Aphakic Intraocular Lens Research Articles

Comparison of surgical outcomes of Carlevale sutureless scleral fixation and Artisan Aphakia intraocular lens.

To compare intra- and postoperative results of sutureless scleral fixated Carlevale intraocular lens (IOL) with iris fixated Artisan IOL. Monocentre, retrospective analysis of refractive outcomes and intra- and postoperative complications of patients who received a Carlevale or Artisan IOL between January 2019 and March 2022. 178 eyes of 169 patients were included (101 Carlevale and 77 Artisan IOLs). The standard follow-up time was 1 month. Two statistically significant differences were found: in the deviation of the postoperative spherical equivalent of the refraction from the preoperative chosen IOL target (p = 0.019; mean deviation was -0.46 in the Carlevale and 0.08 in the Artisan group), and the number of eyes with complications between the Carlevale and Artisan groups (p = 0.003; 33 in the Carlevale and 42 in the Artisan group). The current study is the largest so far comparing both refractive outcomes and complications after implantation of Carlevale and Artisan IOL. The Carlevale IOL does not carry a greater complication risk on the short-term follow-up. This provides additional evidence that the Carlevale IOL has to be added to the armamentarium of the ophthalmic surgeon.

Comparing clinical outcomes of Optiwave Refractive Analysis, Lenstar, and surgeon’s modified method for intraocular lens power calculation in Asian eyes

The study aimed to compare the accuracy of intraocular lens (IOL) calculation to predict postoperative refraction by Optiwave Refractive Analysis (ORA), Lenstar LS 900, and the surgeon’s Modify method in normal Asian eyes. The IOL power of the Lenstar group was calculated according to Lenstar LS 900, whereas the surgeon's Modify group used topography, axial length (AL) of Lenstar, and Barrett Universal II online formula. Intraoperative aphakic measurements and IOL power calculations were obtained with the ORA system. From the results acquired through Lenstar, Modify, and ORA, the surgeon used his judgment to select the actual IOL power. Postoperative manifest refraction spherical equivalent (MRSE) was obtained 2 months after surgery. The prediction error (PE) was calculated as the difference between the postoperative MRSE and the target refraction proposed by three methods. AL, anterior chamber depth (ACD, measured from corneal endothelium to lens), lens thickness (LT), and ACD + 1/2LT were also included in the survey. In 67 eyes, the average real PE was smaller for the Lenstar (0.06 ± 0.44) and Modify (− 0.05 ± 0.40) than for the ORA group (− 0.25 ± 0.60, p < 0.05). The ORA system demonstrated the best results of IOL power selection in eyes with a normal range of ACD + 0.5 LT (5.2–5.6 mm) in Asian eyes.

Prospective analysis of Artisan aphakia intraocular lens implantation for nontraumatic ectopia lentis in children

To report long-term outcomes of iris claw aphakia intraocular lens (IOL) implantation for nontraumatic ectopia lentis (EL) in children. In this prospective study, children who underwent Artisan Aphakia IOL placement were included if they have a minimum of 1-year follow-up after implantation. Main outcome measures were: best-corrected distance visual acuity, reoperations, change in central corneal thickness (CCT), and corneal endothelial cell counts (ECC). The Artisan Aphakia IOL was implanted in a total of 76 eyes of 43 patients (68 eyes of 34 patients with EL). 56 eyes of 28 patients have been followed long enough to meet the inclusion criteria for this report. The average age at Artisan Aphakia IOL implantation was 11.1 years (range of 2-20 years). Average follow-up was 3.59 years, and 23% of patients have >5 years' follow-up. Mean best-corrected visual acuity improved from 0.36 (20/46) to logMAR 0.18 (20/30) after implantation (P = 0.02). Five reoperations were needed in 4 patients, 3 (7%) related to post-implantation trauma. Average preoperative CCT was 580 μm; estimated mean increase in CCT at the 5-year postoperative visit was 11.9 μm higher (P = 0.047). Average preoperative ECC was 3178 cells/mm2; estimated mean loss of ECC at the 5-year postoperative visit was not significantly different from zero (187.7 cells/mm2 [P = 0.102]). The Artisan Aphakia IOL, used in the absence of capsular support, had an acceptable safety profile in our patients.

Intraoperative aberrometry compared to preoperative Barrett True-K formula for intraocular lens power selection in eyes with prior refractive surgery.

To compare the predictive refractive accuracy of intraoperative aberrometry (ORA) to the preoperative Barrett True-K formula in the calculation of intraocular lens (IOL) power in eyes with prior refractive surgery undergoing cataract surgery at the Loma Linda University Eye Institute, Loma Linda, California, USA. We conducted a retrospective chart review of patients with a history of post-myopic or hyperopic LASIK/PRK who underwent uncomplicated cataract surgery between October 2016 and March 2020. Pre-operative measurements were performed utilizing the Barrett True-K formula. Intraoperative aberrometry (ORA) was used for aphakic refraction and IOL power calculation during surgery. Predictive refractive accuracy of the two methods was compared based on the difference between achieved and intended target spherical equivalent. A total of 97 eyes (69 patients) were included in the study. Of these, 81 eyes (83.5%) had previous myopic LASIK/PRK and 16 eyes (16.5%) had previous hyperopic LASIK/PRK. Median (MedAE)/mean (MAE) absolute prediction errors for preoperative as compared to intraoperative methods were 0.49 D/0.58 D compared to 0.42 D/0.51 D, respectively (P = 0.001/0.002). Over all, ORA led to a statistically significant lower median and mean absolute error compared to the Barrett True-K formula in post-refractive eyes. Percentage of eyes within ± 1.00 D of intended target refraction as predicted by the preoperative versus the intraoperative method was 82.3% and 89.6%, respectively (P = 0.04). Although ORA led to a statistically significant lower median absolute error compared to the Barrett True-K formula, the two methods are clinically comparable in predictive refractive accuracy in patients with prior refractive surgery.

Pupil dynamics after in-the-bag versus anterior and retropupillary iris-fixated intraocular lens implantation

An Intraocular Lens (IOL) fixated on the iris either anteriorly, as a phakic IOL, or posteriorly, as an aphakic IOL, can influence pupil motility. In this interventional case series study, we evaluated pupil size under different levels of illumination (scotopic = 0.04 lx, low-mesopic = 0.4 lx and high-mesopic = 4 lx) for anterior iris-claw IOL fixation for correcting myopia or hyperopia (IFPH), retropupillary iris-claw IOL fixation to correct aphakia or as treatment for late in-the-bag IOL dislocation/subluxation (IFRP), and capsular-fixation IOL in-the-bag implantation (IB). Pupil size was measured preoperatively for the IFPH- and IB-group as well as 6 months after surgery for all groups. We analyzed a total of 70 eyes: 22 eyes of 11 patients with phakic IOLs, 22 eyes of 20 patients in the IFRP group and 26 eyes of 13 patients in the IB group. Both IFPH and IB showed a smaller postoperative scotopic pupil size, compared with the preoperative values. When compared to postoperative values of IB and IFPH, IFRP showed a significantly smaller postoperative scotopic pupil size (IFPH: 5.89 ± 0.83 mm, IFRP: 4.37 ± 0.83 mm, IB: 5.34 ± 0.98 mm, p < 0.001) while no differences were seen at high-mesopic lighting. Neither of the surgical techniques seems to impair the constriction of the pupil.

Single-Haptic Dislocation of Retropupillary Iris-Claw Intraocular Lens: Outcomes of Reenclavation.

To report the clinical feature of dislocated retropupillary iris-claw aphakic intraocular lens (IOL) and outcomes of reenclavation. In this multicenter, retrospective case series, 225 eyes of 225 patients underwent retropupillary fixation of iris-claw aphakic IOL and the cases with haptic dislocation were reviewed. Single haptic dislocation was observed in 22 of 225 eyes (9.8%) after 89 ± 77 days (range: 5 days to 277 days) postoperatively, and resolution was achieved through reenclavation without any intraoperative complications in all patients. Iris atrophy in 13 eyes (59%) and history of face washing at the time of dislocation in five patients (23%) were noted. Reenclavation did not cause statistically significant change in best-corrected visual acuity (P = .315), spherical equivalent (P = .660), or endothelial cell count (P = .182) compared to those after the primary surgery. Single-haptic dislocation of retropupillary iris-claw aphakic IOL is not a rare complication and can be safely and effectively corrected by reenclavation. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:384-390.].

The Influence of Decentration on Higher-Order Aberrations in Artisan Aphakic Intraocular Lens Implantation Eyes.

Purpose To characterize the influence of decentration on higher-order aberrations of Artisan aphakic intraocular lens implantation eyes. Setting. Department of Ophthalmology and Vision Science, Eye and ENT Hospital of Fudan University, Shanghai, China. Design Retrospective case series. Methods Twenty-three eyes of 18 patients were retrospectively examined. Location of the IOL was imaged using a slit-lamp, and decentration (the distance from the center of a pupil to the geometric center of the IOL) was measured using the AutoCAD 2007 software. Ocular and internal higher-order aberrations were measured using the wavefront analyzer KR-1W (Topcon) and their correlation with decentration were analyzed. Coma, spherical, 3rd-, 4th-order, trefoil, tetrafoil aberrations, ocular, and internal higher-order aberrations were calculated for a 4.0 mm pupil diameter. Results The mean age of patients was 33.6 ± 21.4 years (ranging from 7 to 72 years). The mean follow-up period was 28.2 ± 10.5 months (ranging from 12 to 52 months). The mean postoperative best-corrected visual acuity (BCVA) was 0.19 ± 0.19 logMAR (range −0.18–0.52). The mean decentration was 0.57 ± 0.28 mm (range 0.15–1.21 mm). There was no correlation between Artisan IOL decentration and ocular higher-order aberrations, internal higher-order aberrations, coma, spherical, 3rd-, 4th-order, trefoil, and tetrafoil aberrations, respectively. There was a positive correlation between Artisan IOL decentration and 2nd-astig aberrations when 2nd-astig aberrations were less than 0.1. Conclusions The position of Artisan IOLs showed slight decentration and the amounts of decentration were not large enough to influence higher-order aberrations.

A Study of the Mechanical Forces on Aphakic Iris-Fixated Intraocular Lenses.

Iris-fixated aphakic intraocular lenses (IFIOL) are used in cataract surgery when more common intraocular lenses (IOL) cannot be adopted because of the absence of capsular bag support. These lenses can be implanted on either the posterior or the anterior surface of the iris. In this work, we study whether one of these options is preferable over the other from the mechanical point of view. In particular, we focus on the forces that the IFIOL transmits to the iris, which are associated with the risk of lens dislocation. We study the problem numerically and consider aqueous flow induced by saccadic rotations in the cases of an IFIOL in the anterior and posterior sides of the iris. The considered IFIOL is the Artisan Aphakia +30.0 D lens (IFIOL) produced by Ophtec BV. We perform the simulations in openfoam. We find that the forces transmitted by the aphakic IFIOL to the iris are significantly higher in the case of posterior implantation. This suggests that lens implantation on the posterior surface of the iris might be associated with a higher risk of lens dislocation, when an inadequate amount of iris tissue is enclavated during implantation.

Complications and outcomes of descemet stripping automated endothelial keratoplasty with artisan aphakia intraocular lens implantation

To evaluate the complications and outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) combined with artisan aphakia intraocular lens (IOL) implantation in severely damaged eyes without capsular support. DSAEK combined with artisan iris claw IOL implantation was performed on 29 eyes. All eyes were of abnormal structure due to complications from prior intraocular surgeries and ocular trauma. Ocular complications observed included graft dislocations, high intraocular pressure (IOP), IOL dislocations, macular edema and hyphema. Best corrected visual acuity (BCVA), IOP and mean central endothelial cell density (ECD) were recorded. Thirteen eyes had a history of ocular trauma, 10 eyes had an anterior chamber IOL, 16 eyes had prior vitrectomy. The iris was abnormal in 22 cases. Graft dislocation occurred in 5 (17.2%) of 29 eyes. IOL dislocation occurred in 2 eyes (6.9%). High IOP was found in 9 eyes and was controlled with treatment. The preoperative mean BCVA was 20/286. The 6mo postoperative mean BCVA was 20/42. The average center ECD was 1965.3 cells/mm2 at 6mo, and the rate of the donor cell loss was 34.7%. DSAEK combined with artisan aphakia IOL implantation is an alternative option for resolving endothelial and lens disorders in aphakic eyes without capsular support. However, it should be performed cautiously for eyes with severe iris defects.

Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation.

Purpose:To compare the outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens (IOL) power calculation in eyes undergoing cataract surgery with monofocal IOL implantation.Methods:Preoperative data were obtained with the IOLMaster. Intraoperative aphakic measurements and IOL power calculations were obtained in some patients with the optiwave refractive analysis (ORA) system. Analysis was performed to determine the accuracy of monofocal IOL power prediction and postoperative manifest refraction at 1 month of the ORA versus IOLMaster.Results:Two hundred and ninety-five eyes reviewed, 61 had only preoperative IOLMaster measurements and 234 had both IOLMaster and ORA measurements. Of these 234 eyes, 6 were excluded, 107 had the same recommended IOL power by ORA and IOLMaster. Sixty-four percent of these eyes were within ±0.5D. 95 eyes had IOL power implantation based on ORA instead of IOLMaster. Seventy percent of these eyes were within ±0.5D of target refraction. 26 eyes had IOL power chosen based on IOLMaster predictions instead of ORA. Sixty-five percent were within ±0.5D. In the group with IOLMaster without ORA measurements, 80% of eyes were within ±0.5D of target refraction. The absolute error was statistically smaller in those eyes where the ORA and IOLMaster recommended the same IOL power based on preoperative target refraction compared to instances in which IOL selection was based on ORA or IOLMaster alone. Neither prediction errors were statistically different between the ORA and IOLMaster alone.Conclusion:Intraoperative wavefront aberrometry with the ORA system provides postoperative refractive results comparable to conventional biometry with the IOLMaster for monofocal IOL selection.

Visual outcomes and complications of posterior iris-claw intraocular lens implantation in aphakic postvitrectomized eyes

Purpose: To evaluate refractive outcome, anatomical outcome, complications of posterior chamber iris-claw aphakic intraocular lens (IOL) implantation after pars plana vitrectomy. Methods: A retrospective analysis of consecutive 25 eyes of 25 pts (12 males & 13 females) without capsular support in which we performed posterior chamber iris-claw implantation after pars plana vitrectomy. Retro-pupillary iris claw lens were either implanted in the same procedure along with vitrectomy (15 eyes, Group A) or later in different procedure (10 eyes, Group B) in post vitrectomised eyes. Posterior vitrectomy procedures were performed with 23- or 25-gauge techniques for different associated anterior or posterior segment indications. Visual outcomes, anatomical outcome, stability of the implants, and complications were analysed. Results: The mean patient age was 62.3 years(range, 21–78 years) in group A; 60.1 years (range, 19-80 years) in group B. The mean follow-up time was 4.12 months (range, 1-12 months). In Group A 6 eyes had lens dislocation aphakia (5 traumatic, 1 surgical) & 7 IOL dislocation aphakia (3traumatic, 4 surgical). In Group B 5 eyes had lens dislocation aphakia(4 traumatic,1 surgical) and 2 IOL dislocation aphakia(1 traumatic,1 surgical). At the end of the follow up the mean post-operative best-corrected LogMAR visual acuity was 0.244±0.25 in group A; 0.286±042 in group B which was statistically significant as compared preoperatively. Intergroup best corrected visual acuity comparisons at the end of follow up were not statistically significant. Similarly within group spherical equivalent decreased statistically when compared to the preoperative values. Between group comparisons, spherical equivalent values were not significant. Intra-op anterior chamber collapse was not seen in any case. Disenclavation of iris claw lens was not seen in any case. No corneal edema was observed. 1 case of uveitis was observed. 1 case of post-op macular edema was observed. 3 cases had increased post-op intraocular pressure.1 case had post-op vitreous hemorrhage which resolved spontaneously, retina attached in all cases. Conclusion: In summary posterior chamber iris-claw IOL implantation in aphakic eyes without capsular support in post vitrectomized is an effective, predictable and safe procedure.

Visual Outcomes after Primary Iris Claw Artisan Intraocular Lens Implantation during Complicated Cataract Surgery

ABSTRACTPurpose: To evaluate the efficacy and safety of aphakic Artisan–Verysise intraocular lens (IOL) primarily implanted for complicated cataract surgery. Methods: A retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared. Results: The mean age of the participants was 68 ± 12.7 years, and the mean follow-up time was 30.7 ± 14.8 months. The mean BCVA improved significantly from 0.58 ± 0.4 at baseline to 0.44 ± 0.41 after the operation (P = 0.008). The spherical equivalent changed insignificantly from -0.13 ± 1.55 preoperatively to -0.6 ± 1.88 (P = 0.724) at the last visit. Postoperative complications were transient pigmented precipitates in five cases and raised intraocular pressure in one case. Conclusion: Aphakic Artisan IOLs are attractive alternatives in complicated cataract surgery without sufficient capsular bag support.

Intraoperative aberrometry-based aphakia refraction in patients with cataract: status and options

AimTo explore the application of intraoperative wavefront aberrometry (IWA) for aphakia-based biometry using three existing formulae derived from autorefractive retinoscopy and introducing new improved formulae.MethodsIn 74 patients undergoing cataract surgery,...

Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study.

To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support. In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion. All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred. Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.

Endothelial cell loss after retropupillary iris-claw intraocular lens implantation

The aim of this study was to evaluate the indication, visual and refractive outcome, endothelial cell loss and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL). This retrospective study comprised 62 eyes of 56 patients without adequate capsular support undergoing posterior iris-claw aphakic IOL implantation (Verisyse™/Artisan®) between 2006 and 2012. Mean follow-up was 34 months (range from 13 to 78 months). The IOLs were inserted during primary lens surgery in 11 phakic eyes (17.8 %), during an IOL exchange procedure for dislocated posterior chamber IOLs in 34 eyes (54.8 %), and as a secondary procedure in 17 aphakic eyes (27.4 %). The final best spectacle-corrected visual acuity (BSCVA) in logMAR (mean 0.24 ± 0.45) improved significantly (p < 0.001) compared to the preoperative BSCVA (mean 0.61 ± 0.65). The mean spherical equivalent improved from preoperative 7,25 ± 5,04 diopters (D) (range - 10.25 to + 16.0 D) to - 0.21 ± 1.01 D (range - 4.0 to 3.0 D) postoperatively. Mean central endothelial cell density was 1844 ± 690 cells/mm(2) preoperatively. After surgery mean endothelial cell density decreased statistically not significant with a loss of 5.5 % to 1743 ± 721 cells/mm(2) (p > 0.05) at last follow-up visit. Complications included cystoid macular oedema in 4 eyes (6.4 %), early postoperative hypotony in 2 eyes (3.2 %), pupil ovalisation in 2 eyes (3.2 %), traumatic iris-claw IOL disenclavation in 2 eyes (3.2 %) and spontaneous IOL disenclavation in one eye (1.6 %). Retropupillar iris-claw IOL provides good visual and refractive outcomes with a low endothelial cell loss and can be used for a wide range of indications in eyes without adequate capsular support.

Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty

PurposeTo evaluate clinical outcomes and complications after Descemet membrane endothelial keratoplasty (DMEK) and posterior iris-claw aphakic intraocular lens (IOL) implantation.MethodsThis prospective cohort study comprised seven consecutive eyes (seven patients) without...

Posterior Iris-Claw Aphakic Intraocular Lens Implantation in Subluxated Lenses due to Marfan Syndrome

To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in subluxated lenses due to Marfan syndrome. Eyes without adequate capsular support had posterior chamber iris-claw aphakic IOL implantation between 2006 and 2012. This retrospective cohort study comprised 13 eyes of 10 patients (7 female, 3 male; mean age ± standard deviation, 34.7 ± 19.6; range 9-61 years). The mean follow-up was 37 months (range 6-74 months). The mean final postoperative best-corrected visual acuity was significantly (0.24 ± 0.36 logMAR) better at the last follow-up than 1 day preoperatively (0.72 ± 0.46 logMAR) (p<0.05). There was no significant change in intraocular pressure before and after surgery. The mean endothelial cell density decreased from 2793 ± 478 cells/mm2 preoperatively to 2637 ± 612 cells/mm2 at last follow-up, representing a mean endothelial cell loss of 5.6%. Complications included early transient postoperative hypotony in 2 eyes (15.4%), slight persistent pupil ovalization in 1 eye (7.7%), and retinal detachment in 1 eye (7.7%). The posterior implantation technique of aphakic iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used as a reasonable alternative in subluxated lenses due to Marfan syndrome without adequate capsular support.

Posterior Iris-claw Aphakic Intraocular Lens Implantation in Children

To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in children. Noncomparative retrospective cohort study. setting: Institutional practice. patients/intervention procedures: Seven eyes of 4 children without adequate capsular support had posterior chamber iris-claw aphakic IOL implantation between 2007 and 2012. main outcome measures: Visual acuity, endothelial cell changes, intraoperative and postoperative complications. The mean age of the 3 boys and 1 girl was 12.0 ± 3.4 (SD) years (range 8-16 years). In all eyes, the mean postoperative best spectacle-corrected visual acuity (0.13 ± 0.17 logMAR) was statistically significantly better at the last follow-up than at 1 day preoperatively (0.60 ± 0.39 logMAR) (P < .05). The mean follow-up was 31 months (range 10-64 months). The mean endothelial cell density decreased from 3013 ± 155 cells/mm(2) preoperatively to 2831 ± 236 cells/mm(2) at last follow-up, representing a mean endothelial cell loss of 6.4%. No corneal decompensation, iritis, secondary glaucoma, or pupillary block occurred after surgery in any eye. Postoperative complications included transient postoperative hypotony in 1 eye and a traumatic dislocation of a posterior aphakic iris-claw IOL in 1 eye. The posterior implantation technique of aphakic iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used as a reasonable alternative for a wide range of indications in pediatric eyes without adequate capsular support.

Outcomes of iris-enclaved Artisan-Ophtec intraocular lens implantation in aphakic children

Children treated by lensectomy for ectopia lentis, traumatic cataract with lens subluxation or severe persistent fetal vasculature-related cataracts lack capsular support for implantation of standard, posterior-chamber intraocular lenses (IOL). We reported previously use of trans-scleral sutured IOLs in this population. Here we describe outcomes of Artisan iris-enclaved IOL implantation. Clinical outcome data were collated prospectively in 28 aphakic eyes of 17 implanted children (7 Marfan syndrome; 5 familial ectopia lentis; 5 persistent fetal vasculature). All children had difficulties with contact lens or spectacle wear. Peripheral iridectomy was performed at IOL implantation. Mean age at surgery was 8.1 yrs (range, 1-17 years); mean follow-up was 3.1 yrs. Aphakic spherical correction averaged 14.06 D (range, +7.75 to +19.75). 26/28 eyes (93%) were corrected to within ±1.0 D of emmetropia and all to within 1.5 D. Uncorrected visual acuity improved from an average logMAR 1.50 (20/640) to 0.17 (20/30); best-corrected acuity improved an average 2 Snellen lines (0.18 logMAR). Four eyes (20%) required an additional vitrectomy or laser-iridotomy for pupillary block 1 day to 9 mos after IOL implantation. Two IOLs (7%) were explanted; one for repeated de-enclavation and one for microcornea-related glaucoma and corneal decompensation. Implantation of the Artisan aphakic IOL improved visual acuity substantially and was well-tolerated in the majority of children. Repeat vitrectomy at IOL implantation is recommended to reduce the risk of pupillary block caused by vitreous plugging of the iridectomy. Implantation of the Artisan aphakic IOL improved visual acuity substantially and was well-tolerated in the majority of children. Repeat vitrectomy at IOL implantation is recommended to reduce the risk of pupillary block caused by vitreous plugging of the iridectomy.

Visual Outcome and Changes in Corneal Endothelial Cell Density Following Aphakic Iris-Fixated Intraocular Lens Implantation in Pediatric Eyes With Subluxated Lenses

To evaluate the visual outcome and corneal endothelial cell density after Artisan aphakic intraocular lens (IOL) implantation (Ophtec, Groningen, the Netherlands) in pediatric eyes with subluxated lenses. Artisan aphakic IOLs were implanted in 18 eyes of 11 children with subluxated lenses. Idiopathic subluxations and ectopia lentis due to Marfan syndrome were included, whereas subluxations due to trauma or buphthalmos were excluded. Best-corrected visual acuity (BCVA) and endothelial cell density were monitored. Mean postoperative BCVA and endothelial cell density at last follow-up visit were calculated. The age of children at the time of Artisan aphakic IOL implantation ranged from 8 to 16 years (mean: 11.58 ± 2.9 years). Mean follow-up was 9.12 ± 4.30 months. Mean postoperative logarithm of the minimum angle of resolution BCVA was 0.26 ± 0.13 (P = .001) and mean postoperative endothelial cell density was 2,860 ± 435 cells/mm(2) (P = .000). Mean endothelial cell loss was 17.1%. Artisan aphakic IOL implantation is a safe surgical choice in the management of ectopia lentis in the pediatric age group. It has minimal complications and is less traumatic to pediatric eyes. However, long-term follow-up of these children is required.[J Pediatr Ophthalmol Strabismus 2013;50(3):178-182.].