Incidence of corneal ulcer in hydrogel contact lens wearers and post-cataract endophthalmitis: Do they Compare?

Abstract

Our patients today often perceive current corneal refractive surgery to be a painless, successful, and overall safe procedure, which becomes an alternative to contact lenses and spectacles. This thinking is about to be taken one step further—to also embrace and to include as one of refractive surgery’s many options, the implantation of intraocular contact lenses (IOCL) in a healthy phakic eye. The IOCL can be placed either anterior, posterior or adjacent to the iris in an eye with a clear crystalline lens. An example of an anterior chamber IOCL is the Nu Vita lens by Bausch & Lomb Surgical while, the posterior chamber IOCL is represented by Intraocular Contact Lens developed by Staar Surgical. The Artisan lens by Optech BV is the latest designed iris supported lens, which is currently in the final phase of the Food and Drug Administration’s clinical investigation for its safety and efficacy in the treatment of myopia [1]. While IOCLs may require different ocular placement, they all still require the penetration of the globe, which ophthalmic surgeons, due to the risks involved in the past, would avoid unless it becomes clinically necessary. In the case of a cataract, the surgeon opens the globe, removes part or all of the crystalline lens and implants a lens that essentially replaces the function of the crystalline lens. This type of intraocular surgery has a distinct health benefit in restoring lost vision. It is generally accepted that the benefits outweigh the risks inherent with intraocular surgery. However, with clear lens IOCL procedures, there is no such health benefit, but presumably the risks are the same or even greater than those encountered in cataract surgery. The old wisdom of not opening the globe unless it is absolutely clinically necessary is abandoned in these procedures. Logic dictates that the IOCL procedure must not be accepted as a variant of “safe” cataract surgery or another “safe” refractive procedure. The IOCL carries it’s own unique risk benefit ratio, on which it should be eval-