Bilateral giant tear-associated retinal detachment following Artisan phakic intraocular lens implantation for correction of moderate myopia

Pars plana vitrectomy in management of giant retinal tear and retinal detachment following iris-fixated anterior chamber phakic intraocular lens implantation

This case report describes a 26-year-old man presenting with a giant retinal tear (GRT) with retinal detachment (RD) following implantation of iris-fixated anterior chamber phakic intraocular lens (AC-PIOL) for high myopia and occurrence of intraoperative aberrations during vitrectomy due to the presence of AC-PIOL in situ. Posterior chamber PIOL have been well reported to be associated with GRT with RD. Very few reports exist of GRT with RD following AC-PIOL. Moreover, the presence of iris-fixated AC-PIOL, in this case, led to the formation of ghost images intraoperatively especially during crucial steps like induction of posterior vitreous detachment which has never been reported.

Comparison of preoperative and postoperative ocular biometry in eyes with phakic intraocular lens implantations

PURPOSE

To compare preoperative and postoperative ocular biometry in patients with iris-fixated phakic intraocular lens (pIOLs): Artisan and Artiflex.

MATERIALS AND METHODS

This study included 40 eyes with Artisan and 36 eyes with Artiflex pIOL implants. Anterior chamber depth (ACD) and axial length (AL) were measured by applanation ultrasonography (A-scan) and partial coherence interferometry (IOLMaster) preoperatively and 3 months after pIOL implantation.

RESULTS

ACD measurements after Artisan or Artiflex pIOL implantation were smaller than preoperative measurements. Specifically, the difference after Artisan pIOL implantation was -1.07 ± 0.17 mm by A-scan and -0.08 ± 0.08 mm by IOLMaster. The difference after Artiflex pIOL implantation was -1.31 ± 0.15 mm by A-scan and -0.05 ± 0.07 mm by IOLMaster. After Artisan pIOL implantation, differences in AL measurements by A-scan were insignificant (difference: -0.03 ± 0.15 mm), whereas postoperative AL measurements by IOLMaster were significantly longer than preoperative measurements (difference: 0.12 ± 0.07 mm). After Artiflex pIOL implantation, AL measurements by both A-scan and IOLMaster were significantly longer than preoperative measurements (difference: 0.09 ± 0.16 mm by A-scan and 0.07 ± 0.10 mm by IOLMaster). In the Artiflex group, differences in AL measurements by A-scan correlated with the central thickness of the Artiflex pIOL.

CONCLUSION

ACD and AL measurements were influenced by iris-fixated phakic IOL implantation.

Giant retinal tears after prior pars plana vitrectomy: management strategies and outcomes

Purpose

To evaluate management strategies and outcomes for patients with giant retinal tear (GRT)-associated retinal detachment (RD) that had undergone previous pars plana vitrectomy (PPV).

Methods

A noncomparative consecutive case series between January 2005 and July 2010. Patients with a preceding history of PPV undergoing retinal reattachment surgery for GRTs were identified.

Results

Using International Classification of Diseases 9 codes for GRTs, 227 cases were identified. A total of eight eyes in eight patients were identified as having had preceding PPV for non-RD-related pathology. The mean age was 45.5 (range of 10–79) years. The mean time between PPV and diagnosis of GRT was 2.4 months. The mean follow-up after RD surgery was 24.3 months. Presenting visual acuity was 20/400 or better in four of eight patients (50%). All patients underwent repeat PPV with either gas or oil tamponade. A scleral buckling procedure was performed in seven patients (88%). Perfluorocarbon liquid was used during reattachment surgery in four patients (50%). Although anatomic success was achieved in all patients, visual acuity at last follow-up was 20/400 or better in 6 patients (75%).

Conclusion

GRTs are an uncommon complication of PPV. The majority of patients underwent repeat PPV, scleral buckling procedure, perfluorocarbon liquid use and silicone-oil tamponade. Patients presenting with GRT-associated RD after PPV undergoing additional surgery achieved high rates of anatomic success, but visual outcomes were variable.

A retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia

OBJECTIVES

To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens (PIOL) for the correction of moderate and high myopia.

MATERIALS AND METHODS

A retrospective non-controlled clinical study of the data of patients who underwent Artisan PIOLs between March 2006 and July 2008 was evaluated. Pre-operative examination included age, gender, refraction, uncorrected (UCVA) and best spectacle corrected (BSCVA) visual acuity, predictability and safety were analyzed. Post-operative time course ranged from 12 to 36 months.

RESULTS

An Artisan myopia lens was implanted in 62 eyes of 39 patients. The mean pre-operative spherical equivalent (SE) was -13.17 ± 5.62 D. The pre-operative myopia ranged from -4.5 to -24 D. Mean patient age was 25.44 ± 5.22 years. At last follow-up visit, residual SE was within ±1.00 D in 36 eyes (58.1%) and ±2.00 D in 56 eyes (90.3%). In the last visit UCVA was equal to or better than pre-operative BSCVA in 57 (91.9%) of the eyes. One eye (1.6%) lost one Snellen line, three eyes (4.8%) lost two or more Snellen lines and one eye lost vision (1.6%). Post-operative complications included anterior chamber reaction in one eye, rise in intraocular pressure in two eyes and retinal detachment in one eye.

CONCLUSION

When laser keratorefractive surgery is not an option, implantation of Artisan PIOL to correct moderate to high myopia results in a stable and good refractive result with few complications that must be kept in mind.

Complications of NewColorIris implantation in phakic eyes: a review

Purpose:

To provide a literature review of implant related complications from bilateral NewColorIris implantation (Kahn Medical Devices, Panama City, Panama).

Methods:

A PubMed search of peer-reviewed ophthalmology journals for complications related to NewColorIris implants was performed.

Results:

Including a recent case published by the authors, a total of nine patients (18 eyes) with management of complications such as endothelial cell loss, elevated intraocular pressure (IOP), corneal edema, anterior chamber inflammation, decreased visual acuity, and cataract formation were reviewed.

Conclusions:

Sight-threatening complications including corneal decompensation, IOP elevation, uveitis, and hyphema have been described after NewColorIris implantation.

Dealing with retinal detachment in a patient with aphakia, an Artisan lens, and an ExPress valve in situ

PURPOSE

To report our experience from a case with a retinal detachment in an eye with aphakia, an Artisan phakic anterior chamber lens, and an ExPress valve and describe its course after vitrectomy and gas tamponade.

METHODS

Interventional case report.

RESULTS

A 65-year-old man who had previously undergone cataract extraction, Artisan/Verisyse lens implantation, and ExPress valve insertion for the treatment of aphakia and refractory glaucoma presented with a superior retinal detachment. The patient underwent a 20-g pars plana 20g vitrectomy, cryotherapy, and sulfur hexafluoride (SF(6)) tamponade. Twenty days after vitrectomy, the Artisan lens remained in place and the retina attached. Twelve months postoperatively, the situation remained unchanged.

CONCLUSION

Iris-claw lenses have been introduced in 2004 as an alternative option for the correction of aphakia. Vitreoretinal surgeons face a new therapeutic challenge since data with regard to retinal detachment repair in patients with Artisan lenses are very limited. In our case, all intraoperative vitrectomy manipulations were performed without difficulty through the Artisan lens, which remained stable during fluid-air exchange as well as postoperatively, despite the movements of the gas bubble and the presence of the ExPress valve. Moreover, there was no displacement of the ExPress valve during the intraoperative manipulations of vitrectomy or dysfunction of the valve due to the existence of the gas in the postoperative period.