Traumatic Dislocation and Successful Re-enclavation of an Artisan Phakic IOL With Analysis of the Endothelium

Injectable suture device for intraocular lens fixation

We describe a surgical technique for scleral fixation of a posterior chamber intraocular lens (PC IOL) using a 24-gauge injectable polypropylene suture delivery system. A 3-piece PC IOL is inserted into the anterior chamber of the eye. Two sclerotomies are made 1.5 mm posterior to the limbus using a microvitreoretinal blade. The 24-gauge injector delivers a preformed suture loop into the eye with the double-armed needles still external to the eye. Each polypropylene IOL haptic is directed through the loop using microforceps. The suture loop is tightened around the haptic, and the attached needles are used to fixate the IOL to the sclera and close the sclerotomies simultaneously. This technique has been used in an ex vivo porcine eye and in an aphakic patient. In the latter, the IOL was quickly fixated to the sclera and maintained a stable position postoperatively.

FINANCIAL DISCLOSURE

Dr. Olson has a patent pending for the device described in this article. No other author has a financial or proprietary interest in any material or method mentioned.

Pediatric phakic intraocular lens surgery: review of clinical studies

PURPOSE OF REVIEW

To report on the accumulating peer-reviewed data of phakic intraocular lens (pIOL) implantation in the pediatric population. I evaluate and compare the published peer-reviewed articles for the reported efficacy and complications of phakic intraocular lens implantations in children for correction of clinically significant high refractive errors.

RECENT FINDINGS

Multiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment.

SUMMARY

In the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials should focus on children of various age groups to assess the variables of visual acuity gain or loss, stereopsis, contrast sensitivity, high-order aberrations, corneal physiology, and long-term complications to accurately and properly address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.

Late-onset nontraumatic dislocation of anterior chamber phakic intraocular lens

Long-term stability of the position of phakic intraocular lenses (pIOLs) is important in maintaining visual acuity as well as avoiding injury to the local tissues. We report a case of late nontraumatic dislocation of an iris-fixated pIOL, with subsequent successful repositioning.

Spontaneous dislocation of a Verisyse phakic intraocular lens with severe corneal endothelial cell loss

PURPOSE

To report a case of spontaneous dislocation of a Verisyse phakic intraocular lens (PIOL) with severe corneal endothelial cell loss.

METHODS

A 29-year-old woman with no history of trauma presented with complaint of blurred vision in the right eye of 5 months' duration. History included uneventful implantation of a PIOL bilaterally to correct high myopia in January 2007.

RESULTS

Visual acuity was 20/100, central endothelial cell density had decreased to 592/mm(2), central corneal pachymetry was 634 microm. The PIOL dislocated temporally and was removed without any lens implanted again. Three months postoperatively, her best-corrected visual acuity was 20/60.

CONCLUSIONS

A correct fixation with sufficient folded iris inside the claw and long-term follow-up are important for patients with implanted PIOL, and the long-term effects on endothelial cell density in this patient remain to be seen.

Long-term endothelial cell loss after traumatic dislocation and repositioning of Artisan phakic IOL

PURPOSE

To evaluate long-term endothelial cell loss after traumatic dislocation and repositioning of an Artisan phakic intraocular lens (PIOL).

METHODS

Traumatic PIOL dislocation occurred in the patient's left eye 4 months after uneventful implantation for unilateral congenital myopia. Using the Konan semi-automated analysis method, endothelial cell density was measured preoperatively, before Artisan repositioning, and 1, 2, and 4 years after primary implantation.

RESULTS

Endothelial cell density was 2770 cells/mm2 preoperatively and 2634 cells/mm2 before Artisan repositioning. After successful repositioning, endothelial cell density progressively decreased--1, 2, and 4 years from primary implantation, endothelial cell density was 2582, 2524, and 2538 cells/mm2, respectively, corresponding to losses of 6.8%, 8.9%, and 8.4%, respectively.

CONCLUSIONS

Progressive and long-term endothelial loss after traumatic dislocation and repositioning of the Artisan PIOL may be comparable to that reported after uneventful implantation.

Traumatic aniridia and aphakia after Artisan intraocular lens implantation

Traumatic aniridia and aphakia occurred in the left eye of a 22-year-old man who had had Artisan (Ophtec) phakic intraocular lens (IOL) implantation. Aniridia was probably the result of the relatively large wound used to implant the nonfoldable IOL. Although the eye had severe traumatic damage, vision was recoverable through a 2-stage procedure of vitrectomy and subsequent scleral suture fixation of an iris-diaphragm IOL.

Implants phakes de chambre antérieure versus chambre postérieure

At a time when some of the limitations of photoablation have been defined, such as worry concerning secondary ectasia, a renewed interest in phakic implantation has arisen. This is driven by the goal of avoiding correcting high ametropia with LASIK and is based on the development of soft foldable biomaterials. When all phakic IOLs are in front of the natural lens, two varieties of lenses can be distinguished, depending on whether it is located in the anterior or posterior chamber. The various models available in 2006 and those under current evaluation are reviewed. We do not report details of clinical studies that vary in cohort size and follow-up. The advantages and limitations are discussed for each type of phakic IOL. Adequate although not exclusive indications are deduced. There is no phakic lens that has proved to be superior to the others in terms of safety. All have the ability to provide a visual benefit with a gain in best corrected visual acuity. The difference is based on anatomical effects, requiring long-term follow-up in the evaluation of angles, lens, iris, and endothelium.

Traumatic pupillary capture of the haptic of an angle-supported phakic intraocular lens

A 27-year-old woman had implantation of an angle-supported phakic intraocular lens (pIOL) for myopia in the left eye in 2003. Moderate iris atrophy and pupil ovalization were noted in 2005. In 2006, the eye was hit by a plastic bullet shot from a toy gun. The pupil became distorted as the inferior haptic engaged the pupil edge. Visual acuity was not affected. Surgical repositioning was uneventful, yielding a round pupil with no damage to the iris sphincter or the lens. The endothelium was not affected by the trauma or surgery. Previous iris atrophy may have facilitated pupillary capture because of reduced iris elasticity and pupil ovalization by the haptic. Blunt trauma can dislocate angle-supported pIOLs. Implantation of these IOLs should be discouraged in patients who perform activities that put them at risk for eye trauma.