Anterior Chamber Intraocular Lens Implantation Research Articles

Pediatric phakic intraocular lens surgery: review of clinical studies

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. 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. 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.

Clinical compartion of Suture fixation of posterior chamber intraocular lens and anterior chamber intraocular lens implantation

Objective To investigate the posterior capsule can not be supported by better artificial lens implantation surgery. Methods In our hospital posterior chamber intraocular lens suture fixation(65 cases) and anterior chamber intraocular lens implantation(54 patients) compared the clinical follow-up. Results off residual rate( corrected visual acuity ＞ 0. 3 ) difference was not statistically significant, suture fixation of intraocular lens group a higher incidence of displacement, there were significant differences between the two groups, early high intraocular pressure group the incidence of anterior chamber high significant difference between the two groups, but a month after the incidence of high intraocular pressure was no significant difference between the two groups, corneal edema ,uveitis ,hyphema, the incidence of deformed pupil was no significant difference between two groups. Conclusion Anterior chamber intraocular lens implantation, surgery is relatively simple, with few complications. Key words: Intraocular lens; Suture fixation; Anterior chamber

Corneal Graft Detachment Without Corneal Edema After Descemet Stripping Automated Endothelial Keratoplasty

To report the case of a patient who underwent Descemet stripping automated endothelial keratoplasty complicated by corneal graft detachment without corneal edema. Case report. A 60-year-old man with bilateral decompensated endothelium 10 years after cataract extraction and anterior chamber intraocular lens implantation underwent combined anterior chamber intraocular lens explantation with iris-sutured posterior chamber intraocular lens implantation and Descemet stripping automated endothelial keratoplasty on the right eye. On the second postoperative day, the corneal graft was attached. Two weeks postoperatively, slit lamp examination revealed a double anterior chamber resulting from corneal graft detachment. The corneal graft was reattached by repositioning and injecting air. One week later, the corneal graft had detached again, creating a double anterior chamber. No corneal edema was present. Nine months postoperatively, the cornea remained clear, although a double anterior chamber was still evident as a result of the detached corneal graft. Despite post-Descemet stripping automated endothelial keratoplasty corneal graft detachment, the cornea remained without edema.

Phakic anterior chamber intraocular lens (Verisyse™) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature

The current study aims to evaluate both safety and efficacy of Verisyse() (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (>-8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses. Retrospective interventional case series. Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean <20/400). All patients underwent Verisyse() phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible. The age of patients ranged from 5-11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity >6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of >2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted. Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy. To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment.

102: Anterior chamber phakic intraocular lens implants for treatment of severe pediatric anisometropic myopia: 3-year follow-up

Purpose: To evaluate the efficacy of Verisyse phakic anterior chamber intraocular lens (IOL) implantation in the reduction of significant (≥8D) myopic anisometropia in children.

Evaluation of a pseudophakic pupillary block with an anterior segment OCT

Pupillary block has been recognised as a complication of cataract surgery and has been reported after the implantation of all major types of IOLs.1 2 We report the case of...

Diagnosis and management of corneal keloid

A 29-year-old man presented with a slowly growing mass in his left eye for the past 6 months. He had undergone a lens aspiration for traumatic cataract with an anterior chamber intraocular lens implantation several years ago. On examination, a pearly white mass was seen on the cornea. Ultrasound biomicroscopy revealed a hyperdense mass well demarcated from the underlying corneal tissue. The mass was excised by superficial keratectomy and the bare stroma covered with amniotic membrane. Histopathological examination of the excised mass revealed findings consistent with the diagnosis of a corneal keloid. At follow up after 6 months, no recurrence was observed.

The clinical evaluation of the implantation of phakic anterior chamber intraoclular lens for high myopia

目的 观察有晶状体眼前房型人工晶状体植入治疗高度近视的临床效果.方法 对近视屈光度为-8.50D～-32.00D的22例(40眼)高度近视行有晶状体眼前房角支撑袢型人工晶状体植入术,连续观察1年.结果 40眼均成功植入前房型人工晶状体.裸眼视力术前数指/20 cm～0.08,术后12月0.2～1.2;最佳矫正视力术前0.2～1.0,术后0.2～1.2.术后12月时最佳矫正视力均好于或等于术前;术后不同频段的对比敏感度和眩光对比敏感度都较术前改善.结论 有晶状体眼前房型人工晶状体植入矫正高度近视疗效好,视力恢复快,屈光状态稳定。

Comparison of Outcomes of Primary Scleral-Fixated versus Primary Anterior Chamber Intraocular Lens Implantation in Complicated Cataract Surgeries

To compare the visual outcomes and complication profiles of primary scleral-fixated intraocular lens (SFIOL) versus primary anterior chamber intraocular lens (ACIOL) implantation in cataract surgeries complicated by inadequate capsular support. Retrospective, interventional, comparative cases series. Thirty-six eyes of 36 patients undergoing SFIOL implantation (group 1) and 46 eyes of 46 patients undergoing ACIOL implantation (group 2). Retrospective analysis of medical records of a consecutive series of complicated cataract surgeries with primary SFIOL or ACIOL implantation. Postoperative best-corrected visual acuity (BCVA), intraoperative and postoperative complications, if any, and postoperative corneal endothelial cell counts. A multiple linear regression model was constructed with postoperative BCVA as the dependent variable and with IOL group (SFIOL vs. ACIOL), preoperative BCVA, surgeon's operative experience, planned operation, and patient's age as independent variables. Fifty-eight percent (group 1) and 37% (group 2) of patients underwent phacoemulsification, whereas the rest underwent extracapsular cataract extraction. The mean postoperative follow-up was 33.4+/-17.9 months (range, 6-61 months). Postoperative Snellen BCVA of 20/40 or better was achieved in 47.2% (group 1) and 71.7% (group 2) of patients (P = 0.038). Regression analysis showed that primary ACIOL implantation was associated with a significantly better postoperative BCVA of -0.157 on the logarithm of minimum angle of resolution scale (95% confidence interval, -0.306 to -0.007; P = 0.040), compared with primary SFIOL implantation. Although both the number of eyes with complications and the total number of complications were higher in the SFIOL group, the differences in early (P = 0.073) and late (P = 0.377) complications were not statistically significant. The results indicate that satisfactory results are achieved with primary implantation of current open-loop ACIOLs during cataract surgery complicated by loss of posterior capsule integrity. Eyes with these IOLs fared better than a cohort of eyes undergoing SFIOL implantation in a similar situation, at intermediate-term follow-up. Further prospective clinical trials with longer follow-up may help to evaluate the long-term visual outcomes and complication profiles after primary implantation of these lenses.

Intracapsular cataract extraction with anterior chamber intraocular lens implantation in a developing country

Aim: To assess the visual outcome of cataract extraction with ACIOL implantation in a Nigerian hospital. Methods: The visual outcome of 50 eyes of 42 patients aged 40 years and above, out of 212 eyes that underwent intracapsular cataract extraction (ICCE) and anterior chamber intraocular lens (ACIOL) implantation, were reviewed retrospectively. The follow-up period ranged from 3 months to 2 years. The operation was carried out with a loupe and standard IOL (multiflex open loop ACIOLs of 19.00 DS). Result: Good visual outcome of 6/6 to 6/18 was recorded in 27 (54%) eyes and 6/24 to 6/60 was recorded in 14 (28%) eyes. Poor visual outcome of

The Clinical observation of Anterior Chamber Intraocular Lens implantation for Complex Injuries of Ocular Anterior Segment

目的 观察眼前段复合伤手术处理联合前房型人工晶体植入的疗效.方法 追踪眼前段复合伤前房型人工晶体植入联合手术后35只眼,随访3～24个月,观察视力、眼压、角膜、前房角、虹膜、睫状体的变化以及人工晶体襻的位置.结果 术后视力增进者30只眼(85.85%),视力0.3以上者28只眼(76.4%).眼压正常者33只眼(94.4%),另2只眼眼压24～26mmHg,滴用噻吗心安眼液控制眼压;虹膜部分前粘连5只眼,35只眼襻脚均有少许色素沉着.襻脚固位于巩膜突上.结论 伴有外伤性白内障的眼前段复合伤可联合施行前房型人工晶体植入术。

Long-term follow-up of flexible open-loop anterior chamber intraocular lenses implantation

To evaluate the long-term outcome in eyes had flexible open-loop anterior chamber intraocular lens (ACIOL) implantation. Cataract extraction with primary flexible open-loop ACIOL and anterior vitrectomy were performed in 34 eyes (group I), and secondary AC IOL implantation were performed in 49 eyes (group II). Visual acuity, intraocular pressure (IOP), corneal endothelial cell, anterior chamber angle and the presence of associated complication were examined in a mean follow up of 4.8 years (range 3 to 7 years). The final best correct visual acuity was 0.5 or better in 65 eyes (78.3%). The IOP were (13.55 +/- 3.21) mm Hg preoperatively and (13.40 +/- 4.29) mm Hg (1 mm Hg = 0.133 kPa) at the last follow-up (t = 0.5427, P = 0.5888). In group I, the corneal endothelial cell density were (2497 +/- 629)/mm(2) preoperatively, while at the last follow-up it was (1995 +/- 648)/mm(2) and the rate of endothelial cell loss was (20.6 +/- 14.1)%; In group II, the corneal endothelial cell density before and after operation was (2459 +/- 681)/mm(2) and (2238 +/- 817)/mm(2) respectively. The rate endothelial cell loss was higher in group I compared with group II (P = 0.023). Postoperative complication include transient secondary glaucoma caused by block of pupil in 4 eyes and remain of viscoelastic substance in 3 eyes, hypotension in 5 eyes, persistent glaucoma in 2 eyes, hyphema in 2 eyes, IOLs slightly dislocation and shift in 3 eyes, pupil deformation in 1 eye, retina detachment in 2 eyes, and corneal decompensation in 2 eyes. Flexible open-loop ACIOL is relatively safe and effective in selected cataract surgery. Postoperative complication could be reduced if operative indication and surgical technique were emphasized.

Implantation of phakic anterior chamber intraocular lens for the correction of severe myopia

To evaluate the efficacy, safety, and predictability of the implantation of phakic anterior chamber intraocular lens (PAC-IOL) for the correction of severe myopia. In this prospective study, 15 cases (29 eyes) with myopia at -15.00 - -24.50 dioperts (D) were implanted with Phakic 6H(2) PAC-IOL. Visual acuity, refraction, intraocular pressure, corneal endothelium, the PAC-IOL position, contrast sensitivity, glare sensitivity, operative complications and poor visual symptoms were observed. Postoperative uncorrected visual acuity 0.5 or better was presented in 79.3% eyes (23/29) at 3 months and in 82.6% eyes (24/29) at 6 months. Best corrected visual acuity 0.8 or better was presented in 69.0 % eyes (20/29) at 3 months and in 69.0% eyes (20/29) at 6 months, they were all significantly better than that of preoperative values (P < 0.05); and there was no statistically significant difference between visual acuity at 3 months and 6 months (P > 0.05). Compared with preoperative best corrected visual acuity, postoperative uncorrected visual acuity improved 2 lines or more in 70.0% of eyes (20/29) at 3 months and 72.4% eyes (21/29) at 6 months. The mean postoperative spherical equivalent refraction was -1.00D at 3 months, -1.00D at 6 months, they were significantly lower than that of preoperative values (P < 0.05); and there was no statistically significant difference of spherical equivalent refraction between 3 months and 6 months (P > 0.05). There were no statistically significant difference between pre- and post-operative mean intraocular pressure, corneal endothelial density (P > 0.05) at 3 and 6 months. There was no significant difference of these data between 3 months and 6 months (P > 0.05). The PAC-IOL was located (2.341 +/- 0.116) behind the central cornea, (0.841 +/- 0.140) mm in front of the crystalline lens. The footplates appeared to be correctly positioned in the anterior chamber angle in all eyes. Contrast sensitivity and glare sensitivity in all spatial frequencies increased at 6 months post-operatively as compared with those of preoperative values (best spectacle-corrected) (P < 0.05). Postoperative complications included a slight inflammatory deposits on the PAC-IOL surface at 3 months in 10.3% eyes (3/29) and 6.9% eyes (2/29) at 6 months; oval pupil in 10.3% eyes (3/29); PAC-IOL rotation in 27.6% eyes (8/29); night glare in 17.2% eyes (5/29); all of the other patients were satisfied. PAC-IOL implantation for the correction of severe myopia is effective, safe and predictable. It can be a supplement for corneal refractive surgery, but follow-up is still required for the evaluation of long-term results.

MCQs

Objectives: To describe the surgical technique of penetrating keratoplasty (PKP) combined with scleral fixation of posterior chamber intraocular lens (PC-IOL). To determine the visual outcome and complications of PKP combined with scleral fixation of PC-IOL. Study Design: Prospective study. Setting: Department of Ophthalmology and Ophthalmic out-patient clinic, Nahariya Medical Center, Israel. Patients: 10 patients, aged 47–81 (mean 66.4 years), underwent PKP combined with scleral fixation of PC-IOL and were followed for periods of 20–34 months (mean 27.4 months). Seven of the patients had aphakic bullous keratopathy, one had Fuch's corneal dystrophy with cataract and two had corneal opacities and cataract. Main Outcome Measures: Periodic visual acuity, complete eye examination and fluorescein angiography, when indicated. Results: Visual acuity improved in all patients from light perception to counting fingers preoperatively, to 20/40 to 20/300 postoperatively. Pre-existing ocular pathologic findings were the main reason for only partial improvement of visual acuity in some of the patients. No significant complications were encountered in any of the patients. Conclusions: Scleral fixation of PC-IOL may be considered as an alternative surgical procedure to anterior chamber IOL implantation when combined with PKP and when capsular or zonular support is absent or unsafe.

Phacofragmentation with perfluorocarbon liquid and anterior chamber or scleral-fixated intraocular lens implantation for the management of luxated crystalline lenses

To present a complex surgical technique used for the management of luxated crystalline lenses and evaluate treatment results. Department of Ophthalmology, Medical University of Lodz, Lodz, Poland. This prospective study involved 29 consecutive patients (30 eyes) with the mean age of 60.3 years. The applied surgical technique comprised pars plana vitrectomy, perfluorocarbon liquid injection, and crystalline lens phacofragmentation in the vitreous cavity. Simultaneously, anterior chamber intraocular lenses (IOLs) were implanted in 10 eyes, and scleral-fixated posterior chamber IOLs in 20 eyes. The follow-up mean was 5.2 month (range 1 to 16 months). No complications were observed during phacofragmentation. Visual acuity improved in 22 cases and did not change in the other 8 eyes. The mean visual acuity was 0.40 +/- 0.37 (SD) (range between hand movements and 1.0) preoperatively and 0.68 +/- 0.34 (range 0.05 to 1.0) postoperatively. In 22 cases (73%), very good or good visual acuity (6/6 to 6/12) was achieved. There were no intraoperative complications. Postoperatively, transient hypotony was observed in 10 eyes, fibrinous reaction in the anterior chamber in 1 eye, dispersed blood in the vitreous cavity in 8 eyes, hyphema in 1 eye, corneal edema in 1 eye, vitritis in 3 cases, iris tug in 1 eye with an anterior chamber IOL, and slight dislocation of the scleral-fixated IOL in 1 case. Intraocular pressure was elevated in 11 eyes preoperatively; postoperatively, it normalized in 7 eyes without medication. Phacofragmentation with perfluorocarbon liquid and IOL implantation for the management of luxated crystalline lenses was safe and effective method, providing good functional results.

Anterior megalophthalmos in a family with 3 female siblings

This report describes different modes of management in 3 sisters with anterior megalophthalmos. We report our management of the anterior megalophthalmos and a new technique of anterior chamber intraocular lens implantation, which was used in 1 case.

Perioperative complications of intraocular lens exchange in patients with opacified Aqua-Sense lenses

To evaluate the perioperative complications of intraocular lens (IOL) exchange in 25 eyes of 22 patients with opacified Aqua-Sense IOLs (Ophthalmic Innovations International). Department of Ophthalmology, University Hospital Aintree, Liverpool, United Kingdom. The study comprised 22 patients (25 eyes) who had previous phacoemulsification and implantation of Aqua-Sense single-piece hydrophilic acrylic IOLs in the capsular bag and developed severe late opacification of the IOL. All patients reported glare and deterioration in vision. The IOLs were explanted and replaced with new lenses. The perioperative complications were evaluated. The best corrected visual acuity (BCVA) before and after surgery was compared. In 24 eyes, the opacification was complete, involving the optic, haptics, and substance of the IOLs. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 13 eyes (52%). Complications occurred in the remaining 12 eyes (48%). Ten eyes (40%) developed zonular dehiscence, 4 (16%) of which were managed with anterior chamber IOL implantation. One eye (4%) developed posterior capsule rupture and 1 eye (4%), posterior capsule rupture and zonular dehiscence. The cornea decompensated in 2 eyes (8%). One eye (4%) developed Pseudomonas keratitis. The mean BCVA (decimal scale) before and after IOL exchange was 0.57 +/- 0.24 and 0.60 +/- 0.28, respectively. There was no significant difference in visual acuity between before and after IOL exchange (P=.782, paired t test). Explantation of Aqua-Sense IOLs was challenging because of the tight adherence of the optic and haptics to the capsule. Long-term follow-up of patients with Aqua-Sense IOLs should be maintained.

A two-years fellow-up for phackic anterior chamber intraocular lens implantation in severe myopia

目的 研究前房负镜植入术矫正超高度近视的临床效果.方法高度近视患者11例(20眼).屈光度数最高-29d,最低-9.45d.术前进行眼轴长度、前房深度、角膜直径、角膜内皮计数、裸眼视力、矫正视力检查.计算人工晶状体度数.显微手术植入前房型人工晶状体.术后随访2年,观察裸眼视力、最佳矫正视力、眼压、角膜内皮计数、前房反应、人工晶状体位置、瞳孔改变等.结果术后2年所有患者平均裸眼视力0.73,矫正视力0.92.平均眼压为14.17 mmHg,无一例眼压升高.角膜内皮细胞计数(2 499.3±319.6)个/mm2,平均损失率3.4%,与术前无明显差异.ICL袢脚均未造成对房角的影响.所有患者瞳孔对光反应良好,无一例出现白内障.结论前房负镜植入矫正高度近视,尤其是高于-12d的超高度近视,2年观察临床效果令人满意。

Iris-sutured posterior chamber intraocular lens implantation during penetrating keratoplasty.

To evaluate the clinical indications and postoperative results of iris-sutured posterior chamber intraocular lens implants performed during penetrating keratoplasty. Medical records were retrospectively reviewed for preoperative indications and postoperative results of 342 consecutive patients (366 eyes) who underwent iris suturing of a posterior chamber intraocular lens implant during penetrating keratoplasty over a 9-year period. Mean follow-up was 36 months. The principal indications for corneal transplantation were pseudophakic and aphakic bullous keratopathy. Mean postoperative best spectacle-corrected visual acuity was better than preoperatively at all measured time points (P < 0.0001) and improved from 20/474 preoperatively to 20/85 at 1 year. Nine eyes (7.7%) with known preoperative glaucoma required escalation of therapy by medication or surgery to control the intraocular pressure. Seventy-two eyes (29%) without known preoperative glaucoma required treatment of elevated intraocular pressure. Seventy-nine eyes (28%) without known preoperative cystoid macular edema were additionally diagnosed. Mean endothelial cell counts declined throughout the study time frame. Corneal donor rejection episodes occurred in 36 (9.8%) eyes, with the majority having a single episode. Overall, 27 (7.4%) eyes had known graft failure at last follow-up. Two eyes (0.5%) were enucleated following wound disruption. These long-term results of iris-sutured posterior chamber intraocular lens implants performed during penetrating keratoplasty suggest acceptable visual acuity, graft survival, and complication rates. They are similar to published retrospective and prospective results of flexible open-loop anterior chamber and transsclerally-sutured posterior chamber intraocular lens implants placed during penetrating keratoplasty.

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery

Purpose To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs). Setting Eye Clinic, University of Trieste, Trieste, Italy. Methods This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level. Results The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes ( P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation ( P<.05). The ECD ranged from 1015 to 2980 cells/mm 2. The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously. Conclusions Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.