Anterior Chamber Phakic Intraocular Lens Research Articles

Anterior chamber phakic lens implantation after deep anterior lamellar keratoplasty. Retrospective cohort with 24‐month follow‐up

Aims/Purpose: To report the outcome of correction of high myopia with anterior chamber phakic intraocular lenses (IOLs) implantation after deep anterior lamellar keratoplasty (DALK).Methods: Retrospective study with 7 eyes of patients who underwent DALK. The main variables measured were corrected visual acuity (CVA) and uncorrected visual acuity (UCVA), spherical equivalent, and endothelial cell density (ECD). Follow‐up was performed up to 24 months after the lens implant.Results: The spherical equivalent (SE) recorded a mean of −14.16 (± 3.50) before the lens implant and −0.30 (±0.93) after the implant, with a mean difference of 13.85 (10.25 to 13.85) and a p‐value of <0.001. The mean of uncorrected visual acuity (UCVA) before the lens was 1.82 (±0.63), 6 months after lens implant was 0.22 (±0.07), and after 24 months, 0.30 (±0.14) with a p‐value of 0.001. Among patients, 85.71% had a UCVA equal to or better than 0.3 logMAR and 42.85% had a UCVA of 0.2 logMAR vs. 0% preoperatively. 71.42% of the patients had residual ametropia within ±1.00 D. The mean corrected visual acuity (CVA) was 0.31 (±0.06) before lens implantation, 0.12 (±0.04) 6 months post‐ implantation and 0.14 (±0.05) 24 months post‐implantation. All patients had improvement of UCVA of at least 10 lines of vision (range 10 to 14); at 6 months, 71.42% of patients had a gain of at least 2 lines of vision in CVA and at 24 months only one patient had a decrease in UCVA. The mean difference in ECD was 68.71 (95% CI 11.97 to 125.44), corresponding to a loss of 1.26% of cells per year.Conclusions: Phakic IOLs are an effective and stable procedure for management of high myopia after DALK, demonstrating stable safety and efficacy rates up to 24 months. The known risk of endothelial loss should be closely monitored, as such loss is higher compared to eyes with phakic IOL implants without DALK.

Phakic intraocular Lens implantation in keratoconus patients.

Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1. pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

MANAGEMENT CASE OF POST PHAKIC INTRAOCULAR LENS IMPLANT IN HIGH MYOPIA WITH COMPLICATED CATARACT AFTER VITRECTOMY: POST SURGERY CHALLENGES

Introduction: To highlight the therapeutic dilemma in managing complications in high myopia patient with complicated cataract after vitrectomy who previously had refractive surgery.
 Case Report: A 37-years old man, presented with half the right eye view was being blocked by a black curtain for one week before admission. He had a history of high myopia on both eyes and underwent phakic intraocular lens (PIOL) implantation 12 years ago. Presenting visual acuity (VA) of the right eye was hand motion (HM). Retinal detachment (RD) on inferior side, and clear lens with anterior chamber (AC) PIOL were found in the examination. Patient underwent vitrectomy, endolaser, and silicone oil in the next four days. A sudden severe pain with red-eye was found one month after surgery, intraocular pressure (IOP) was increased to 43 mmHg, the lens was white opaque with lens material seen in AC. 
 Discussion: The diagnosis of traumatic cataract and lens-particle-induced glaucoma was made. Lens mass evacuation surgery was performed after initial antiglaucoma medication. Posterior capsule rupture was found intraoperatively with only a small amount of lens mass remaining. Visual acuity result after the second surgery is still dissatisfied with the presence of rubeosis iridis, with the possibility of retinal re-detachment was still present.
 Conclusion: High myopia still poses a greater risk of ocular complications. It can be corrected by refractive surgery, with expensive cost and it will not prevent potential future ocular problems. Repeated assessment before and after refractive surgery procedure is mandatory in order to prevent sight-threatening complications of high myopia which might lead to other blinding complications.

Long-term efficacy and safety profiles of iris-fixated foldable anterior chamber phakic intraocular lens implantation in eyes with more than 10 years of follow-up.

To evaluate the long-term efficacy, safety, predictability, and stability of a foldable anterior chamber phakic intraocular lens (pIOL) (Artiflex) implantation in eyes with more than 10 years of follow-up. Instituto de Microcirugía Ocular, Barcelona, Spain. Retrospective study. Patients who underwent Artiflex pIOL implantation during 2008 to 2011 and with more than 10 years of follow-up were included. Variables analyzed were as follows: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE), endothelial cell count (ECC), and intraocular pressure (IOP) preoperatively and at 1 month, 1 year, 5 years, and the final follow-up. Descriptive statistics were performed and results reported following the Standard for Reporting Refractive Surgery Outcomes. 76 eyes (40 patients) were analyzed, and the mean follow-up was 10.67 ± 0.64 years. The mean preoperative SE was -8.26 ± 2.47 diopters (D), and the mean preoperative cylinder was -0.95 ± 0.86 D. At the final follow-up, efficacy and safety indices were 0.82 and 1.11, respectively. In total, 58 eyes (76%) achieved a UDVA of ≥20/40. 30 eyes (39%) gained ≥1 line of CDVA, and no eye lost ≥2 lines of CDVA. At the final follow-up, 46 (61%) and 58 (76%) eyes were within ±0.50 D and ±1.00 D of attempted SE correction, respectively. 72 eyes (95%) had ≤1.00 D of postoperative astigmatism, and 46 eyes (61%) were within ±15 degrees from the intended correction axis. At the last visit, a statistically significant myopic progression of -0.56 ± 0.83 D was observed ( P = .01). The mean ECC loss at the final follow-up was 12.2 ± 12.5%. IOP remained stable. Two eyes (2.63%) developed cataract after 10.3 years. Long-term results demonstrated that Artiflex pIOL implantation was effective, predictable, stable, and safe.

Femtosecond Laser Assisted Cataract Surgery in a Patient with Anterior Chamber Phakic IOL in situ

Introduction: Conventional phacoemulsification and intraocular lens (IOL) implantation for patients who already have a phakic IOL (PIOL) in situ can present challenges in IOL power calculation and the surgical procedure. Here we report a case of phacoemulsification with IOL implantation without removing the anterior toric PIOL. Patient and Clinical Findings: This 45-year-old male was referred to our clinic with mature cataract in the right eye, and a history of multiple corneal surgical procedures including radial keratotomy, LASIK, corneal cross-linking, and Artiflex toric PIOL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity were 20/2000. Diagnosis, Intervention, and Outcomes: Since CDVA was 20/25 after toric PIOL implantation and prior to the development of cataract, and the cornea was compromised, the toric PIOL was not removed. Using femtosecond laser assisted cataract surgery (FLACS) through the toric PIOL, capsulotomy and lens fragmentation were completed without modifying the device setting, and an IOL was inserted in the bag. At one year after surgery, right eye UDVA, CDVA, and refraction were 20/32, 20/25, and +1.25/-1.00*120ᵒ. Conclusion: In this case, FLACS was a successful technique for preserving the toric PIOL, and results were stable during the one year of postoperative follow up.

Accuracy of Intraocular Lens Calculation Formulas in Patients Undergoing Combined Phakic Intraocular Lens Removal and Cataract Surgery

To investigate the prediction accuracy of intraocular lens (IOL) calculation formulas, and the impact of anterior chamber depth (ACD) and lens thickness (LT) measurement errors on IOL power calculation in patients undergoing combined phakic IOL (PIOL) removal and cataract surgery. Retrospective, consecutive case series study. Thirty-six PIOL implanted eyes (12 anterior chamber PIOLs and 24 posterior chamber PIOLs [PC-PIOL]) undergoing cataract surgery were included. The prediction accuracy of new formulas (Barrett universal II, Emmetropia verifying optical, Kane, and Ladas super formula) and traditional formulas (Haigis, Hoffer Q, Holladay 1 and SRK/T) with or without Wang-Koch (WK) axial length (AL) adjustment was evaluated. The influence of ACD and LT measurement errors of IOLMaster 700 on refractive outcomes was also investigated. The Kane and traditional formulas with WK AL adjustment had no significant systematic prediction error and displayed a smaller median absolute error, whereas the other formulas showed significant hyperopia shift (P < .05) and relatively lower prediction accuracy. The accuracy rate of IOLMaster 700 in measuring the ACD and LT was 100% in eyes with anterior chamber PIOL implantation, and 37.50% in the PC-PIOL subgroup. No significant difference was observed in refractive outcomes of formulas using correct and wrong parameters in the PC-PIOL subgroup (P > .05). The Kane and traditional formulas with WK AL adjustment exhibited relatively higher prediction accuracy in patients who underwent combined PIOL removal and cataract surgery. The IOLMaster 700 displayed low accuracy in ACD and LT measurements for PC-PIOL implanted eyes, but showed negligible impact on IOL prediction accuracy.

Toric phakic IOLs in keratoconus\u2014evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus

PurposeTo evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus.MethodsIn this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed.ResultsThe mean postoperative uncorrected distance visual acuity (UDVApost) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVApre), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVApost/CDVApre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia (n = 14) showed significantly (p = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus (n = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (p = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVApost. The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D (p < 0.001). No significant difference was found in endothelial cell count.ConclusionThe results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.

Descemet membrane endothelial keratoplasty for corneal decompensation caused by a phakic anterior chamber intraocular lens implantation.

To describe the clinical outcomes of Descemet membrane endothelial keratoplasty combined with phacoemulsification/posterior chamber intraocular lens implantation (triple procedure) for treatment of corneal decompensation induced by a phakic anterior chamber intraocular lens (AC IOL) implantation. Ten patients (10 eyes) with corneal decompensation due to phakic AC IOL implantation that had undergone the triple procedure were included in this study. Among the 10 eyes, 5 eyes underwent explantation of AC IOL prior to the transplantation, and then underwent the triple procedure. The remaining 5 eyes with a phakic AC IOL in situ underwent the triple procedure with concurrent explantation of AC IOL. Corrected distance visual acuity (CDVA), subjective refraction, endothelial cell density (ECD), and complications were documented. The triple procedure was performed across all eyes without any adverse events. The average CDVA improved from 1.32 ± 0.24 preoperatively to 0.15 ± 0.05 logarithm of the minimum angle of resolution (logMAR), which represents an improvement in Snellen equivalent from 20/400 (0.05) preoperatively to 20/28 (0.71) at 12 months after surgery. At 12 months, all eyes reached a CDVA of 20/32 (0.63) or better, and 50% of eyes reached a CDVA of 20/25 (0.8) or better. The mean donor ECD±SD was 2868.7 ± 67.9 cells/mm2, which decreased to 1724.1 ± 84.6 cells/mm2 at 12 months, representing 39.9% of endothelial cell loss. Patients did not experience any severe adverse events. The triple procedure is a safe and effective option for corneal decompensation induced by a phakic AC IOL implantation, helping achieve a satisfactory visual rehabilitation with few complications.

Explantation of phakic intraocular lenses: causes and outcomes.

To describe reasons for explantation of anterior and posterior chamber phakic intraocular lenses (pIOLs), as well as outcomes of the surgery. The medical files of patients who underwent pIOL explantation due to complications were reviewed. All patients were divided into three groups based on the type of explanted pIOL: anterior chamber angle-supported (AS pIOL), anterior chamber iris-fixated (IF pIOL), and posterior chamber (PC pIOL). Sixty-two eyes of 41 patients were evaluated. There were 26 (41.9%), 16 (25.8%), and 20 (32.2%) eyes in the AS pIOL, IF pIOL, and PC pIOL groups, respectively. The mean interval between the implantation and removal of the pIOL (i.e., survival time) was 13.6 ± 8.1years (range 0.01-21.22years). The mean follow-up after the explantation was 22.5 ± 4.0months (range 11.3-28.7months). The main causes of explantation were cataract in the PC pIOL group (60%) and chronic endothelial cell loss in the AS pIOL group (53.8%) and IF pIOL group (56.2%). Overall, the procedure most often combined with pIOL explantation was phacoemulsification and implantation of a posterior chamber IOL (40.3%), followed by keratoplasty (9.6%). Intraoperative complications were significantly more common in the AS pIOL group than the other groups (p < 0.001). Explantation of anterior chamber pIOLs due to severe endothelial cell loss and the proportion of keratoplasty was more common in patients with a relatively long survival time. Therefore, patients with pIOL implantation should be monitored regularly after surgery.

Comparative study of small-incision lenticule extraction and phakic intraocular lens implantation for the correction of high myopia: 6-year results.

To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. University of Health Science Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey. Retrospective comparative case series. Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from -6.00 to -10.00 diopters (D) were included in the study. There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

Current Trends in Modern Visual Intraocular Lens Enhancement Surgery in Stable Keratoconus: A Synopsis of Do's, Don'ts and Pitfalls.

Keratoconus is a relatively common ectatic, non-inflammatory corneal disorder that involves gradual visual deterioration through progressive alteration of the shape of the cornea. The corneal thinning, irregular astigmatism and higher order aberrations that occur as the disease progresses pose major challenges in the visual rehabilitation of such patients. This paper summarizes the current literature regarding the results of visual enhancement procedures in patients with stable keratoconus treated with standalone anterior or posterior chamber phakic intraocular lens implantation and monofocal, toric or multifocal toric intraocular lens implantation following phacoemulsification for age-related cataract extraction or refractive lens exchange.

The pattern of increasing intraocular pressure after phakic anterior chamber intraocular Lens Implantation

&#x0D; &#x0D; &#x0D; Background: Phakic intraocular lenses (IOL) are being used to correct refractive errors. We studied the pattern of increasing Intraocular Pressure (IOP) after Phakic Anterior chamber intraocular lens implantation as the risk after surgery. Methods: Sixty eyes of 30 patients were enrolled. All eyes underwent the same protocol with IOP examination before surgical procedure, and during follow up (one day after, 2 weeks, 1 month, 2 months and 3 months) after implantation of phakic IOL anterior chamber. All results were analyzed statistically using SPSS 16 statistics software. Correlation between parameter were analyzed using the wilcoxon test. &#x0D; Results: Median IOP before surgery were 14.00 mmHg (IOP), during follow up 17.00 mmHg (IOP I), 16.00 mmHg (IOP II) , 17.00 mmHg (IOP III), 15.00 mmHg (IOP IV), 15.00 mmHg (IOP V). The increasing of IOP between pre surgery and follow up a day after was found to correlate significantly (p=0.03), there were increasing of IOP after 2 weeks, a month, 2 and 3 months but no significant difference. &#x0D; Conclusion: There were significant of increasing IOP before surgery compare to a day after surgery,then the pattern of increasing IOP tend to be stable. There were no significant increasing of IOP during 3 months follow up. &#x0D; &#x0D; &#x0D;

Refractive Outcomes After Femtosecond Laser-Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses.

To report the efficacy, predictability, and safety of femtosecond laser-assisted cataract surgery (FLACS) in eyes with anterior chamber phakic intraocular lenses (IOLs). This retrospective case series included eyes with previous implantation of an angle-supported and an iris-fixated phakic IOL for the correction of myopia that underwent a combined procedure of phakic IOL ex-plantation and FLACS with in-the-bag implantation of a posterior chamber IOL. Postoperative corrected distance visual acuity (CDVA), predictability of refractive outcome, and occurrence of intraoperative and postoperative complications were analyzed. Ten eyes of 7 patients with significant cataract were included: 5 eyes with an angle-supported foldable hydrophobic phakic IOL, 4 eyes with an angle-supported polymethylmethacrylate (PMMA) phakic IOL, and 1 eye with an iris-fixated PMMA phakic IOL. Mean follow-up after FLACS was 8.4 ± 5.8 months. Mean interval between phakic IOL implantation and FLACS was 11.9 ± 4.0 years. After the combined procedure of phakic IOL explantation and FLACS, mean manifest refractive spherical equivalent (MRSE) was -0.11 ± 0.49 diopters (D) and MRSE was within ± 0.75 D of target refraction in all eyes. Four eyes received a toric posterior chamber IOL after phacoemulsification. Mean preoperative CDVA of 0.40 ± 0.23 logMAR improved significantly to 0.22 ± 0.11 logMAR postoperatively (P = .027). No intraoperative or postoperative complications occurred. The results in this series showed that FLACS in eyes with previous implantation of both rigid and foldable anterior chamber phakic IOLs offers good refractive outcomes with a high level of predictability and safety. [J Refract Surg. 2018;34(5):338-342.].

Femtosecond laser–assisted cataract surgery in eyes with foldable anterior or posterior chamber phakic intraocular lenses

We describe a technique for the application of femtosecond laser-assisted cataract surgery in eyes with cataract and previous implantation of a foldable anterior or posterior chamber phakic intraocular lens (pIOL). In 2 eyes with an anterior chamber pIOL (angle-supported Acrysof Cachet) and 3 eyes with a posterior chamber pIOL (2 eyes with an Implantable Collamer Lens pIOL; 1 eye with a Phakic Refractive Lens), a femtosecond laser was used to create a capsulotomy, perform lens fragmentation, and create corneal incisions with the pIOL insitu. In all cases, the capsulotomy was created successfully. Lens fragmentation was complete in 4 eyes and incomplete in 1 eye, where trapped cavitationbubbles in the space between the posterior chamber pIOL and anterior lens capsule were evident as a result of a shallow vault of the pIOL.

Corneal Endothelial Changes after Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation

Background: Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOL) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures., however disabilities resulting from pIOL are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss, pIOL implantation is subjected to debate. Aim of the Work: To evaluate the endothelial cell count changes in eyes implanted with the iris-claw phakic lens for treatment of moderate to high myopia as regard changes in cell density. Patients and Methods: This study included Ten eyes of patients with moderate to high myopia implanted with The Iris-Claw Anterior Chamber Phakic Intraocular Lens at Al-Hussein University Hospital, In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal ECD and the percentage of corneal endothelial cell loss. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications. Results: Preoperative mean endothelial cell count was 3198.50 ± 444.67 cells/ mm² (range, 2715.00 – 3846.00 cells/ mm²)., it was 3074.50 ± 410.76 cells/ mm² (range, 2609.00 – 3686.00 cells/ mm²) at 1 month after surgery., 3003.00 ± 411.91cells/ mm² (range, 2532.00 – 3610.00cells/ mm²) at 6 months after surgery. The mean endothelial cell loss was 6.07% at the end of the follow up period with 3.79% at one month postoperative, 2.37% from one to six months postoperative. The mean BCVA improved from 0.27 ± 0.09 preoperatively to 0.44 ± 0.12 postoperatively and the mean UCVA, from 0.02 ± 0.01 to 0.33 ± 0.09 postoperatively, the mean SE was -0.93 ±0.57 D Postoperatively. Conclusion: Artisan phakic IOL had excellent results including., their suitability for high myopes, reversibility, high optical quality, predictability, safety, efficacy, potential gain in visual acuity in myopic patients and did not produce significant corneal endothelial cell loss 6months after surgery.

Phakic Intraocular Lens Implantation: Refractive Outcome and Safety in Patients with Anterior Chamber Depth between 2.8 and 3.0 versus ≥3.0 mm

Purpose: To compare endothelial cell (EC) variation after anterior chamber phakic intraocular lens (AC-pIOL) implantation in highly myopic patients with a preoperative anterior chamber depth (ACD) between 2.8 and 3.0 versus ≥3.0 mm. Methods: A total of 280 eyes submitted to primary AC-pIOL implantation were analyzed. Pre- and postoperative values for uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, ACD (endothelial surface), and EC count were collected. The eyes were divided into 2 groups: group A - ACD between 2.8 and 3.0 mm; group B - ACD ≥3.0 mm. Mean global EC loss (ECL) and loss for each ACD group, according to pIOL type, were analyzed. Results: Significant improvement of the spherical equivalent (-11.38 ± 4.57 vs. -0.49 ± 0.79; p = 0.000) and a significant decrease in EC density (2,810.95 ± 343.88 vs. 2,584.09 ± 374.88 cells/mm²; p = 0.000) were noted. The mean annual ECL was -2.19 ± 3.97%. Regarding group A (n = 80), a mean annual ECL of -2.06 ± 3.88% was registered, higher for the Acrysof Cachet® subtype, while group B (n = 200) showed -2.25 ± 4.01% ECL, higher for the Verisyse® subtype. There was no significant difference between the groups (p = 0.96). Conclusions: AC-pIOL implantation significantly improves the spherical equivalent in myopic patients. The mean annual ECL after pIOL implantation was higher in the larger ACD group, but this value was not statistically significant. A 2.8-mm ACD value seems to be a safe cutoff for AC-pIOL implantation.

Phakic intraocular lens (Verisyse) implantation for correction of high anisometropia in pediatric patients

PurposeOur study evaluated safety and efficacy of Verisyse™ (AMO) phakic anterior chamber intraocular lens (IOL) in the correction of significant myopic (&gt;−9 D) or hyperopic anisometropia (&gt;+6D) in children who are noncompliant to conventional treatment with spectacle correction or contact lenses.Methods28 children with myopic anisometropia (range −9.0 to −18.0 D, SE) and 7 patients with hyperopic anisometropia (range +6.0 to +9.5 D, SE) underwent unilateral Verisyse phakic IOL implantation under general anesthesia. All patients had chronic difficulties with spectacles due to aniseikonia or with contact lens intolerance. Pre‐ and post‐operative visual acuity, cycloplegic refraction, anterior and posterior segment examination, axial biometry measurements, endothelial cell counts, stereoacuity and aniseikonia examinations were performed in all patients. Target refraction was approximately 0 to −1 D. The mean age was 6.7 years; range 5–14 years. Mean follow‐up was 19.5 months (range, 10–36 months).ResultsThe mean spherical equivalent cyloplegic refraction of myopic eyes changed from −15.2 D preoperatively to −0.73 D postoperatively. The mean hyperopia reduced from +7.65 D preop. to +0.94. 81% of treated eyes were in the range ±1.0 D of emetropia. The mean uncorrected visual acuity improved from 0.012 to 0.35 (logMAR 0.45 ± 0.22), t‐test; p = 0.0014. The mean best spectacles corrected visual acuity (BSCVA) changed from 0.23 (logMAR 0.58 ± 0.15) to 0.62 (log MAR 0.17 ± 0.13), t‐test; p = 0.0238. The mean Safety Index (BSCVA postop/preop) was 2.18. Improvement in stereoacuity was reached in all 35 patients.ConclusionsAnterior chamber phakic IOLs may provide a safe and effective alternative in management of highly anisometropic myopic and hyperopic children, who are noncompliant with conventional treatment with spectacles or contact lenses.

Asymptomatic haptic migration of phakic anterior chamber intraocular lens through the peripheral iridectomy

ObjectiveCase series of haptic migration in patients with angle-supported phakic anterior chamber intraocular lens (PAC-IOL: Phakic6H) through the superior peripheral iridectomy (PI). MethodsCharts of 23 patients (35 eyes) with at least 6 months’ postoperative follow-up were retrospectively reviewed. Evaluation included preoperative and postoperative cycloplegic and manifest refractions, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, fundoscopy, corneal topography, and biometry. ResultsMean UCVA was 1.67 ± 0.30 (1.17–2.00) for all 35 eyes preoperatively and 0.35 ± 0.25 (0.00–1.00) postoperatively (p < 0.001; 95% CI 1.21–1.44). BCVA had a mean of 0.31 ± 0.26 for all 35 eyes preoperatively, and a mean of 0.22 ± 0.25 postoperatively (p < 0.001; 95% CI 0.04–0.14). Haptic migration into the superior PI was noted in 8 eyes (23%). The first migration was noted 2 years postoperatively and the last 8 years after implantation (mean, 5.6 ± 2 years). There was no statistically significant difference in the BCVA and UCVA before and after haptic migration. Follow-up ranged from 8 months to 8.5 years. ConclusionsAngle-supported PAC-IOL implantation resulted in significant improvement in both UCVA and BCVA. However, there is a 23% incidence of haptic migration in our series with no sequelae on BCVA or harmful effect on the intraocular structures. This IOL movement may be explained by changes in aqueous dynamics at the level of the PI leading to migration of the haptic into the area of least resistance. ObjectifÉtudier des cas de migration de l’haptique dans le site de l’iridectomie périphérique (IP) supérieure après l’implantation de lentilles intraoculaires phaques (LIOP) à support angulaire dans la chambre antérieure (Phakic 6H®). MéthodesOn a examiné rétrospectivement les dossiers de 23 patients (35 yeux) ayant fait l’objet d’au moins 6 mois de suivi postopératoire. Éléments évalués: réfraction sous cycloplégie et réfraction manifeste préopératoires et postopératoires, acuité visuelle non corrigée (AVNC), meilleure acuité visuelle corrigée (MAVC), examen à la lampe à fente, fondoscopie, topographie cornéenne et biométrie. RésultatsL’AVNC moyenne était de 1,67 ±0,30 (1,17-2,00) avant l’intervention et de 0,35 ±0,25 (0,00-1,00) après l’intervention (P <0,001; IC 95 %, 1,21-1,44). La MAVC moyenne était de 0,31 ± 0,26 avant l’intervention et de 0,22 ± 0,25 après l’intervention (P <0,001; IC 95 %, 0,04-0,14). Il y a eu migration de l’haptique dans le site de l’IP supérieure pour 8 yeux (23 %). La première migration a été notée 2 ans après l’intervention et la dernière, 8 ans après l’implantation (moyenne de 5,6 ± 2 ans). Il n’y avait pas d’écart statistiquement significatif entre les MAVC et les AVNC avant et après la migration de l’haptique. La durée du suivi allait de 8 mois à 8,5 ans. ConclusionsL’implantation de LIOP à support angulaire dans la chambre antérieure a donné lieu à une amélioration significative de l’AVNC et de la MAVC. Cependant, il y a eu parmi les cas étudiés une incidence de 23 % de migration de l’haptique, sans séquelles pour la MAVC ni effet nocif sur les structures intraoculaires. Le déplacement des LIO pourrait découler de variations de la dynamique aqueuse au niveau de l’IP, entraînant une migration de l’haptique vers l’endroit où la résistance est la moindre.

Long-Term Observation of Triplex Surgery for Cataract after Phakic 6H Implantation for Super High Myopia

Purpose. To analyze the safety, effectiveness, and stability of triplex surgery for phakic 6H anterior chamber phakic intraocular lens explantation and phacoemulsification with in-the-bag IOL implantation for super high myopia in long-term observations. Methods. This retrospective case series evaluated 16 eyes of 10 patients who underwent triplex surgery. Best corrected visual acuity (BCVA), endothelial cell density (ECD), and associated adverse events were evaluated. Results. The mean follow-up time after the triplex surgery was 46 ± 14 months. The mean logMAR BCVA was significantly improved after triplex surgery (P = 0.047). One eye developed endophthalmitis five days postoperatively and underwent pars plana vitrectomy (PPV). Five eyes with preoperative severe endothelial cell loss developed corneal decompensation and underwent keratoplasty at a mean time of 9.4 ± 2.6 months after the triplex surgery. One eye had graft failure and underwent a second keratoplasty. The eye developed rhegmatogenous retinal detachment and underwent PPV with silicone oil 18 months later. ECD before the triplex surgery was not significantly different compared with that at last follow-up (P = 0.495) apart from these five eyes. Three eyes (18.8%) developed posterior capsule opacification. Conclusions. Triplex surgery was safe and effective for phakic 6H related complicated cataracts. Early extraction before severe ECD loss is recommended.

The effect of pupil dilation on AL-Scan biometric parameters

The purpose of this study was to investigate the effects of pupil dilation on the parameters of the AL-Scan (Nidek Co., Ltd, Gamagori, Japan). We compared the measurements of axial length (AL), anterior chamber depth (ACD), central corneal keratometry reading, pupil diameter, and intraocular lens (IOL) power of 72 eyes of 72 healthy volunteers and patients scheduled for cataract surgery before and 45min after instillation of cyclopentolate hydrochloride 1% using the AL-Scan. Intraobserver repeatability was assessed by taking three consecutive recordings of ACD and AL. Only ACD readings were significantly different between predilation and postdilation (P<0.001). The difference of the other measurements between two sessions was not statistically significant (P>0.001). Only two cases in the study demonstrated changes in IOL power higher than 0.5D. The intraobserver repeatability of both devices was good (CV values for ACD and AL were 0.16 and 0.20%, respectively). Dilated pupil size did not affect the measurement of IOL power using the A-Scan optical biometer, but increase in ACD after dilation should be taken into account when performing refractive surgeries in which ACD is very important such as phakic anterior chamber IOL implantation.