Artisan Phakic Intraocular Lens Implantation Research Articles

Laser in situ keratomileusis versus Artisan lens implantation in correcting ametropia after penetrating keratoplasty for keratoconus

PurposeTo compare the long-term safety and efficacy of laser in situ keratomileusis (LASIK) with Artisan phakic intraocular lens implantation to correct refractive errors after penetrating keratoplasty (PK) for keratoconus.MethodsThis retrospective comparative interventional case series included a total of 33 consecutive keratoconus eyes that had previous PK and received subsequent LASIK (n = 16) or Artisan lens implantation (n = 17) were included in this study. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and complications.ResultsPostoperatively, the UDVA of ≥20/40 was achieved in none of the LASIK group compared to 62.5% of eyes in the Artisan group (P < 0.001); the respective values for CDVA of ≥20/40 were 87.5 and 94.1% (P = 0.51). Spherical equivalent refraction decreased from − 6.97 ± 1.50 D preoperatively to − 4.20 ± 2.05 D postoperatively in the LASIK group (P < 0.001) and from − 10.79 ± 2.15 D preoperatively to − 2.13 ± 1.23 D postoperatively in the Artisan group (P < 0.001). There was no significant change in the refractive astigmatism in LASIK group (P = 0.30) or Artisan group (P = 0.11). The efficacy and safety indices were significantly better for Artisan (0.82 ± 0.34 and 1.13 ± 0.30, respectively) than for LASIK (0.22 ± 0.17 and 0.85 ± 0.24, respectively, P ≤ 0.006 for both comparisons). While refractive error changed significantly from postoperative year 3 to the final visit in the LASIK group, it remained stable in the Artisan group through follow-up period. No significant complications were observed in any group.ConclusionArtisan lens implantation provided superior and stable visual outcomes compared to LASIK for the management of post PK refractive errors in keratoconus eyes.

Effect of incision types for Artisan phakic intraocular lens implantation on ocular higher order aberrations.

To evaluate the effect of incision types for Artisan phakic intraocular lens (PIOL) implantation on ocular higher-order aberrations (HOAs). A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type: cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter (D) were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity, special equivalents, astigmatism, predictability (±1 D from target refraction), HOAs (coma, trefoil, spherical aberration), and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively. At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square (RMS) total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group. Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.

Short-term outcome after artisan phakic intraocular lens implantation for treatment of high myopia

Purpose The aim of this study was to evaluate the efficiency and safety after artisan phakic intraocular lens (IOL) implantation for treatment of high myopia. Setting The study was conducted in Qena University Hospital. Methods This was a prospective nonrandomized interventional case study. A total of 28 eyes in 24 patients having myopia ranging from −13 to −21 D underwent implantation of artisan phakic IOL (Ophtec; polymethylmethacrylate lens). Eyes were examined at day 1, 1 week, 1, 2, and 4 months after surgery. At each visit, the following data were recorded: manifest refraction, uncorrected visual acuity, best spectacle corrected visual acuity (BSCVA), change in BSCVA, slit lamp examination, applanation tonometry, as well as any adverse effects. Results At 4 months postoperatively, the mean spherical equivalent was −1.5 D ± 0.6. The mean uncorrected visual acuity was 0.33 ± 0.17 and mean BSCVA was 0.48 ± 0.15. As regards the safety of artisan phakic IOL, the BSCVA remained the same or improved for all eyes; an average gain of 1.8 ± 0.62 lines of improvement was observed in 15 cases compared with preoperative BSCVA. Night glare/halos were noted in 10% of the eyes. Corneal edema was observed in one eye during the immediate postoperative period. Conclusion Artisan phakic IOL is a safe (short-term), efficient, and predictable modality for the treatment of high myopia. Improvement of postoperative vision is a valuable outcome.

Changes in the Accommodation-convergence Relationship after the Artisan Phakic Intraocular Lens Implantation for Myopic Patients

PurposeTo evaluate the change of accommodation-convergence parameters after implantation of Artisan phakic intraocular lens (PIOL).MethodsProspective study for the patients with the Artisan PIOL implantation was performed. A total of 37 patients (3 males and 34 females) enrolled the study. Preoperatively, convergence amplitude, the stimulus accommodative convergence per unit of accommodation (AC/A) ratio and the near point of convergence (NPC) were evaluated. After the Artisan PIOL implantation, the identical evaluations were repeated at 1 week, 1, 3, and 6 months after the surgery.ResultsMean age was 24.3 ± 4.8 years old, and preoperative refractive error was -8.92 ± 4.13 diopters (D). After the implantation, mean refractive errors significantly decreased to within ±1.00 D, and noticeable complications were not found. The convergence amplitude and the stimulus AC/A ratio increased 1 month after the surgery, but progressively stabilized afterward to near preoperative values. NPC didn't show any significant change over follow-up period up to 6 months.ConclusionsThese results regarding implantation of the Artisan PIOL revealed the increase of accommodation-convergence relationship within first 1 month after the surgery, but progressive stabilization was noted during follow-up periods.

A retrospective analysis of the first Yemeni experience on Artisan phakic intraocular lens for the treatment of moderate and high myopia

Objectives:To evaluate the outcome and safety of the iris-fixated Artisan phakic intraocular lens (PIOL) for the correction of moderate and high myopia.Materials and Methods:A retrospective non-controlled clinical study of the data of patients who underwent Artisan PIOLs between March 2006 and July 2008 was evaluated. Pre-operative examination included age, gender, refraction, uncorrected (UCVA) and best spectacle corrected (BSCVA) visual acuity, predictability and safety were analyzed. Post-operative time course ranged from 12 to 36 months.Results:An Artisan myopia lens was implanted in 62 eyes of 39 patients. The mean pre-operative spherical equivalent (SE) was –13.17 ± 5.62 D. The pre-operative myopia ranged from –4.5 to –24 D. Mean patient age was 25.44 ± 5.22 years. At last follow-up visit, residual SE was within ±1.00 D in 36 eyes (58.1%) and ±2.00 D in 56 eyes (90.3%). In the last visit UCVA was equal to or better than pre-operative BSCVA in 57 (91.9%) of the eyes. One eye (1.6%) lost one Snellen line, three eyes (4.8%) lost two or more Snellen lines and one eye lost vision (1.6%). Post-operative complications included anterior chamber reaction in one eye, rise in intraocular pressure in two eyes and retinal detachment in one eye.Conclusion:When laser keratorefractive surgery is not an option, implantation of Artisan PIOL to correct moderate to high myopia results in a stable and good refractive result with few complications that must be kept in mind.

Surgical-induced astigmatism via a 5.5mm superior scleral tunnel incision for implantation of an Artisan phakic intraocular lens

Background Surgical induced astigmatism induced by a 5.5mm of superior scleral tunnel incision is a key cause of influencing vision outcome in the high myopic eyes after implantation of Artisan phakic intraocular lens(IOL).Objective This study was to evaluate the surgical induced astigmatism through a 5.5mm superior scleral tunnel incision during the implantation of Artisan phakic IOL.Methods This was a case observational study.The clinical data of 202 eyes of 111 patients with Artisan IOL implantation for high myopia from October 2004 through October 2008 was collected.The patients were followed-up for 12 months.The uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BCVA),spherical equivalent(SE),cylinder equivalent(CE) and cylinder axis were examined before surgery and postoperative 1,3,6,12 months.The patients were divided into with rule group and against rule group according to the cylinder axis.Surgery-induced astigmatism value was calculated using Holladay vector analysis formula.This clinical trial was approved by the Ethics Committee of Guangdong General Hospital.Written informed consent was obtained from each patient prior to the surgery.Results The UCVA of 195 eyes(94.1%) was 0.5 or better in postoperative 12 months,and that of 172 eyes(85.1%) showed the improvement of BCVA during the follow-up duration.The mean CE values were reduced in 1,3,6,12 months after surgery in comparison with before surgery(t=-4.30,P=0.00;t=-2.27,P=0.01;t=-2.04,P=0.04;t=-2.79,P=0.01).Vector analysis of total surgically induced astigmatism revealed that the mean incision-induced astigmatism value was +1.94D,+2.26D,+2.29D,+2.25D at 171°,170°,181°,175° in 1,3,6,12 months after surgery.The surgery-induced astigmatism was(+1.97±1.84)D,(+2.25±1.75)D,(+2.27±1.76)D,(+2.24±1.75)D in with rule group at postoperative 1,3,6,12 months respectively;while those in against rule group was(+1.75±1.88)D,(+2.35±1.74)D,(+2.38±1.76)D,(+2.34±1.74)D respectively.No significant differences were found between the two groups(t=0.54,-0.29,-0.27,-0.29;P=0.59,0.78,0.79,0.78).Conclusion Implantation of Artisan IOL is an effective approach for correction of high myopia.A 5.5mm superior scleral tunnel incision in operation induces a +2.25D astigmatism at 175° meridian. Key words: Surgical induced astigmatism; Phakic; Intraocular lens; Superior scleral tunnel incision

Analysis and comparison of visual quality following Zyoptix-LASIK and Artisan phakic intraocular lens implantation for high myopia

目的 探讨高度近视Zyoptix-LASIK和有晶状体眼Artisan人工晶状体(IOL)植入术后高阶像差和对比敏感度的差异.方法 按照术眼中央角膜厚度是否能够满足准分子激光角膜原位磨镶术(LASIK)的条件,将术眼分为LASIK组和Artisan IOL 组.LASIK组15例30眼接受波前像差引导的个体化LASIK,平均年龄27.6岁,屈光度-7.0～-12.0D平均等效球镜(-9.16±1.15)D;Artisan IOL组17例30眼接受虹膜固定性有晶状体眼Artisan IOL植入术,平均年龄29.1岁,屈光度-8.0～-14.0 D平均等效球镜(-11.51±1.62)D.对比2组术后视力、最佳矫正视力、瞳孔大小、屈光状态、高阶像差、明光、暗光、暗光眩光条件下的对比敏感度等指标.高阶像差值以均方根(RMS)表示,测量总高阶像差(RMSh)、3阶X轴彗差(RMS3x)、3阶Y轴彗差(RMS3y)、4阶球差(RMS4s)及4阶像差(RMS4g).结果 术前2组间年龄和高阶像差的差异均无统计学意义(P＞0.05).术后Artisan IOL组的高阶像差低于LASIK组,其中2组间RMSh、RMS3x和RMS4g的差异均有统计学意义(P＜0.05).术后2组高阶像差与术前相比均增高,但Artisan IOL组手术前后RMS3x的差异无统计学意义(P=0.793).Artisan IOL组在明光、暗光、暗光眩光条件下各空间频率的对比敏感度均高于LASIK组,暗光条件下3、6、12cpd空间频率间的差异有统计学意义(P＜0.05).结论 与个体化LASIK相比,高度近视有晶状体眼植入Artisan IOL后高阶像差的增加较少,且其暗光下中高空间频率对比敏感度优于LASIK。

Refractive surgery in patients with accommodative and non-accommodative strabismus: 1-year prospective follow-up

AimTo determine the efficacy and safety of keratorefractive surgery in patients with accommodative and non-accommodative strabismus in a prospective study.MethodsPreoperative assessment included uncorrected (UCVA) and best-corrected visual acuity (BCVA), manifest...

Long-term Change in Corneal Endothelium After Iris-fixed Phakic Intraocular Lens Insertion

Purpose: To investigate long-term endothelial changes in phakic eyes implanted with iris-claw phakic intraocular lens (IOL) (Artisanlens Ophtec, Groningen, Netherlands) and to identify the associated factors. Methods: Thirty-one eyes of 18 patients underwent Artisan phakic IOL implantation and were followed up for over 1 year. The authors retrospectively examined the endothelial cell density, percentage of hexagonal cells and coefficient of variation using the result of non-contact specular microscope. Results: The mean endothelial cell loss was 0.9% at 23.99.44 months of the mean follow-up period. There was no statistically significant decrease in endothelial cell density (p=0.445). There was no statistically significant change in pleomorphism and polymegathism of the endothelial cells after the surgery. There was no statistically significant correlation between endothelial cell loss and anterior chamber depth (=0.0488, p=0.377). Conclusions: No clinically significant endothelial damage occurred after iris-claw phakic IOL implantation. However, special attention should be given to patients with shallow anterior chamber depth for iris-claw phakic IOL insertion to avoid unintended endothelial damage and long-term endothelial checkups using a specular microscope are critical for long-term protection of endothelial cells.

Use of Verisyse/Artisan Phakic Intraocular Lens for the Reduction of Myopia in a Patient With Pellucid Marginal Degeneration

To describe a patient who underwent implantation of a Verisyse/Artisan iris-fixated phakic intraocular lens (IOL) for correction of high myopia in pellucid marginal degeneration (PMD). A patient with PMD was observed during a period of 7 years after the implantation of a Verisyse/Artisan phakic IOL. At each visit, slit-lamp evaluation was performed, and corneal topography, endothelial cell count, manifest refraction, and uncorrected and best-corrected visual acuity were determined. Verisyse/Artisan phakic IOL implantation was performed for the correction of the patient's high myopia in the presence of early-stage PMD. The preoperative refraction of the right eye was -13.0 -3.0 x 90 degrees. The postoperative spherical equivalent (SE) was +0.50 D after 1 year and +0.50 D after 7 years. The preoperative refraction of the left eye was -13.0 -1.25 x 55 degrees. The postoperative SE was -0.38 D after 1 year and -0.13 D after 7 years. Preoperative topographic astigmatism for the right and left eye was 2.94 and 0.81 D, respectively. Seven years later, topographic astigmatism for the right and left eye had changed to 4.45 and 0.71 D, respectively. This case shows that the implantation of a Verisyse/Artisan phakic IOL may be effective in the treatment of refractive error in PMD. This case discusses the value of a removable (as opposed to a permanent) solution, such as the Verisyse/Artisan phakic IOL device, in the treatment of refractive error in PMD.

Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia: Ten-Year Follow-up Results

Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia: Ten-Year Follow-up Results

Long-term Follow-up of Endothelial Cell Change after Artisan Phakic Intraocular Lens Implantation

To report endothelial cell densities (ECDs) and their correlation to anterior chamber depth (ACD) after implantation of the Artisan intraocular phakic lens. Prospective observational case series. Three hundred eighteen eyes of 173 myopic patients treated with the Artisan iris-fixated phakic intraocular lens (IOL). Eyes with an ACD ranging between 2.89 and 4.5 mm were implanted with the Artisan phakic IOL. Endothelial cell density measurements were performed preoperatively and at each follow-up examination using a noncontact specular microscope. Endothelial cell density (cells per square millimeter). Follow-up ranged between 1 (82 eyes) and 7 years (13 eyes) (mean, 35.3+/-20.7 [standard deviation] months per eye). After 3 years, there was a significant loss in ECD (P< or =0.03). At 5 years, mean observed endothelial cell loss was 8.3% (5.3% corrected for a natural endothelial cell loss of 0.6% a year). Endothelial cell density loss remained progressive throughout our follow-up period. After 3 years, a significant negative correlation between ACD and endothelial cell loss was revealed (P< or =0.03). Patient age, gender, refractive error, incision size, and side of the eye were not correlated to ECD loss. All corneas remained clear throughout the study. After 3 years, a significant ECD loss was revealed. This ECD loss was significantly negatively correlated to the ACD. We therefore suggest that eyes just meeting the minimum ECD requirement have greater ACDs to compensate for possible greater endothelial cell loss and that patients with shallow anterior chambers have higher ECDs. Artisan phakic lens implantation in young eyes narrowly meeting the minimum criteria of endothelial cell density (2,000 cells/mm(2)) and ACD (2.6 mm) should perhaps be reevaluated, due to longer exposure to higher rates of endothelial cell loss.

Long-term Study of Artisan Phakic Intraocular Lens Implantation for the Correction of Moderate to High Myopia: Ten-Year Follow-up Results

Purpose To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia. Design Long-term (10 years) retrospective follow-up study. Participants Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia. Methods Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery. Main Outcome Measures Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated. Results The mean spherical equivalent (SE) after 10 years was −0.70±1.00 diopters (D; range, −4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5±3.5 mmHg (range, 7–25 mmHg) at 10 years. The mean endothelial cell loss was −8.86±16.01% (range, −51.69% to 34.43%) at 10 years. Conclusions Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare. To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia. Long-term (10 years) retrospective follow-up study. Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia. Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery. Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated. The mean spherical equivalent (SE) after 10 years was −0.70±1.00 diopters (D; range, −4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5±3.5 mmHg (range, 7–25 mmHg) at 10 years. The mean endothelial cell loss was −8.86±16.01% (range, −51.69% to 34.43%) at 10 years. Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare.

Functional Outcome and Patient Satisfaction After Artisan Phakic Intraocular Lens Implantation for the Correction of Myopia

Functional Outcome and Patient Satisfaction After Artisan Phakic Intraocular Lens Implantation for the Correction of Myopia

Comparison of two pupillometers in determining pupil size for refractive surgery

To compare a handheld and a digital pupillometer in determining pupil size in a population of refractive surgery candidates (group 1) and after implantation of an Artisan phakic intraocular lens (PIOL) for correction of myopia (group 2). Pupil size was measured with the Colvard and Procyon pupillometers in 121 eyes in group 1 and 83 eyes in group 2. Pupil sizes measured with the Colvard device were compared with the scotopic, mesopic-low and mesopic-high measurements taken with the Procyon pupillometer in both groups. Analysis of comparison between pupil measurements was performed according to methods described by Bland and Altman. The mean Colvard scotopic pupil diameter, scotopic, mesopic-low and mesopic-high Procyon pupil diameters were 5.86 +/- 0.81 mm, 6.42 +/- 0.88 mm, 5.55 +/- 0.95 mm and 4.21 +/- 0.73 mm in group 1 and 5.32 +/- 0.67 mm, 6.14 +/- 0.81 mm, 5.33 +/- 0.78 mm and 4.02 +/- 0.55 mm in group 2, respectively. The Colvard diameter compared most favourably with the Procyon mesopic-low diameter (group 2; p = 0.78). Measurements of pupil diameter with the Colvard pupillometer correlated best with measurements taken by the Procyon pupillometer under standardized mesopic-low light conditions. We believe that digital binocular infrared pupillometry is advantageous for obtaining standardized measurements of pupil size.

Functional Outcome and Patient Satisfaction After Artisan Phakic Intraocular Lens Implantation for the Correction of Myopia

To determine patient satisfaction after Artisan phakic intraocular lens (PIOL) implantation to correct myopia. Non-comparative prospective case series. One hundred twenty eyes of 60 patients who had undergone Artisan PIOL implantation to correct myopia were analyzed. A validated questionnaire that consisted of 66 satisfaction items were self-administered by patients 12 months after surgery. Clinical parameters (PIOL decentration, the difference between pupil size and PIOL optical zone, and optical aberrations) were measured. Main outcome measures of satisfaction scale scores (global satisfaction, quality of uncorrected and corrected vision, night vision, glare, day and night driving) were analyzed. Correlations with clinical parameters were obtained. After surgery, 98.3% of patients were satisfied, and 73.3% of patients considered their night vision to be the same or better; 44.1% of patients reported more bothersome glare. The night vision score correlated with spheric aberration (r = -0.303; P = .020). The glare score correlated with the difference between scotopic pupil size and PIOL optical zone (r = -0.280; P = .030) and vertical coma (r = -0.337; P = .009). The night driving score correlated with postoperative spheric equivalent (r = 0.375; P = .009), total root mean square aberrations (r = -0.337; P = .017), higher order root mean square aberrations (r = -0.313; P = .027), and vertical coma (r = -0.297; P = .036). Overall satisfaction after Artisan PIOL implantation for myopia is excellent. The quality of night vision and night driving were related to scotopic pupil size, individual higher order aberrations, and residual refractive error.

Evaluation of Pupil Dynamics After Implantation of Artisan Phakic Intraocular Lenses

To compare pre- and postoperative horizontal and vertical pupil diameters after horizontal Artisan phakic intraocular lens (PIOL) (Ophtec BV, Groningen, The Netherlands) implantation for correction of myopia. The pre- and postoperative scotopic pupil diameters measured by the Colvard pupillometer (Oasis Medical, Glendora, Calif) were compared in 71 eyes after Artisan PIOL implantation (Artisan Colvard group). Analysis of pupil shape (vertical vs horizontal diameter, V/H ratio) after horizontal Artisan PIOL implantation was performed with the Procyon pupillometer (Procyon Instruments Ltd, London, United Kingdom) in 121 eyes (Artisan Procyon group) under scotopic, mesopic-low, and mesopic-high conditions and compared to an age- and refraction-matched control group of 121 eyes of refractive surgery candidates (Procyon control group). After horizontal Artisan PIOL implantation, the mean horizontal pupil diameter decreased from 6.231 +/- 0.70 mm preoperatively to 5.34 +/- 0.68 mm postoperatively in the Artisan Colvard group (P < .01). The mean horizontal scotopic diameter was 5.60 +/- 0.66 mm, the mesopic-low diameter was 4.94 +/- 0.71 mm, and the mesopic-high diameter was 3.98 +/- 0.54 mm for the Artisan Procyon group. The mean horizontal scotopic diameter was 6.29 +/- 0.91 mm, the mesopic-low diameter was 5.40 +/- 0.96 mm, and the mesopic-high diameter was 4.16 +/- 0.80 mm in the Procyon control group. A significant increase was noted in V/H ratio under scotopic, mesopic-low, and mesopic-high conditions from 1.02, 1.02, and 1.01, respectively, in the Procyon control group to 1.17, 1.12, and 1.06, respectively, in the Artisan Procyon group (P < .01). Horizontal pupil size was significantly decreased after horizontal Artisan PIOL implantation and might be attributed to a mechanical restriction of the iris in the horizontal meridian.

Experience with the Artisan phakic intraocular lens in Asian eyes

To investigate the efficacy and safety of implantation of an iris-claw phakic intraocular lens (PIOL), Artisan Myopia, in Asian eyes. Minamiaoyama Eye Clinic, Tokyo, Japan. Forty-four eyes of 32 Japanese patients and 1 Korean patient with high myopia had Artisan Myopia lens implantation to correct their refractive errors. Lens models, 5/8.5 or 6/8.5 (optic diameter/overall diameter), were chosen as standard lens model. A smaller lens model (5/7.5-Artisan Myopia Small) was implanted in eyes with corneal diameter less than 11.0 mm. Postoperative examinations were performed on 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, corneal endothelial cell counts, intraocular pressure, and complications were evaluated. Artisan Myopia Small lenses were implanted in 4 eyes (9.1%) and 8.5 mm diameter lenses were implanted in 40 eyes. Preoperative UCVA (logMAR) improved from 1.57 to 0.09 at 1 month after surgery and no regression was observed thereafter. Postoperative manifest refraction was -1.02 +/- 0.87 D (-3.25 to -0.00 D), and within 1.0 D in 20 eyes (55.6%), within 2.0 D in 32 eyes (88.9%) at 1 month after surgery, and stable during the follow-up period. The final BCVA decreased 2 lines in 2 eyes (4.5%) due to progression of age-related cataract. No serious complications such as angle closure or progressive endothelial cell loss were observed. Implantation of an Artisan iris-claw PIOL implantation may be a safe and effective procedure for Asian eyes.

Pigment dispersion and Artisan phakic intraocular lenses

To validate the theory that crystalline lens rise can be used as a safety criterion to prevent pigment dispersion in eyes with an Artisan phakic intraocular lens (IOL) (Ophtec BV). Monticelli Clinic, Marseilles, France. A comparative analysis of crystalline lens rise in 9 eyes with pigment dispersion and 78 eyes without dispersion was performed. All eyes had previous implantation of an Artisan IOL. Anterior segment imaging was done using an anterior chamber optical coherence tomography (AC OCT) prototype. Crystalline lens rise was defined by the distance between the anterior pole of the crystalline lens and the horizontal plane joining the opposite iridocorneal recesses. The study confirmed that crystalline lens rise can be considered a safety criterion for implantation of Artisan-type phakic IOLs. The higher the crystalline lens rise, the greater the risk for developing pigment dispersion in the area of the pupil. This complication occurred more frequently in hyperopic eyes than in myopic eyes. Results indicate there is little or no risk for pigment dispersion if the rise is less than 600 microm; 67% of eyes with a rise of 600 microm or more developed pupillary pigment dispersion. In some cases in which the IOL was loosely fixated, there was no traction on the iris root and dispersion was prevented or delayed. Crystalline lens rise should be considered a new safety criterion for Artisan phakic IOL implantation and should also be applied to other types of phakic IOLs. The distance remaining between the crystalline lens rise and a 600 microm theoretical safety level allows one to calculate how long the IOL can safely remain in the eye.

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia

To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. Instituto Oftalmólogico de Alicante, Alicante, Spain. This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.