's Honest Significant Difference). There was no statistically significant difference in CDVA between the two groups during each follow-up visits (P = NS, unpaired t-test) and in the CDVA improvement percentage between the two groups (P = 0.882, Chi-square test). No significant changes in CECD were noted after surgery in both groups (ANOVA Group A: P = 0.067, Group B: P = 0.330P). No intra-operative complications occurred in both groups. There was no statistically significant difference in the rate of complications between the two groups (P = NS, Chi-square test), except for pigment precipitates which were higher in Group A (P<0.05, Chi-square test). CONCLUSIONS Five-year follow-up shows that secondary implantation of aphakic IOLs is effective and safe for the correction treatment of aphakia in eyes without capsule support.
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Affiliation(s)
- Mario Damiano Toro
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Katarzyna Nowomiejska
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
- Institute for Ophthalmic Research, University Eye Hospital, Tuebingen, Germany
| | | | - Sarah Tripodi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Tomasz Choragiewicz
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kaminska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Pisa, Italy
| | - Matteo Forlini
- Institute of Ophthalmology, University of Parma, Parma, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, Lublin, Poland
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Frisina R, Pilotto E, Tozzi L, Parrozzani R, Midena E. A new technique of needle-guided retropupillary fixation of iris-claw intraocular lens. J Cataract Refract Surg 2019; 45:267-271. [PMID: 30733108 DOI: 10.1016/j.jcrs.2018.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/17/2018] [Accepted: 10/28/2018] [Indexed: 12/01/2022]
Abstract
The authors developed a new surgical technique of retropupillary implantation of an iris-claw intraocular lens (RP-ICIOL). RP-ICIOL is an alternative surgical option to the scleral-fixation technique for the treatment of aphakia without capsular support. Several studies have shown that RP-ICIOL is efficient and safe. However, although it is easier to perform than scleral fixation, it presents some critical issues related to the enclavation procedure. The success of the correct enclavation without excessive surgical manipulations, with subsequent pigment dispersion and without pupil distortion, is highly related to the surgical skills of the individual surgeon. The new technique proposed by the authors consists of using a guide needle to facilitate the enclavation, and to make this surgical procedure standard. The new technique was performed in 26 patients affected by aphakia without capsular support with encouraging functional and anatomical results.
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Affiliation(s)
- Rino Frisina
- Department of Ophthalmology, University of Padova, Italy.
| | | | - Luigi Tozzi
- Department of Ophthalmology, University of Padova, Italy
| | | | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Italy
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Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Massa HF, Gobej I, Jacquier P, Jonescu-Cuypers C, Le Quoy O. Cystoid macular oedema and iris-fixated intraocular lens treated with intraocular lens exchange: A case series and review. J Int Med Res 2018; 47:188-195. [PMID: 30270801 PMCID: PMC6384471 DOI: 10.1177/0300060518799004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This series of case reports describes six eyes from five patients that underwent intraocular lens (IOL) exchange with scleral-fixated IOLs for cystoid macular oedema associated with iris-fixated IOLs between 2005 and 2015. Macular oedema was assessed using ocular coherence tomography (OCT). The six eyes in this series were treated by IOL removal and implantation of a scleral-sutured IOL with four points of fixation in the sulcus. Visual acuity improved in all six eyes. On OCT, macular oedema resolved after 3 months in all eyes. There were no surgical complications from the IOL exchange. One eye had a pupilloplasty and another had a diaphragm IOL to treat a major iris impairment from prior surgeries. The cause of cystoid macular oedema in these cases remains controversial but has been well recognized in eyes with iris-sutured IOLs. The absence of sutures with posterior fixation of an iris claw IOL prevents progressive corneal endothelial cell loss but does not prevent macular oedema, even in vitrectomized eyes. In conclusion, macular oedema resolved and visual acuity improved after implant exchange with a secondary scleral-fixated IOL in these cases. This procedure should be considered as a solution to persistent symptomatic cystoid macular oedema from an iris-fixated implant.
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Affiliation(s)
- Horace F Massa
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,2 Fondation Ophthalmologique Rothschild, Paris, France
| | - Iona Gobej
- 2 Fondation Ophthalmologique Rothschild, Paris, France
| | - Paul Jacquier
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Jonescu-Cuypers
- 1 Department of Ophthalmology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Lajoie J, Glimois V, Petit T, Amelie R, Varenne F, Fournie P, Pagot Mathis V, Malecaze F, Wargny M, Gallini A, Soler V. [Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. J Fr Ophtalmol 2018; 41:696-707. [PMID: 30217610 DOI: 10.1016/j.jfo.2018.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.
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Affiliation(s)
- J Lajoie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France.
| | - V Glimois
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - T Petit
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - R Amelie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Varenne
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - P Fournie
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Pagot Mathis
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - F Malecaze
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - M Wargny
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - A Gallini
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
| | - V Soler
- Hôpital Purpan, place du Dr Joseph-Baylac, 31300 Toulouse, France
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Lens Placement in the Absence of Capsular Support: Scleral-fixated Versus Iris-fixated IOL Versus ACIOL. Int Ophthalmol Clin 2017; 56:93-106. [PMID: 27257725 DOI: 10.1097/iio.0000000000000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fouda SM, Al Aswad MA, Ibrahim BM, Bori A, Mattout HK. Retropupillary iris-claw intraocular lens for the surgical correction of aphakia in cases with microspherophakia. Indian J Ophthalmol 2017; 64:884-887. [PMID: 28112127 PMCID: PMC5322701 DOI: 10.4103/0301-4738.198844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aimed to evaluate the safety and efficacy of retropupillary fixation of an iris-claw intraocular lens (IOL; Verisyse polymethyl methacrylate IOL, Abbott Medical Optics [AMO], Netherlands) for the surgical correction of aphakia in microspherophakic eyes without sufficient capsular support. DESIGN This was a prospective, interventional, noncomparative case series. METHODS This interventional case series comprised 17 eyes of 9 microspherophakic patients. Retropupillary fixation of the Verisyse iris-claw IOL (AMO) was performed in all cases. The surgical time was measured. Corrected distance visual acuity, astigmatism, intraocular pressure (IOP), tissue reaction, pigment dispersion, and stability of the IOL were studied 1 day, 3 days, 1 week, 2 weeks, 1 month, and 6 months postoperatively. RESULTS Eight patients had familial microspherophakia and one patient had Marfan's syndrome. Eighty-two percent of the cases achieved a visual acuity of 0.3 or better. There was no significant postoperative inflammatory reaction. Transient elevation of IOP was recorded in two cases in the 1st week only. One IOL developed disengagement of one of the haptics from the iris and was successfully re-engaged. All the other IOLs were well centered and stable. The mean surgical time was 18.0 ± 4.5 min. CONCLUSIONS Retropupillary fixation of an iris-claw IOL is a safe and effective procedure that provides early visual recovery. It is also a time-saving method for correcting aphakia in microspherophakic eyes without sufficient capsular support.
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Affiliation(s)
- Sameh Mosaad Fouda
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Mahmoud A Al Aswad
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Basem M Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Ashraf Bori
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
| | - Hala K Mattout
- Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
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Zhang H, Zhao J, Zhang LJ, Liu J, Liu Y, Song W, Tian QF, Wang Q, Hamilton DR. Comparison of iris-fixated foldable lens and scleral-fixated foldable lens implantation in eyes with insufficient capsular support. Int J Ophthalmol 2016; 9:1608-1613. [PMID: 27990363 DOI: 10.18240/ijo.2016.11.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the outcomes of vision using two different intraocular lens (IOL) replacement techniques, iris-fixated foldable intraocular lens (IF-IOL) and scleral-fixated foldable intraocular lens (SF-IOL) in patients with insufficient capsular support. METHODS Total 63 eyes (62 patients) with insufficient posterior capsule support underwent replacement of IF-IOL or SF-IOL between January 2008 and August 2011. Outcome measures included changes in visual acuity, slit lamp examination, refractive indices and corneal curvatures. RESULTS The mean improvement of uncorrected visual acuity (UCVA) was greater in IF-IOL group compared to the SF-IOL group (0.43 D±0.19 D vs 0.35 D±0.18 D, P<0.05). Moreover, 12 (38.71%) eyes in IF-IOL group and 4 (12.50%) in SF-IOL group had a higher postoperative UCVA than preoperative best corrected visual acuity (BCVA) while 9 (29.03%) eyes in IF-IOL group and 18 (56.25%) in SF-IOL group had a lower postoperative UCVA than preoperative BCVA. The myopic mean manifest sphere and mean cylinder magnitude were lower in the IF-IOL group than that in the SF-IOL group (-0.47 D±0.58 D vs 0.50 D±0.43 D, P<0.01; 0.84 D±0.53 D vs 1.23 D±0.70 D, P<0.05). No difference of corneal astigmatism and surgically induced astigmatism was found between the two groups. In addition, fewer complications were observed in IF-IOL eyes. CONCLUSION IF-IOL implantation can give a significant improvement in vision with fewer complications than SF-IOL in patients with insufficient capsular support.
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Affiliation(s)
- Han Zhang
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Jun Zhao
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
| | - Li-Jun Zhang
- Refractive Center, Third Hospital Affiliated of Dalian Medical University, Dalian 116033, Liaoning Province, China
| | - Jing Liu
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Yuan Liu
- Department of Ophthalmology, Zibo Kangming Ophthalmology Hospital, Zibo 255025, Shandong Province, China
| | - Wei Song
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qing-Fen Tian
- Department of Ophthalmology, the Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, General Hospital of Liaohe Oil Field, Panjin 124010, Liaoning Province, China
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Faria MY, Pinto Ferreira N, Gama I, Pinto JM, Canastro M, Monteiro Grillo M. Retropupilar positioning of foldable iris-claw intraocular lens for correction of aphakia with no capsular support. Int Med Case Rep J 2016; 9:337-340. [PMID: 27843355 PMCID: PMC5098758 DOI: 10.2147/imcrj.s119347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Summary Iris-claw intraocular lens (ICIOL) for aphakia needs a large 5.4 mm corneal incision for its implantation. The technique needs corneal suture, associated with some postoperative astigmatism. Foldable ICIOL is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated intraocular lens (IOL) and no capsular support. Dislocated IOL with its capsular bag was released with three-port, 23-gauge vitrectomy; placed in the anterior chamber; sliced; and extruded through a 3.2-mm corneal incision, where a foldable ICIOL was introduced and placed retropupillary. This technique achieved a stable fixation of the IOL. Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a polymethylmethacrylate (PMMA) ICIOL due to smaller corneal incision. The technique may be safe and easy to perform. Purpose The purpose of this report was to describe the technique of retropupillary implantation of a foldable iris-claw intraocular lens (ICIOL) in a patient with dislocated intraocular lens (IOL) in mid vitreous cavity. Methods Foldable ICIOL (Artiflex® Myopia Model 401) is used in phakic patients undergoing refractive surgery and has the advantage of a sutureless small corneal incision. We report a case of a high myopic patient with dislocated IOL and no capsular support. The calculation was a −5.0 D IOL for retropupilar position, and a foldable ICIOL was introduced through a 3.2-mm corneal incision and placed retropupillary. Results The technique was easy to achieve. IOL was properly positioned retropupillary and maintained stable. There was no ocular hypertension and no anterior chamber flare or iris atrophy. Conclusion Retropupillary implantation of a foldable ICIOL on aphakic patients has advantages over that of a PMMA ICIOL due to smaller corneal incision. The technique may be safe and easy to perform.
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Affiliation(s)
- Mun Yueh Faria
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Nuno Pinto Ferreira
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Ivo Gama
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Joana Medeiros Pinto
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon; Hospital Divino Espirito Santo, Ponta Delgada, Portugal
| | - Mario Canastro
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
| | - Manuel Monteiro Grillo
- Hospital Santa Maria, Ophthalmology Department; Vision Study Center, University of Lisbon; Faculty of Medicine, University of Lisbon, Lisbon
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Faria MY, Ferreira NP, Pinto JM, Sousa DC, Leal I, Neto E, Marques-Neves C. Retropupillary iris claw intraocular lens implantation in aphakia for dislocated intraocular lens. Int Med Case Rep J 2016; 9:261-5. [PMID: 27621670 PMCID: PMC5010170 DOI: 10.2147/imcrj.s116771] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL. Methods This study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth. Results The mean follow-up was 23 months (range: 6–48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes. Conclusion The results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases.
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Affiliation(s)
- Mun Yueh Faria
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Nuno Pinto Ferreira
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Medeiros Pinto
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - David Cordeiro Sousa
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ines Leal
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Eliana Neto
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Carlos Marques-Neves
- Centro de Estudos da Visão, Universidade de Lisboa; Department of Ophthalmology, Hospital de Santa Maria; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Faria MY, Ferreira N, Neto E. Retropupillary iris-claw intraocular lens in ectopia lentis in Marfan syndrome. Int Med Case Rep J 2016; 9:149-53. [PMID: 27382335 PMCID: PMC4918898 DOI: 10.2147/imcrj.s106382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To report visual outcomes, complication rate, and safety of retropupillary iris-claw intraocular lens (ICIOL) in ectopia lentis in Marfan syndrome (MFS). Design Retrospective study. Methods Six eyes of three MFS patients with ectopia lentis underwent surgery for subluxation lens and retropupillary ICIOL implantation from October 2014 to October 2015 at the Department of Ophthalmology, Santa Maria Hospital in Lisbon, Portugal. Demographics, preoperative and postoperative best-corrected visual acuity (BCVA), and intraocular pressure were evaluated. Endothelium cell count was assessed using specular microscopy; anterior chamber depth was measured using Pentacam postoperatively; and intraocular lens position was viewed by ultrasound biomicroscopy. All patients were female; mean age was 20±14.264 years (range: 7–38 years). Results The average follow-up period was 6.66 months (range: 4–16 months). Preoperative BCVA was 0.568±0.149 logMAR units, and postoperative BCVA was 0.066±0.121 logMAR units. The mean BCVA gain was −0.502±0.221 on the logMAR scale. Postoperative average astigmatism and intraocular pressure were 1.292±0.697 mmHg (range: 0.5–2.25 mmHg) and 16 mmHg (range: 12–18 mmHg), respectively. The average endothelial cell density decreased from 3,121±178 cells/mm2 before surgery to 2,835±533 cells/mm2 after surgery (measured at last follow-up visit) and in the last follow-up, representing an average endothelial cell loss of 9.16%. Mean anterior chamber depth was 4.01 mm (±0.77 mm), as measured by Pentacam. No complications were found intra- or postoperatively in any of the six studied eyes. Conclusion Retropupillary ICIOL implantation is a safe and effective procedure in the treatment of aphakia in MFS eyes, without capsular support after surgery for ectopia lens. The six eyes that underwent lensectomy and retropupillary ICIOL implantation have had excellent visual outcomes with no complications so far.
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Affiliation(s)
- Mun Yueh Faria
- Vitreo Retinal Department, Santa Maria Hospital, Lisbon, Portugal
| | - Nuno Ferreira
- Ophthalmology Department, Santa Maria Hospital, Lisbon, Portugal
| | - Eliana Neto
- Vitreo Retinal Department, Santa Maria Hospital, Lisbon, Portugal
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Ganesh S, Brar S, Relekar K. Long Term Clinical and Visual Outcomes of Retrofixated Iris Claw Lenses Implantation in Complicated Cases. Open Ophthalmol J 2016; 10:111-8. [PMID: 27347246 PMCID: PMC4899510 DOI: 10.2174/1874364101610010111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022] Open
Abstract
Aims: To evaluate the visual outcomes and complications after implantation of retrofixated iris claw (RFIC) lens in various challenging situations.
Settings and Design: Retrospective, single centre, 8 year clinical audit.
Materials and Methods: A retrospective analysis of cases who underwent RFIC lens implantation alone (group 1) or in combination with vitreoretinal (VR), corneal or glaucoma procedures (group 2) was performed. The main outcomes evaluated were corrected distant visual acuity (CDVA) and postoperative complications. The mean follow up was 13.09±6.8 (range 6-24) months.
Results: The study involved 100 eyes of 83 patients with mean age of 51.1±25.4 years. Group 1 included 59 eyes and group 2 had 41 eyes. In group 1, the mean CDVA improved from 0.86±0.81 to 0.38±0.51 LogMAR (p<0.001) with 72.8% eyes having gain in lines (≥ 2 lines) of CDVA with safety index of 1.73. The mean CDVA in group 2 improved from 0.71±0.65 to 0.38±0.34 LogMAR (p=0.003) with 65.8% eyes having gain in lines (≥ 2 lines) of CDVA with a safety index of 1.54. Group 2 showed a higher complication rate of 36.59% compared to group 1 (20.34%). Significant complications noted were secondary glaucoma (8%), disenclavation of haptic (4%), subluxation of RFIC lens (1%). Conclusion: The visual outcome with RFIC lenses when combined with other intraocular procedures is mainly affected by the complexity of co-existing pathologies .The complications are more related to the combined procedures performed rather than RFIC lens implantation alone. This may still be acceptable when complication profile of other intraocular lenses is evaluated in similar challenging situations.
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Affiliation(s)
- Sri Ganesh
- Nethradhama Superspeciality Eye Hospital, Bengaluru, India
| | - Sheetal Brar
- Nethradhama Superspeciality Eye Hospital, Bengaluru, India
| | - Kirti Relekar
- Nethradhama Superspeciality Eye Hospital, Bengaluru, India
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Forlini M, Soliman W, Bratu A, Rossini P, Cavallini GM, Forlini C. Long-term follow-up of retropupillary iris-claw intraocular lens implantation: a retrospective analysis. BMC Ophthalmol 2015; 15:143. [PMID: 26507387 PMCID: PMC4624704 DOI: 10.1186/s12886-015-0146-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/19/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support. METHODS A retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20-, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications. RESULTS The mean patient age was 59.7 years (range, 16-84 years) in group 1; 60.1 years (range, 14-76 years) in group 2; and 65.8 years (range, 25-71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5-0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm(2)) at the end of the follow-up period. CONCLUSIONS RPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation.
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Affiliation(s)
- Matteo Forlini
- Department of Ophthalmology, Policlinico di Modena, Modena, Italy.
| | - Wael Soliman
- Department of Ophthalmology, Assiut University Hospitals, Assiut, Egypt.
| | - Adriana Bratu
- Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
| | - Paolo Rossini
- Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
| | | | - Cesare Forlini
- Department of Ophthalmology, Hospital S. Maria delle Croci, Ravenna, Italy.
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Labeille E, Burillon C, Cornut PL. Pars plana vitrectomy combined with iris-claw intraocular lens implantation for lens nucleus and intraocular lens dislocation. J Cataract Refract Surg 2014; 40:1488-97. [DOI: 10.1016/j.jcrs.2013.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 10/24/2022]
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Brockmann T, Gonnermann J, Brockmann C, Torun N, Joussen AM, Bertelmann E. Morphologic alterations on posterior iris-claw intraocular lenses after traumatic disenclavation. Br J Ophthalmol 2014; 98:1303-7. [DOI: 10.1136/bjophthalmol-2014-305364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hazar L, Kara N, Bozkurt E, Ozgurhan EB, Demirok A. Intraocular Lens Implantation Procedures in Aphakic Eyes With Insufficient Capsular Support Associated With Previous Cataract Surgery. J Refract Surg 2013; 29:685-91. [DOI: 10.3928/1081597x-20130723-02] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
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Schöpfer K, Berger A, Korb C, Stoffelns BM, Pfeiffer N, Sekundo W. Position-dependent accommodative shift of retropupillary fixated iris-claw lenses. Graefes Arch Clin Exp Ophthalmol 2012; 250:1827-34. [DOI: 10.1007/s00417-012-2020-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/13/2012] [Accepted: 03/26/2012] [Indexed: 11/24/2022] Open
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Özer A, Niyaz L. Anterior iris-claw lens implantation with single paracentesis. SURGICAL TECHNIQUES DEVELOPMENT 2011. [DOI: 10.4081/std.2011.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, the technique and results of iris-claw intraocular lens (IOL) implantation with corneal incision and single paracentesis were presented. Eighteen eyes of 18 patients who underwent iris-claw implantation surgery with a single paracentesis were included in this prospective study. Iris-claw lens was grasped by its forceps and placed into the anterior chamber through superior corneal opening. While IOL was held by forceps, a blunt enclavation spatula was introduced through inferior paracentesis. Then the spatula was directed toward underneath of iris through pupil and toward sides where iris was entrapped into the claw by gentle push of iris through the slotted center of the lens haptics. Mean age of patients was 54.28±25.21 years (7-76 years). Mean anterior chamber depth was 4.07±0.32 mm and mean keratometric power was 43.01±2.73 D. Preoperative BCVA was 20/63 or better in 8 (44.4%) patients. At the first postoperative month BCVA was 20/63 or better in 14 (77.8%) patients. Preoperative mean spherical refraction was +11.05±2.62 D, preoperative astigmatism was 2.15±0.85. Postoperative mean spherical refraction was - 0.58±0.25 D and mean astigmatism was - 1.92±0.67 D. The most frequent postoperative complication was mild corneal edema seen in three patients that resolved completely during the first week with medical treatment. Irisclaw IOL implantation can be performed easily with corneal incision and single paracentesis. Single paracentesis does not increase surgical time or cause inconvenience during the procedure.
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De Silva SR, Arun K, Anandan M, Glover N, Patel CK, Rosen P. Iris-claw intraocular lenses to correct aphakia in the absence of capsule support. J Cataract Refract Surg 2011; 37:1667-72. [PMID: 21855764 DOI: 10.1016/j.jcrs.2011.03.051] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 11/26/2022]
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