Iris Claw Phakic Intraocular Lens for High Myopia

Surgical management of aphakia

Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented.

Comparison of Anterior Chamber Depth Measurements using Orbscan II and IOLMaster

PURPOSE

To evaluate and compare anterior chamber depth (ACD) measurements using Orbscan II (Bausch & Lomb, Rochester, NY) and IOLMaster (Carl Zeiss Meditec AG, Jena, Germany).

METHODS

In this prospective clinical study, the authors measured ACD of 145 phakic eyes of 30 healthy volunteers and 115 patients using Orbscan II and IOLMaster. Average patient age was 52.9+/-19.4 (range 16 to 87) years. ACD was evaluated from corneal epithelium to anterior lens surface. Additionally, axial length (AL) was measured using the Zeiss IOLMaster to calculate the regression coefficient between AL and ACD.

RESULTS

Mean ACD was 3.35+/-0.43 mm (range 2.01 mm to 4.37 mm) using Orbscan II and 3.36+/-0.41 mm (range 2.09 mm to 4.24 mm) using IOLMaster. Mean total axial length was 24.04 mm +/- 2.1 mm (range 20.7 mm to 31.41 mm). The linear regression coefficient of ACD between both methods was R=0.95. ACD and AL correlated only slightly (R=0.57). The Spearman coefficients of rank correlation were 0.94 and 0.61, respectively. A p value less than 0.01 (paired Wilcoxon test) was considered statistically significant. However, a significant difference was not calculated comparing ACD measurements using both systems and the Bland-Altman-Plot showed 95% of the differences ranging between 0.25 and -0.27 mm.

CONCLUSIONS

Regarding clinical application, both systems seem to be equally good and interchangeable in clinical practice in terms of ACD evaluation.

Two-Year Follow-Up of Artisan Iris-Supported Phakic Anterior Chamber Intraocular Lens for Correction of High Myopia

PURPOSE

To evaluate the results of Artisan iris-supported phakic anterior chamber intraocular lens (pIOL) implantation in patients with high myopia.

METHODS

Medical records of patients who underwent Artisan pIOL implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a two- year follow-up were included. Spherical equivalent of manifest refractive error (SE), uncorrected visual acuity (UDVA), distance corrected visual acuity (CDVA), and endothelial cell density (ECD) were analyzed at six months, one year, and two years after surgery.

RESULTS

Sixty-two eyes of 42 patients were included in the study. All patients had a minimum anterior chamber depth of 3.0 mm from the endothelium. At two years, 68% of the patients were within ±0.50 D. Mean ECD was 2723 ± 311 cells/mm(2) preoperatively and 2630 ± 291 cells/mm(2) at six months postoperatively (3.4% loss, p = 0.001). ECD loss from six months postoperatively to two years postoperatively was not statistically significantly different. In three eyes (4.8%) of two patients, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected.

CONCLUSION

Artisan pIOL implantation is a safe and highly effective procedure for surgical correction of high myopia. ECD loss stabilizes in the early postoperative period.

Posterior chamber phakic intraocular lens to correct myopia: long-term follow-up

PURPOSE

To evaluate the long-term safety and efficacy of a refractive phakic intraocular lens (pIOL) (PRL) to correct moderate to high myopia.

SETTING

Department of Ophthalmology, University Medicine Charité Berlin, Berlin, Germany.

DESIGN

Retrospective cohort study.

METHODS

Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure, endothelial cell loss, and adverse events were evaluated.

RESULTS

The study enrolled 53 eyes (mean spherical equivalent [SE] -12.17 diopters [D] ± 4.12 [SD]) of 29 patients. The mean age was 34.6 ± 9.2 years and the mean follow-up, 86 ± 21.2 months. The mean UDVA improved from 1.37 ± 0.28 logMAR preoperatively to 0.14 ± 0.19 logMAR at the last postoperative visit (P<.05). The mean CDVA improved from 0.10 ± 0.18 logMAR to -0.01 ± 0.09 logMAR (P<.05). The overall mean efficacy index and mean safety index were 0.9 and 1.21, respectively, at the last follow-up visit. The mean endothelial cell loss at the last follow-up was 6.4%. The complications were slight posterior chamber (PC) pIOL decentration (5 eyes, 9.4%), severe PC pIOL decentration resulting in pIOL removal (1 eye, 1.8%), glaucoma (4 eyes, 7.5%), clinically significant cortical lens opacification resulting in cataract surgery (4 eyes, 7.5%), clinically asymptomatic anterior subcapsular cataract formation (6 eyes, 11.3%), and retinal detachment (2 eyes, 3.8%).

CONCLUSIONS

Posterior chamber phakic pIOL implantation to correct moderate to high myopia provided predictable and stable refractive results but with a high rate of serious complications over the long term.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

PURPOSE

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients' satisfaction after implantation.

DESIGN

Prospective, nonrandomized, and comparative (self-controlled) trial.

METHODS

A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively.

RESULTS

At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation.

CONCLUSION

At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.

Retinal complications of phakic intraocular lenses

High myopia has always been a challenge for refractive correction. Current laser surgical techniques, however, fall short of correcting high refractive errors due to lack of predictability, regression, corneal ectasia, and introduction of high order optical aberration. Phakic intraocular lenses (IOL) have been proposed as an effective refractive surgical procedure for the correction of severe myopia, but, despite recent advances in implant material technology and design, their concept is still under clinical investigation. Most of the concern regarding the complications of phakic IOLs focuses on the anterior segment of the eye. This review examines the posterior segment complications associated with phakic IOL implantation, evaluates possible pathogenetic mechanisms and discusses posterior segment complications, prevention and management.

[Iris-fixated intraocular lenses: reinforced monitoring]

In 1986, the concept of the claw lens was applied to correct myopia in phakic patients. Since then, progress has made iris-fixated phakic intraocular lenses (IOL) relatively safe, predictable, and effective for the correction of myopia, hyperopia, and astigmatism. All these models have undergone a series of design improvements to prevent complications. Despite having excellent refractive results, the principal risk is a potential progressive endothelial cell loss. Many authors have presented encouraging results. Phakic iris-fixated IOL surgery is a potentially reversible procedure, but the surgeon cannot rule out the possibility of complications. Therefore, long-term follow-up is mandatory.

The distribution of anterior chamber depth in a Tehran population: the Tehran eye study

PURPOSE

To determine the normal range of anterior chamber depth (ACD) in the population of Tehran by age and gender.

MATERIALS AND METHODS

Four hundred and ten people (800 eyes) aged 14 years and over, residing in the first four municipality areas of Tehran were selected through a stratified random cluster sampling method. The measurements were all taken by a single skilled technician using Orbscan II, between 9:00 am and 7:00 pm. The ACD was defined as the distance between the corneal endothelium and the anterior lens surface. Considering the high correlation between the ACD readings of contralateral eyes (r = 0.82, p < 0.001), only data from right eyes were analysed.

RESULTS

In the participants, the mean age was 40.6 +/- 16.8 years and 38.8% were male. The mean ACD was 2.79 mm [95% confidence interval (CI): 2.75-2.83]; 2.84 mm (95% CI: 2.79-2.90) in men and 2.75 mm (95% CI: 2.70-2.81) in women. Linear regression analysis revealed a mean ACD reduction of 0.013 mm per year of age (p < 0.001). The ACD decreased by 0.056 mm per diopter of spherical equivalent and 0.018 mm per mmHg of IOP (p < 0.001 and p = 0.030, respectively).

CONCLUSIONS

We found the normal range of ACD in the population of Tehran which is slightly different from that reported from other geographical regions. The study also demonstrated the correlation of ACD with other factors; it decreases with age, and is slightly higher in men.

Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision

PURPOSE

To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction.

DESIGN

Noncomparative, interventional case series.

METHODS

A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients.

RESULTS

BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane.

CONCLUSIONS

Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.

Evaluation of Verisyse and Artiflex phakic intraocular lenses during accommodation using Visante optical coherence tomography

PURPOSE

To perform a dynamic study of the relationship between Verisyse (AMO) and Artiflex (Ophtec B.V.) phakic intraocular lenses (pIOLs) and anterior chamber structures during accommodation using optical coherence tomography (OCT) (Visante, Carl Zeiss Meditec, Inc.)

SETTING

Institutional practice.

METHODS

Eleven myopic patients were randomly selected to have implantation of a Verisyse pIOL in 1 eye and an Artiflex pIOL in the other. Using a 2-dimensional image, dynamic measurements of the relationship between the anterior surface of the pIOL and the corneal endothelium, the posterior surface of the pIOL and the anterior surface of the crystalline lens, and the pupil diameter were performed using Visante OCT. Physiological accommodation was stimulated by adding lenses in 1.00 diopter (D) steps from +1.00 to -7.00 D.

RESULTS

Both groups had a significant decrease in pupil diameter (P<.0001, generalized linear model [GLM]) and in the distance between the anterior surface of the pIOL and the corneal endothelium (P<.0001, GLM) with accommodation. There were no statistically significant changes in the distance between the posterior surface of either pIOL and the anterior surface of the crystalline lens (P = .2845, GLM). There were no statistically significant differences between the 2 pIOLs in any measurement (P>.05, GLM).

CONCLUSIONS

The results fit with Helmholtz' theory of accommodation as forward movement of the diaphragm iris-crystalline lens was seen. There was a decrease in the distance between the pIOL and corneal endothelium and in the pupil diameter, whereas the distance between both pIOLs and the crystalline lens remained constant throughout the accommodation examination. This suggests that the risk for cataract from intermittent contact between the crystalline lens and IOL from accommodative effort is unlikely.

Long-term endothelial changes in phakic eyes after Artisan intraocular lens implantation to correct myopia: five-year study

PURPOSE

To evaluate long-term endothelial cell changes in eyes that had implantation of an iris-fixated phakic Artisan intraocular lens (IOL) for moderate to high myopia.

SETTING

Casa di Cura Villa Igea, Ancona, Italy.

METHODS

Forty-nine eyes of 30 patients having implantation of Artisan IOL for moderate to high myopia were prospectively examined. Preoperative specular microscopy and serial postoperative specular microscopy (Noncon Robo SP 8000, Konan Medical) were performed to evaluate endothelial cell changes over 5 years. Endothelial cell images were collected in the central region of the cornea before surgery and 4, 12, 24, 36, 48, and 60 months after surgery. The endothelial cell density (ECD), coefficient of variation, and percentage of hexagonal cells were determined.

RESULTS

Preoperatively, the mean ECD was 2616 cells/mm(2) +/- 347 (SD), the mean coefficient of variation was 39.6% +/- 4.7%, and the mean percentage of hexagonal cells was 49.2% +/- 6.7%. The mean endothelial cell loss from preoperatively was 2.3% at 4 months, 3.5% at 12 months, 4.7% at 24 months, 6.7% at 3 years, 8.3% at 4 years, and 9.0% at 5 years. Five years after surgery, the mean coefficient of variation was 35.9% +/- 6.9% (P = .1946) and the percentage of hexagonal cells was significantly higher (mean 54.7% +/- 10.3%) (P = .087).

CONCLUSIONS

Continuous endothelial cell loss was observed after surgery during a 5-year follow-up, especially during the first 2 years. A decrease in the coefficient of variation and an increase in the percentage of hexagonal cells were observed over time, reflecting the increasing stability and remodeling of the corneal endothelial cells 5 years postoperatively.

Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia

PURPOSE

To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia.

DESIGN

Long-term (10 years) retrospective follow-up study.

PARTICIPANTS

Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia.

METHODS

Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery.

MAIN OUTCOME MEASURES

Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated.

RESULTS

The mean spherical equivalent (SE) after 10 years was -0.70+/-1.00 diopters (D; range, -4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5+/-3.5 mmHg (range, 7-25 mmHg) at 10 years. The mean endothelial cell loss was -8.86+/-16.01% (range, -51.69% to 34.43%) at 10 years.

CONCLUSIONS

Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare.

Position of myopic iris-claw phakic intraocular lens by Scheimpflug photography and ultrasound biomicroscopy

PURPOSE

To evaluate the position of iris-claw phakic intraocular lens (ICPIOL) in highly myopic eyes by Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM).

METHODS

Nine eyes of five patients aged 31+/-10 years with average spherical equivalent of -16.04+/-5.46 D (range -7.88 to - 22.88 D) were enrolled in this prospective study and implanted with Verisyse ICPIOLs (AMO). The anterior segment was evaluated by SP and UBM preoperatively and for at least 1 month postoperatively. The statistical significance may be questionable due to the limited number (nine) of eyes.

RESULTS

By SP and UBM, the distance between corneal endothelium and lens (anterior chamber depth) preoperatively was 3.10+/-0.14 and 3.07+/-0.11 mm, respectively; between ICPIOL and corneal endothelium (pseudo-anterior chamber depth), 1.88+/-0.09 and 1.99+/-0.12 mm, respectively; between lens and posterior surface of ICPIOL (IL), 0.76+/-0.13 and 0.67+/-0.06 mm, respectively; between superior optic edge and iris (SOEI), 0.23+/-0.23 and 0.58+/-0.24 mm, respectively; between inferior optic edge and iris (IOEI), 0.07+/-0.13 and 0.41+/-0.22 mm, respectively; between ICPIOL haptics and the angle of anterior chamber (HA), 0.90+/-0.17 and 1.45+/-0.13 mm, respectively. ACD was well correlated between the two methods, but PACD, IL, OEI, HA were not. The postoperative measures, except IL, were significantly different between the two methods.

CONCLUSION

The differences between measurements by SP and UBM reveal the ICPIOL's position variations with change of body position. Nevertheless, it seems adequate that space is maintained between ICPIOL and corneal endothelium, angle, and crystalline lens. The ICPIOL implanted in phakic eyes seems a safe alternative for treatment of high myopia.

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

PURPOSE

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSION

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

Iris-fixated toric phakic intraocular lens: Three-year follow-up

PURPOSE

To evaluate the 3-year safety, efficacy, predictability, and stability of iris-fixated toric phakic intraocular lens (pIOL) implantation for the correction of myopia or hyperopia with astigmatism.

SETTING

Department of Ophthalmology, Johannes Gutenberg University, Mainz, and Department of Ophthalmology, University Clinic, Bochum, Germany.

METHODS

A prospective clinical trial of 40 eyes of 23 patients with high ametropia and astigmatism was conducted. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, astigmatism, intraocular pressure, slitlamp biomicroscopy, and indirect ophthalmoscopy were measured preoperatively and postoperatively.

RESULTS

Of the 40 eyes, 28 were myopic and 12 were hyperopic. Three years postoperatively, 70% of eyes were within +/-1.00 diopter (D) of the targeted refraction. In the myopic group, mean preoperative BSCVA was 20/40 and improved postoperatively to 20/25. Sixty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.58 D +/- 1.26 (SD) preoperatively to -1.15 +/- 1.01 D postoperatively. In the hyperopic group, preoperative BSCVA was 20/25 and improved to 20/20 postoperatively. Thirty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.37 +/- 0.88 D to -1.53 +/- 0.69 D postoperatively. The correction was stable in all eyes 3 years after surgery. No potentially sight-threatening complications occurred.

CONCLUSION

The 3-year follow-up showed the iris-fixated toric pIOL was effective in correcting high ametropia and astigmatism.

Correction of high myopia with different phakic anterior chamber intraocular lenses: ICARE angle-supported lens and Verisyse iris-claw lens

PURPOSE

To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patients implanted with different IOLs.

MATERIALS AND METHODS

Forty eyes were implanted with phakic IOLs. The ICARE myopia lens was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from -21.875 to -10.0. The mean patients' age was 30 years. The Verisyse IOL was implanted in 20 eyes of 12 patients with spherical equivalent of the refractive error from -21.625 to -10.375D, and the mean patients' age was 32.25 years. The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up period was 12 months.

RESULTS

Twelve months after surgery, the mean refractive error (SE) was -0.19D (100% of eyes were within +/-1.0D of the target refraction) in the ICARE group, and -0.86D (95% of eyes were within +/-1.0D of the target refraction) in the Verisyse group. The postoperative refraction remained stable during the entire follow-up period. The mean uncorrected visual acuity was 0.7 in the ICARE group, and 0.69 in the Verisyse group 1 year postoperatively. There was no loss in visual acuity 1 year after surgery in the ICARE implanted eyes, one patient in the Verisyse group lost 1 line of BCVA as compared to the preoperative state. Mean endothelial cell density loss was 6.12% and 6.79% in the ICARE and Verisyse groups, respectively. There were no statistically significant differences regarding the analyzed outcome parameters between the two study groups.

CONCLUSION

The implantation of both anterior chamber phakic intraocular lenses to correct high myopia resulted in a stable and predictable refractive outcome. Efficacy and safety of surgery for both implanted lens models are very high.

Evaluation of Pupil Dynamics After Implantation of Artisan Phakic Intraocular Lenses

PURPOSE

To compare pre- and postoperative horizontal and vertical pupil diameters after horizontal Artisan phakic intraocular lens (PIOL) (Ophtec BV, Groningen, The Netherlands) implantation for correction of myopia.

METHODS

The pre- and postoperative scotopic pupil diameters measured by the Colvard pupillometer (Oasis Medical, Glendora, Calif) were compared in 71 eyes after Artisan PIOL implantation (Artisan Colvard group). Analysis of pupil shape (vertical vs horizontal diameter, V/H ratio) after horizontal Artisan PIOL implantation was performed with the Procyon pupillometer (Procyon Instruments Ltd, London, United Kingdom) in 121 eyes (Artisan Procyon group) under scotopic, mesopic-low, and mesopic-high conditions and compared to an age- and refraction-matched control group of 121 eyes of refractive surgery candidates (Procyon control group).

RESULTS

After horizontal Artisan PIOL implantation, the mean horizontal pupil diameter decreased from 6.231 +/- 0.70 mm preoperatively to 5.34 +/- 0.68 mm postoperatively in the Artisan Colvard group (P < .01). The mean horizontal scotopic diameter was 5.60 +/- 0.66 mm, the mesopic-low diameter was 4.94 +/- 0.71 mm, and the mesopic-high diameter was 3.98 +/- 0.54 mm for the Artisan Procyon group. The mean horizontal scotopic diameter was 6.29 +/- 0.91 mm, the mesopic-low diameter was 5.40 +/- 0.96 mm, and the mesopic-high diameter was 4.16 +/- 0.80 mm in the Procyon control group. A significant increase was noted in V/H ratio under scotopic, mesopic-low, and mesopic-high conditions from 1.02, 1.02, and 1.01, respectively, in the Procyon control group to 1.17, 1.12, and 1.06, respectively, in the Artisan Procyon group (P < .01).

CONCLUSIONS

Horizontal pupil size was significantly decreased after horizontal Artisan PIOL implantation and might be attributed to a mechanical restriction of the iris in the horizontal meridian.

Long-Term Complications of Iris-Claw Phakic Intraocular Lens Implantation in Weill-Marchesani Syndrome

PURPOSE

This study was designed to report the long-term complications of iris-claw phakic intraocular lens implantation in a patient with Weill-Marchesani syndrome.

METHODS

Case report and literature review.

RESULTS

A 26-year-old man with a history of glaucoma had bilateral phakic lens implantation for high myopia 10 years previously. Two years later, the left implant dislocated and was repositioned. Slit-lamp examination of both eyes revealed phakic implants of the iris-claw variety. There were moderate iridocorneal adhesions in the areas in which the lens haptics pinched the iris in both eyes and moderate epithelial and stromal edema over the temporal one-third of the left cornea. The crystalline lenses were clear with 3+phacodonesis OU. Dilated fundus examinations revealed bilateral severe optic nerve cupping. Crystalline lens diameters were measured at 7.5mm in the right eye and 8 mm in the left. Anterior chamber depths were 2.63 mm OD and 2.40 mm OS. Specular microscopy revealed central endothelial cell counts of 1133 and 587 cells/mm OD and OS, respectively. Axial lengths were 23.3 mm OD and 25 mm OS. Gonioscopic examination revealed bilateral angle closure with marked peripheral anterior synechiae. Based on our findings of short stature, shortened and thickened fingers, relatively normal axial length, microspherophakia, high myopia, and glaucoma, we diagnosed the patient with Weill-Marchesani syndrome.

CONCLUSION

Iris claw-lens phakic lenses may be an effective surgical alternative to correct high myopia in select patients; however, it may produce long-term complications in eyes with specific features.

Implantation of Verisyse Phakic Intraocular Lens to Correct Myopic Refractive Error After Penetrating Keratoplasty in Pseudophakic Eyes

PURPOSE

We report 2 cases in which a Verisyse phakic intraocular lens (PIOL) was used to successfully treat high myopia after penetrating keratoplasty (PK) in pseudophakic patients.

METHODS

Case 1 involved a 69-year-old pseudophakic man with a manifest refraction (MR) of -6.50 + 1.75 x 048 and a best spectacle corrected visual acuity (BSCVA) of 20/40 approximately 16 months after PK in the right eye. Case 2 was a 78-year-old pseudophakic man who had an MR of -9.00 + 5.75 x 132 with a BSCVA of 20/100 approximately 24 months after PK in the left eye.

RESULTS

In case 1, 10 months after Verisyse PIOL implantation, the MR was pl +2.00 x 135 with a BSCVA of 20/30. Endothelial cell density (ECD) in this patient decreased from 1926.1 to 815.3 cells/mm over 17 months. In case 2, 24 months after Verisyse PIOL implantation, the MR was -3.25 + 3.50 x 105 with a BSCVA of 20/60. ECD in this patient decreased from 2108.4 to 753.8 cells/mm in 30 months.

CONCLUSION

The Verisyse PIOL may provide an alternative method to correct high myopia for anisometropia in pseudophakic patients after PK. In this report, PIOL implantation was associated with a decrease in ECD. Further studies are required to determine the long-term effects and ultimate safety of PIOL placement on the integrity of the cornea endothelium after corneal transplant in pseudophakic patients.

Short-term Follow-up after Implantation of a Foldable Iris-Fixated Intraocular Lens in Phakic Eyes

OBJECTIVE

To evaluate efficiency, predictability, stability, complications, and patient satisfaction after implantation of a foldable iris-fixated phakic intraocular lens (PIOL) for the correction of myopia.

DESIGN

Prospective, nonrandomized, comparative (self-controlled) trial.

PARTICIPANTS

Forty-one eyes of 22 myopic patients aged 18 to 56 years (mean, 36 years) with average sphere of -8.2+/-2.01 diopters (D; range, -12.25 to -3.75 D) and average preoperative cylinder of -0.90+/-0.62 D (range, -2.50 to 0.00 D) were enrolled in this prospective study.

METHODS

All eyes underwent implantation of a foldable iris-fixated PIOL with an optical zone of 6.0 mm. The follow-up was 6 months in all cases. Phakic intraocular lenses were available in powers ranging from -2.0 D to -12.0 D.

MAIN OUTCOME MEASURES

The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, endothelial cell count, intraocular pressure, slit-lamp biomicroscopy, and indirect ophthalmoscopy.

RESULTS

At 6 months' follow-up, no eyes experienced a loss in BSCVA and 78% gained 1 or more lines of their preoperative BSCVA. Uncorrected visual acuity was significantly improved, with 82% of eyes reaching 20/25 or better. There was a significant reduction in spherical errors in all patients after surgery. Ninety-one percent of eyes were within +/-0.50 D of target refraction. A slight loss of endothelial cells (2.3 %) was observed 6 months after surgery. There were no intraoperative complications. In the postoperative follow-up, however, pigment precipitates were noted in 5 eyes of 4 patients.

CONCLUSIONS

At short-term follow-up, the implantation of the foldable iris-fixated PIOL proved to be effective and predictable for the correction of myopia in phakic eyes. However, longer follow-up with larger numbers of patients is necessary to evaluate long-term complications.

Secondary Artisan–Verysise aphakic lens implantation

PURPOSE

To evaluate efficacy, predictability and safety of Artisan-Verysise intraocular lens (IOL) secondary implantation for aphakia correction.

SETTING

Instituto de Microcirugía Ocular, and Autonoma University of Barcelona, Barcelona, Spain.

METHODS

Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell count, and clinical complications were evaluated. Sixteen consecutive eyes of 14 patients with aphakia were submitted to surgery. Postoperative examinations were done at 6 weeks, 6 months, 1 year, and every year for at least 3 years. An iris-supported Artisan-Verysise IOL was implanted for aphakia correction.

RESULTS

Thirty-six months after Artisan-Verysise lens implantation, BSCVA was 20/40 or better in 6 eyes (37.5%). Preoperatively, 5 eyes had the same BSCVA (31.25%). Mean postoperative spherical equivalent (SE) was 0.46 diopter (D). Mean endothelial cell loss was 10.9% 36 months postoperatively. The cell loss occurred predominantly during the first year (7.78%). Cystoid macular edema was observed in 2 cases, 1 of them associated with chronic unresponsive low intraocular pressure. No other serious complications were observed.

CONCLUSION

Artisan-Verysise IOL implantation seems a safe, predictable, and effective option for aphakic eyes without capsule support.

Intraokularlinsen zur Korrektur von Refraktionsfehlern

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses which are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for posterior chamber lenses these are mainly cataract formation and pigment dispersion. RLE is preferable in cases of high ametropia in which the natural lens has lost its accommodative effect. The main complications for myopic RLA include retinal detachment, while hyperopic refractive lens exchange may be associated with surgical problems in the narrower anterior eye segment.

Intraokularlinsen zur Korrektur von Refraktionsfehlern

In this overview, the current status of intraocular lens surgery to correct refractive error is reviewed. The interventions are divided into additive surgery with intraocular lens implantation without extraction of the crystalline lens (phakic intraocular lens, PIOL) or the removal of the crystalline lens with implantation of an IOL (refractive lens exchange, RLE). Phakic IOLs are constructed as angle-supported or iris-fixated anterior chamber lenses and posterior chamber lenses that are fixated in the ciliary sulcus. The implantation of phakic IOLs has been demonstrated to be an effective, safe, predictable and stable procedure to correct higher refractive errors. Complications are rare and differ for the three types of PIOL; for anterior chamber lenses these are mainly pupil ovalization and endothelial cell loss.

Reliability of Orbscan II topography measurements in relation to refractive status

PURPOSE

To investigate the reliability of corneal topography measurements using the Orbscan II topography system (Bausch & Lomb) not only referring to a normal cohort but also to different refractive conditions.

SETTING

Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.

METHODS

Eighty patients (mean age 46.4 +/- 19.0 years) were assigned to 4 refractive groups (Group A: emmetropia (n=20); Group B: astigmatism (n=20) (-1.98 +/- 1.77 diopters [D]); Group C: hyperopia (n=20) (+4.84 +/- 1.6 D); Group D: myopia (n=20) (-9.64 +/- 3.79 D). Three measurements were performed in a series. Thirteen defined, standardized points of the entire cornea (apex, 3.0 mm, 5.0 mm, and 7.0 mm zone) were evaluated for 3 different maps (anterior elevation, pachymetry, keratometry).

RESULTS

In all 80 patients, the following mean values were found in relation to analyzed zones: with regard to the anterior elevation map, the values decreased from 5.53 microm (center) to -6.52 microm (7.0 mm zone), the corneal thickness increased from 549.41 microm to 638.63 microm peripheral and the keratometry from 43.86 D (apex) to 45.4 D (7.0 mm zone), respectively. Analysis of the 3 different maps in all 4 refraction groups showed a tendency toward an increase in SD from the center to the 7.0 mm zone for anterior elevation and pachymetry maps. For keratometry, however, the lowest SD was found in the 7.0 mm zone. In particular, patients with hyperopia showed significant differences (P<.01), compared with emmetropic patients; the SD was higher with regard to anterior elevation as well as keratometry in peripheral zones. Group B (astigmatism) showed significantly higher SD for anterior elevation in zones 3.0, 5.0, and 7.0 mm when compared with emmetropic patients.

CONCLUSIONS

The repeated Orbscan II measurements showed SD in the micrometer range for anterior elevation and pachymetry but values between 0.48 D and 0.97 D for keratometric data. Patients with astigmatism and especially hyperopia showed significantly higher SD values in peripheral zones for anterior elevation and keratometry, indicating a lower reliability, compared with the emmetropic cohort. However, the different ages of the patients could also be a possible explanation for these findings. Therefore, the Orbscan II seems to be a predictable and useful device for measuring corneal topography.

[Multifocal phakic intraocular lens implant to correct presbyopia]

INTRODUCTION

Presbyopic surgery is considered as the new frontier in refractive surgery. Different solutions are proposed: myopization of one eye, insertion of an accommodative crystalline lens, scleral surgery, the effects of which are still unknown, and finally multifocal phakic implants. We therefore decided to undertake a prospective study under the Huriet law to determine its efficacy and specify the conditions required for an anterior chamber multifocal phakic implant.

MATERIAL AND METHOD

Fifty-five eyes of 33 patients received an anterior chamber foldable multifocal phakic implant. Twenty-one females and 12 males underwent surgery. Initial refraction was between -5D and +5D. The implant's single addition was +2.50. Recuperating a distant uncorrected visual acuity of 0.6 or better and near uncorrected vision of Parinaud 3 or better can be considered a very good postoperative result.

RESULTS

Average follow-up was 42.6+/-18 weeks. Mean postoperative refraction was -0.12+/-0.51 D. Mean postoperative uncorrected visual acuity was 0.78+/-0.20. Postoperative uncorrected visual acuity was Parinaud 2.3+/-0.6. Eighty-four percent of eyes operated on recuperated 0.6 or better without correction and Parinaud 3 or better without correction. Lenses in four eyes were explanted for different reasons, essentially optical, and no severe anatomical complications were observed.

CONCLUSIONS

Placing an anterior chamber multifocal phakic implant to correct presbyopia is an effective technique with good predictability and has the advantage of being reversible in case of intolerance, optical parasite effects or undesired complications. Considering the particularity of this surgery, it is imperative to respect very strict inclusion criteria: anterior chamber depth equal to or above 3.1 mm, open angle, endothelial cell count equal to or above 2000 cells/mm2, absence of an incipient cataract or the slightest evidence of macular alteration.

Contact entre le cristallin naturel et différents modèles d’implants réfractifs phakes. Étude avec l’OCT de chambre antérieure

Three patients received three different models of phakic implants. With the usual slit-lamp examination method, we were not able to establish whether there was contact between the implants and the natural crystalline lens. Using the anterior chamber optical coherence tomography scanner (AC-OCT), we were able to demonstrate that there was direct contact between the natural crystalline lens and the three different phakic implants. A dynamic study of these contacts was carried out during accommodation. These observations show that examination of the anterior segment with the optical coherence tomography scanner is essential in refractive surgery.

Correction of Myopia of 7 to 24 Diopters With the Artisan Phakic Intraocular Lens: Two-year Follow-up

PURPOSE

To evaluate the safety and efficacy of the iris claw phakic intraocular lens (Artisan; Ophtec BV, Groningen, The Netherlands) in patients with high myopia.

METHODS

Between May 1999 and July 2001, 93 Artisan phakic intraocular lenses (IOLs) were implanted in 60 patients affected by high myopia. All patients underwent 24-month follow-up. The power of the lenses ranged from -7.5 to -22.0 diopters (D). Patients were divided into two groups: group 1 (68 eyes), myopia -6.75 to -15.50 D (SE), and group 2 (25 eyes), myopia -16.0 to -23.0 D (SE). Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), endothelial cell count, intraocular pressure, complication rate, safety, and efficacy.

RESULTS

At 4 months, 83.8% (57/68) (group 1, myopia -6.75 to -15.50 D) and 68% (17/25) (group 2, myopia -16.0 to -23.0 D) of eyes achieved UCVA of > or =20/40. The BSCVA remained the same or improved in 100% of eyes. After 4 months, 69.1% (47/68) of eyes in group 1 and 52% (13/25) of eyes in group 2 were within +/-1.00 D of the desired refraction; the mean refraction was stable between 4 and 24 months. Of the intraoperative complications, 69.2% were observed in the first 25 lenses implanted; postoperative complications included iris atrophy in 11.8% (11/93), lens decentration in 5.4% (5/93), and night glare in 6.4% (6/93) of eyes. No IOLs were removed. Mean endothelial cell loss was 2.8% at 4 months, 3.9% at 12 months, and 5.4% at 24 months.

CONCLUSIONS

Our results regarding implantation of the Artisan phakic IOL confirm that these lenses are safe and effective for the correction of high myopia, with a stable refractive outcome but with a higher than normal rate of endothelial cell loss during 2-year follow-up.

Clinical results of ZSAL-4 angle-supported phakic intraocular lenses in 190 myopic eyes

PURPOSE

To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (IOLs) in myopia.

SETTING

Private practice, Siena, Italy.

METHODS

This prospective noncomparative single-surgeon interventional case series comprised 190 consecutive myopic eyes of 115 patients having implantation of a ZSAL-4 IOL (Morcher GmbH) through a 5.5 mm x 3.0 mm sclerocorneal tunnel along the steepest meridian with a surgical iridectomy. Preoperatively, the mean spherical equivalent was -14.37 diopters (D) +/- 4.40 (SD) and the mean astigmatism, 1.66 +/- 1.36 D.

RESULTS

Postoperatively, the mean defocus equivalent (DEQ) was 1.55 +/- 1.06 D and the mean astigmatism, 1.41 +/- 1.11 D. The mean surgically induced astigmatism (vector analysis) was 1.03 +/- 0.77 D (95% confidence interval [CI], 0.92 to 1.15); 146 eyes (77%) were within +/-2.0 D of the DEQ, 76 eyes (40%) were within +/-1.0 D, and 36 eyes (19%) were within +/-0.5 D. The safety index was 1.25 and the efficacy index, 0.78. The improvement in best spectacle-corrected visual acuity (0.17) was statistically significant (95% CI, 0.14 to 0.2). Complications were intraocular pressure spike due to topical steroids, 18%; chronic iridocyclitis, 1%; explantation of unstable IOL, 1%; explantation of IOL for iridocyclitis, 0.5%; pupil ovalization, 11%; halos, 18%; and macular hemorrhage, 1%.

CONCLUSIONS

Angle-supported IOLs can effectively correct high myopia, although residual refractive errors may require secondary procedures. The main intraoperative and postoperative complications were halos, steroid response, and incorrect IOL sizing. The role of surgery in inducing macular hemorrhages should be assessed further.

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia

PURPOSE

To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia.

SETTING

Instituto Oftalmólogico de Alicante, Alicante, Spain.

METHODS

This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months.

RESULTS

At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high.

CONCLUSIONS

The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.

Position of angle-supported, iris-fixated, and ciliary sulcus-implanted myopic phakic intraocular lenses evaluated by Scheimpflug photography

PURPOSE

To examine postoperative positional stability of myopic phakic intraocular lenses (IOLs).

DESIGN

Prospective, nonrandomized clinical study.

METHODS

The study included 46 eyes which received an anterior chamber angle-supported (Bausch & Lomb NuVita; 10 eyes), anterior chamber iris-fixated (Ophtec Artisan; 20 eyes) or ciliary sulcus-implanted phakic IOL (Staar ICL; 16 eyes). The distance between the phakic IOL and the crystalline lens and the cornea as well as rotation around the optical axis was evaluated using Scheimpflug photography at 1, 3 to 6, and 12 months postsurgery.

RESULTS

The anterior chamber phakic IOLs showed no significant movement in anteroposterior direction. The posterior chamber phakic IOL showed a significant movement toward the crystalline lens between postoperative months 3 and 12. The median amount of rotation around the optical axis between the 3- and the 12-month evaluation was 1.9 degrees (range = 0.0-33.5 degrees) for the NuVita, 0.6 degrees (range = 0.0-3.5 degrees) for the Artisan, and 0.9 degrees (range = 0.2-2.3 degrees) for the ICL. Four NuVita IOLs rotated more than 10 degrees.

CONCLUSIONS

The angle-supported anterior chamber phakic IOLs showed a generally stable position regarding distance to cornea and natural lens, but rotation was observed in four IOLs. The iris-fixated phakic IOL showed the highest overall stability. The posterior chamber phakic IOL was stable in terms of rotation but had a tendency to decrease in distance toward the crystalline lens. Intraocular lenses implanted in phakic eyes followed for 12 months demonstrate stable IOL position overall.

Contact between 3 phakic intraocular lens models and the crystalline lens: An anterior chamber optical coherence tomography study

Three phakic intraocular lens (IOL) models were implanted in 3 different patients. With the usual slitlamp examination, it was not possible to determine whether there was contact between the IOLs and the natural crystalline lens. Using the anterior chamber optical coherence tomography (AC OCT) scanner, direct contact between the natural crystalline lens and the 3 phakic IOLs was revealed. A dynamic study of the contact was performed during accommodation. These observations show that examination of the anterior segment with the AC OCT scanner provides new data about the status of the anterior segment after implantation of phakic IOLs.

Rate of Cataract Formation in 343 Highly Myopic Eyes After Implantation of Three Types of Phakic Intraocular Lenses

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.

Correction of presbyopia with refractive multifocal phakic intraocular lenses

PURPOSE

To evaluate the efficacy of and specify the conditions required for implantation of an anterior chamber multifocal phakic intraocular lens (IOL) to correct presbyopia.

SETTING

Monticelli Clinic, Marseilles, France.

METHOD

Fifty-five eyes of 33 patients (21 women, 12 men) had implantation of a foldable anterior chamber multifocal phakic IOL. The initial refraction was between -5.00 diopters (D) and +5.00 D. The IOL had an addition of +2.50 D. An uncorrected distance acuity of 0.6 or better (decimal scale) and an uncorrected near acuity (Parinaud scale) of 3 or better (Parinaud 2 approximately equal to Jaeger 1) was considered a successful postoperative result.

RESULTS

The mean follow-up was 42.6 weeks +/- 18 (SD). Postoperatively, the mean refraction was -0.12 +/- 0.51 D, the mean decimal uncorrected distance acuity was 0.78 +/- 0.20, and the mean Parinaud uncorrected near acuity was 2.3 +/- 0.6. Eighty-four percent of eyes achieved an uncorrected distance acuity of 0.60 or better and an uncorrected near acuity of Parinaud 3 or better. The IOL was explanted in 4 eyes for different, but essentially optical, reasons. No significant anatomic complications were observed.

CONCLUSIONS

Implantation of an anterior chamber multifocal phakic IOL to correct presbyopia was effective and gave good predictability. The procedure is reversible in cases of patient intolerance to the IOL, unwanted optical phenomena, or complications. Strict inclusion criteria should be used for patient selection.

Corneal endothelial assessment after ICL implantation

PURPOSE

To evaluate the 3- to 4-year effects of the Implantable Contact Lens (ICL) on the corneal endothelium.

SETTING

Multicenter study.

METHODS

Noncontact specular microscopy was performed as a subgroup study in a Phase III U.S. Food and Drug Administration clinical trial. Endothelial cell images were collected in the central region of the cornea before surgery and 3, 12, 24, and 36 months after surgery, with a few at 48 months. The images were recorded and analyzed later by a central reading center. The cell density, coefficient of variation, and percentage of hexagonal cells were determined.

RESULTS

The cumulative endothelial cell loss was between 8.4% and 8.9% over the first 3 years and between 8.4% and 9.5% over the first 4 years depending on the method of calculation. The cell loss between baseline and 3 months was 2.1%; 3 months and 1 year, 0.9%; 1 year and 2 years, 2.3%; 2 years and 3 years, 3.2%; and 3 years and 4 years, -0.1%. The coefficient of variation decreased over the course of the study, and the proportion of cases with hexagonal cells increased slightly.

CONCLUSIONS

The cell loss between 1 year and 3 years in the absence of an increase in the coefficient of variation and/or a decrease in the percentage of hexagonal cells is most readily explained by prolonged corneal remodeling following the surgical procedure rather than ongoing cell loss. The cell loss observed between 3 years and 4 years (0.1% gain) was negligible. Regardless of the cause of the change in endothelial cell density over the first 3 years, the available 4-year data suggest there was no ongoing chronic loss.

Initial results of endothelial cell counts after Artisan Lens for Phakic Eyes

PURPOSE

To evaluate the endothelial cell count change in eyes implanted with the iris-claw phakic Artisan lens for treatment of moderate to high myopia.

DESIGN

Prospective, multicenter clinical trial.

PARTICIPANTS

The first 765 eyes enrolled at 25 North American sites in the United States Food and Drug Administration Ophtec clinical trial of the myopic Artisan IOL. Outcome analyses of endothelial cell count measurements were based on those obtained before surgery and at 6, 12, and 24 months after surgery performed between October 1998 and December 2001.

SETTING

Multiple private and university practices.

METHODS

Percentage change in endothelial cell count from baseline to 6, 12, and 24 months were analyzed using specular microscopy. Upper limit of detecting endothelial cell density change was estimated using 3 repeated counts at preoperative and postoperative time frames.

MAIN OUTCOME MEASURES

Percentage change in endothelial cell loss.

RESULTS

The mean preoperative endothelial cell count was 2631+/-442 cells/mm(2). Percentage change from baseline at 6, 12, and 24 months was -0.09%+/-16.39%, -0.87%+/-16.35%, and -0.78%+/-17.41%. No statistically significative postoperative endothelial cell loss was found. The endothelial cell loss rate was higher among patients who wore spectacles before surgery and was correlated negatively with preoperative endothelial cell density (P<0.001). No relationships were noted between endothelial cell loss and either patient age or implant power. A 4.1% repeatability of measurements was found based on the average of 3 repeated counts, whereas single cell count estimates were associated with a 23% accuracy in detecting endothelial cell density change. In a worst-case scenario, adjusting for measurement accuracy, 9% of all eyes were at higher risk of a 10% loss of cell density at 12 months after surgery, although eyes at higher risk were found to have high preoperative endothelial cell counts (P<0.0001).

CONCLUSIONS

The Artisan iris-claw phakic intraocular lens did not result in significant loss of endothelial cell density up to 2 years after implantation of the myopic Artisan phakic lens.