Iris-fixated Intraocular Lens Research Articles

Spontaneous disinsertion of an iris-fixated 3-piece intraocular lens haptic from the optic in a patient with pathologic myopia

Spontaneous disinsertion of an iris-fixated 3-piece intraocular lens haptic from the optic in a patient with pathologic myopia

Aqueous flow in the presence of a perforated iris-fixated intraocular lens

The aim of this study is to investigate the characteristics of the aqueous humour flow in the anterior chamber of the eye in the presence of a perforated, phakic, iris-fixated intraocular lens (pIOL). Such pIOLs are implanted in the anterior chamber in front of the iris and therefore they interfere with aqueous motion. The aim of this work is to investigate whether a perforation in the body of the pIOL can improve its fluid dynamics performance. Numerical simulations are conducted using the free computational fluid dynamics program OpenFOAM. The aqueous humour is modelled as a Newtonian incompressible fluid and, when temperature effects are considered, the Navier–Stokes equations are coupled to the energy equation, using Boussinesq’s approach to account for fluid density changes associated temperature variations. The pressure drop across the anterior chamber is calculated considering perforations in the pIOL of various sizes and also studying the extreme case in which the passage between the iris and the pIOL gets plugged, thus leaving the hole in the pIOL as the only possible pathway for aqueous flow. The study shows that the presence of a hole in the pIOL can only have a significant role on the pressure in the eye if the normal aqueous flow in the region between the pIOL and the iris gets blocked and has a negligible effect on the wall shear stress on the cornea.

Phakic intraocular lens: Two-year results and comparison of endothelial cell loss with iris-fixated intraocular lenses

To evaluate the efficacy, safety, and stability of a foldable angle-supported Acrysof Cachet phakic intraocular lens (pIOL) to correct moderate to high myopia and compare endothelial cell loss after iris-fixated Artisan and Artiflex pIOL implantation. University Eye Clinic Maastricht, the Netherlands. Retrospective observational study. Foldable angle-supported pIOL implantation for myopia ranging from -6.0 to -16.5 diopters (D) was done. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), and adverse events were documented preoperatively and 6 months and 1 and 2 years postoperatively. Endothelial cell loss after implantation of the foldable angle-supported pIOL and iris-fixated pIOLs was compared 6 months and 1 and 2 years postoperatively. There were 158 eyes. The UDVA was equal to or more than 20/25 in 95% of eyes at 1 and 2 years postoperatively. The mean SE was -0.17 D ± 0.43 (SD) 2 years postoperatively. One patient developed pupil ovalization, resulting in explantation of the pIOL from both eyes. Acute endothelial cell loss in the foldable angle-supported pIOL group was -3.2% ± 0.7%, significantly higher than after iris-fixated pIOL implantation. Chronic endothelial cell loss from 6 to 24 months after surgery was -3.8% ± 0.7%. At the 2-year follow-up, the chronic endothelial cell loss in the foldable angle-supported pIOL group was not different than with iris-fixated pIOLs (P > .05). The foldable angle-supported pIOL effectively corrected moderate to high myopia. However, acute surgical endothelial cell loss was significantly higher than with iris-fixated pIOLs. Dr. Nuijts is a consultant to Alcon Laboratories, Inc., Théa Pharma GmbH, and ASICO LLC; he has received study grants from Acufocus, Inc., Alcon Laboratories, Inc., Carl Zeiss Meditec AG, Ophtec BV, and Physiol S.A. No other author has a financial or proprietary interest in any material or method mentioned.

What is the best surgical approach for ectopia lentis in Marfan syndrome?

The surgical management of ectopia lentis (EL) in Marfan syndrome (MFS) represents a challenge to the ophthalmologist. We reviewed the literature on the surgical management of ectopia lentis in MFS patients from the classical pars plana lensectomy (PPL) to the most innovative scleral- and iris-fixated intraocular lens (IOL) surgical techniques. The results with the innovative approaches have been satisfactory but with a relatively short follow-up period and several complications associated, and the need of a highly experienced and skilled surgeon. We suggest that PPL approach with postsurgical aphakia is the safest surgical approach to ectopia lentis in MFS on a routinely basis.

Pinhole iris-fixated intraocular lens for dysphotopsia and photophobia

We present the pinhole iris-fixated diaphragm intraocular lens (IOL), which is a 1-piece black polycarbonate IOL with rigid iris-fixated haptics, an 8.5 mm overall length, a 6.0 mm diameter optic, and a central opening, the pinhole. The IOL was implanted in a 36-year-old man who had a history of debilitating dysphotopsia (star burst, halos, glare, and ghosting) and severe light sensitivity in his right eye following several interventions for keratoconus. The diameter of the central opening of the pinhole IOL, 2.0 mm, was based on the patient's corneal aberration profile. Postoperatively, the dysphotopic symptoms and photophobia markedly improved. We recommend the use of the pinhole iris-fixated IOL in patients with severe photophobia or dysphotopsia refractory to other treatment modalities. No author has a financial or proprietary interest in any material or method mentioned.

Scheimpflug photography for the examination of phakic intraocular lenses

High myopia phakic intraocular lenses (IOL) have become an established means of surgical correction for high ametropia. Scheimpflug photography is one of the methods which are frequently applied for postoperative examination of the implants. Results from published studies employing Scheimpflug photography for examination of anterior chamber angle-fixated, iris-fixated and sulcus-fixated phakic IOLs were evaluated. In several published studies Scheimpflug photography was used to examine the position of the implant and opacification of the crystalline lens. The results provided valuable evidence for the improvement of phakic IOL design. Scheimpflug photography offers an easy to use, rapid non-contact examination of phakic IOLs.

Descemet membrane endothelial keratoplasty in cases with existing scleral-sutured and iris-sutured intraocular lenses

BackgroundTo report two cases of Descemet Membrane Endothelial Keratoplasty (DMEK) in patients with existing scleral-fixated and iris-fixated intraocular lenses (sf-IOL and if-IOL, respectively).Case presentationDMEK procedures were performed on a 49-year-old woman with a pre-existing sf-IOL (case 1) and a 69-year-old woman with a pre-existing if-IOL (case 2) in order to treat secondary corneal edema due to pseudophakic bullous keratopathy. Visual acuity, refractive error, intraocular pressure, slit lamp examination, pachymetry measurements and endothelial cell density (ECD) were considered and repeated during follow-ups.Both cases had no intraoperative complications. At postoperative day 1 graft centration and complete attachment were noted. The IOL positions were unchanged in comparison to their preoperative positions. In case 1, visual acuity improved from 1/15 at 1 meter preoperative to 20/200 within one week and to 20/63 within 12 weeks of follow up. In case 2, visual acuity improved from counting fingers at 1 meter preoperative to 20/200 within one week and to 20/100 within 12 weeks of follow-up. In case 2 a partial graft dislocation was observed at postoperative day twenty. Complete graft re-apposition was achieved by rebubbling procedure performed with intracameral air injection.ConclusionsDMEK surgery in the treatment of pseudophakic bullous keratopathy in the presence of sf-IOL and if-IOL can successfully be performed. These eyes are at increased risk of IOL dislocation into the vitreous cavity during DMEK surgery.

Artisan iris-fixated toric phakic intraocular lens for the correction of high astigmatism after deep anterior lamellar keratoplasty

We report the refractive correction of high astigmatism in one eye of a 23-year-old woman following deep anterior lamellar keratoplasty (DALK) using an Artisan iris-fixated, toric, phakic intraocular lens (IOL). One year after implantation, uncorrected and corrected distance visual acuities were both 20/25, refraction was -1.00 D cylinder, and the endothelial cell count was 1827 cells/mm(2). Iris-fixated phakic IOLs are not recommended for every postkeratoplasty patient with high refractive error; however, this procedure can offer good outcomes in carefully selected cases of previous DALK.

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.].

Retro-pupillary iris fixated intraocular lens in pediatric subluxated lens

Aims: The aim of this study was to evaluate the post-operative visual acuity and complications in pediatric patients with ectopia lentis who underwent lens removal and retro-pupillary iris fixated intraocular lens (IOL) implantation. Settings and Design: Retrospective, single center, 5-year clinical audit. Materials and Methods: A retrospective analysis of all pediatric cases who presented with lens subluxation and who underwent lens extraction with posterior iris claw implantation was performed over a period of 5 years from March 2008 to February 2013. A detail record of visual acuity, slit lamp examination and fundus examination was carried out. The iris claw IOL used in this case series had a 5.5/4.5 mm optic and 8/9 mm overall length. After lens removal iris claw, IOL was enclaved to the posterior surface of the iris. The main indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measure was pre-operative and post-operative best corrected visual acuity (BCVA) and secondarily post-operative complications. Results: The study involved 36 eyes of 20 patients who underwent iris claw implantation showed improvement in mean BCVA from 2/60 pre-operatively to 6/18 post-operative. The mean age of the presentation was 12 years. Post-operative outcome in all patients was good. Only one patient developed traumatic dis-enclavation with subluxation of the iris claw IOL at 6 months in which re-enclavation was performed with success. The mean follow-up period was 7 months. No eye had serious complication such as cystoid macula edema, infection, glaucoma and dislocation of IOL. Conclusions: Retro-pupillary iris fixation of IOL is a simple, safe and viable option for correction of ectopia lentis in pediatric group.

Three-year follow-up of secondary anterior iris fixation of an aphakic intraocular lens to correct aphakia

To evaluate the efficacy, predictability, stability, safety, and complications of secondary anterior iris fixation of the Artisan iris-fixated intraocular lens (IOL) to correct aphakia in eyes without sufficient capsule support. Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China. Cohort study. Eyes having implantation of aphakic iris-fixated IOLs for aphakia correction were followed for 3 years. The study evaluated 72 eyes (72 patients). After 3 years, the uncorrected distance visual acuity improved in all eyes (P<.05); 53 eyes (73.6%) reached 20/40 or better. Two eyes had a postoperative corrected distance visual acuity (CDVA) worse than the preoperative CDVA due to postoperative ischemic optic neuropathy and retinal detachment, respectively. The mean spherical equivalent (SE) decreased from 11.65 diopters (D) ± 1.21 (SD) to -0.58 ± 0.56 D (P<.05); the SE at the last follow-up was within ±1.00 D of the target refraction in 63 eyes (87.5%). The mean endothelial cell loss 3 years postoperatively was 9.78%. There was no significant postoperative intraocular pressure increase throughout the follow-up. Twelve patients (16.7%) reported glare and halos during night driving. Iris pigment precipitates on the IOLs occurred in 4 eyes (5.6%) 3 years postoperatively. No other serious complications occurred. Three-year results indicate that secondary implantation of aphakic IOLs is effective, predictable, and safe for the correction of aphakia in eyes without capsule support. However, longer follow-up with a larger cohort is necessary to confirm these conclusions.

Iris-fixated intraocular lens implantation to correct moderate to high myopia in Asian-Indian eyes: Five-year results

To evaluate the efficacy, safety, predictability, and stability of iris-fixated phakic intraocular lenses (pIOLs) to correct high myopia in an Asian-Indian population. Tertiary eyecare center. Interventional case series. Eyes with myopia from -5.5 to -24.0 diopters (D) had pIOL implantation and were examined postoperatively at 1 day, 1 week, 1, 3, and 6 months, and yearly for 5 years. Parameters evaluated were postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability, efficacy, stability of mean spherical equivalent (SE), and endothelial cell loss. The study enrolled 85 eyes (44 patients). The mean CDVA improved from 6/10 preoperatively to 6/7 postoperatively and the mean UDVA, from 6/319 to 6/9. Postoperatively, the mean SE was -0.63 ± 0.55 D. Of the 51 eyes completing a 4-year follow-up; 19 (37.3%) had a mean SE of 0.50 D or less and 37 (72.5%) had a mean SE of 1.00 D or less. The CDVA improved 1 line or more in 35 eyes (68.6%); 14 eyes (27.5%) had postoperative CDVA similar to the preoperative CDVA. At 4years, the safety index was 1.46 and the efficacy index, 0.96. Thirty-six eyes (70.6%) had a postoperative UDVA better than the preoperative CDVA. The mean endothelial cell loss at 1, 3, 6, 12, 24, 36, and 48 months was 4.3%, 5.7%, 7.1%, 7.6%, 8.7%, 9.2%, 11.07%, and 12.4% respectively. Twenty eyes (23.5%) had reenclavation for spontaneous or traumatic disenclavation. Postsurgical refractive outcomes of iris-fixated pIOL implantation for myopia were fairly predictable and stable in an Asian-Indian population. No author has a financial or proprietary interest in any material or method mentioned.

Foldable iris‐fixated intraocular lens implantation in children

To describe the results of foldable iris-fixated intraocular lens (IOL) implantation in children. Children with high bilateral or unilateral myopia who were intolerant of spectacle or contact lens correction were implanted with an iris-fixated foldable IOL and prospectively followed. We measured pre- and postoperative visual acuity, refraction, endothelial cell density (ECD) and National Eye Institute Visual Functioning Questionnaire-25. Eleven eyes of six children were implanted. Indications were high bilateral myopia in children with comorbid neurobehavioural disorders, high anisometropia and high myopic astigmatism. Mean preoperative spherical equivalent (SE) refraction was -14.6 dioptres (D)±4.2 SD. Mean follow-up was 15 months. Postoperative SE refraction was -2.40 D±2.40 SD. Corrected distance visual acuity (CDVA) improved from mean logMAR 0.84±0.4 SD to postoperative 0.67±0.34 SD (p=0.005). CDVA was reduced because of coexistent ocular disorders and amblyopia. Vision-related quality of life (QOL) measures improved significantly. There were no intraoperative or postoperative serious complications. Foldable iris-fixated IOL insertion can give a significant improvement in vision and in vision-related QOL in a subset of paediatric patients with special refractive needs who are intolerant to conventional treatment. Long-term follow-up is required for monitoring of ECD.

Técnica Tied Out Open Sky: fixação iriana de lente intraocular combinada com transplante penetrante de córnea

To describe a new method for iris fixation of intraocular lens in the absence of capsular support during penetrating keratoplasty. Its a new technique of iris fixation of intraocular lens without capsular support during penetrating keratoplasty. This technique is used in cases with a healthy iris and partial or total absence of capsular support during penetrating keratoplasty. Tied Out Open Sky is a technique easy to perform for iris fixation of intraocular lens during penetrating keratoplasty. The big advantage is [...]

Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients' satisfaction after implantation. Prospective, nonrandomized, and comparative (self-controlled) trial. A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively. At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation. At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.

Simultaneous Descemet Stripping Automated Endothelial Keratoplasty and Aphakic Iris-Fixated Intraocular Lens Implantation: A Case Series

To report 3 cases of simultaneous Descemet stripping automated endothelial keratoplasty (DSAEK) and aphakic iris-fixated intraocular lens (IOL) implantation in patients with aphakia and bullous keratopathy. We retrospectively documented the clinical characteristics of patients before and after simultaneous DSAEK and aphakic iris-fixated IOL implantation undergoing operation between November 2008 and September 2009. None of the cases showed any intraoperative complications. During the postoperative period, the corneal lenticule was clear and well-attached, and the iris-fixated IOL was well-positioned. Simultaneous DSAEK and aphakic iris-fixated IOL implantation can be used successfully and simultaneously in patients with aphakia and bullous keratopathy.

Correction of extreme hyperopia: artisan iris-fixated intraocular lens implantation for pseudophakia after clear lens extraction.

A 22-year-old patient suffering from both-side extreme hyperopia with amblyopia was corrected with an Artisan iris-fixated intraocular lens (IOL) implantation followed to clear lens extraction (CLE) with posterior chamber (PC)-IOL implantation. The preoperative refraction values were +17.75DS -1.50DC × 168° for the right eye and +17.25DS -0.75DC × 8° for the left eye. The uncorrected visual acuity (UCVA) was 20/200 bilaterally and the spectacle-corrected visual acuity (BSCVA) was 20/50 bilaterally. One year after Artisan iris-fixated IOL implantation, bilateral BSCVA was 20/50 with a refraction of +1.25DS -0.75DC × 13° for the right eye and +1.50DS -1.00DC × 55° for the left eye. The outcomes of an Artisan iris-fixated IOL implantation followed to CLE with PC-IOL implantation were encouraging for the correction of extreme hyperopia. Long term follow-up examinations were necessary for further determination of the efficacy and safety of this combinational procedure.

Long-term follow-up of the corneal endothelium after aphakic iris-fixated IOL implantation for bilateral cataract in children

To evaluate the long-term corneal endothelial cell density (ECD) and outcomes after iris-fixated aphakic intraocular lens (IOL) implantation in children after bilateral congenital or juvenile cataract extraction and to compare the outcomes with data in the literature. Academic Medical Centre, Amsterdam, The Netherlands. Case series. This retrospective study evaluated the charts and endothelial photographs of children who had Artisan aphakic IOL implantation. The main outcome measure was the ECD at the last follow-up visit. The mean age of the 10 patients (20 eyes) at IOL implantation was 7.4 years (range 4.3 to 11.1 years) and at the last follow-up, 19.6 years (range 14.3 to 26.6 years). After a mean follow-up of 12.3 years (range 10.0 to 15.6 years), the mean ECD was 2702 cells/mm(2) (range 1382 to 3974 cells/mm(2)). Although this is comparable to the mean normal endothelial cell counts in this age group reported in the literature, a wider range of ECD was found in the current study. The mean corneal ECD after more then 10 years of follow-up was comparable to the mean normal ECD for this age group reported in the literature. The high standard deviation of the mean ECD in the current study highlights the importance of prospective studies on the ECD after iris-fixated aphakic IOL implantation in young patients.

Intraocular Lens Exchange 1 Week After Descemet Stripping Automated Endothelial Keratoplasty

To report a case of intraocular lens (IOL) exchange performed 1 week after Descemet stripping automated endothelial keratoplasty (DSAEK). Describe the clinical findings and outcome of IOL exchange in an 80-year-old man with pseudophakic bullous keratopathy and retained Artisan (Ophtec BV, Groningen, the Netherlands) iris-fixated IOL after uneventful DSAEK. The patient presented on the third postoperative day after DSAEK with disenclavation of the nasal iris claw and inferior dislocation of the IOL. The dislocated IOL was removed and exchanged with an angle-supported open-loop anterior chamber lens 7 days after the initial DSAEK procedure. Despite the relatively traumatic intraocular manipulation, the donor tissue was unaffected in its position and clarity. This case demonstrates that successful DSAEK surgery is compatible with additional surgical procedures, even if they are performed in the early postoperative period.

Implants de chambre antérieure à fixation irienne : une surveillance renforcée

In 1986, the concept of the claw lens was applied to correct myopia in phakic patients. Since then, progress has made iris-fixated phakic intraocular lenses (IOL) relatively safe, predictable, and effective for the correction of myopia, hyperopia, and astigmatism. All these models have undergone a series of design improvements to prevent complications. Despite having excellent refractive results, the principal risk is a potential progressive endothelial cell loss. Many authors have presented encouraging results. Phakic iris-fixated IOL surgery is a potentially reversible procedure, but the surgeon cannot rule out the possibility of complications. Therefore, long-term follow-up is mandatory.