Lens Implantation For High Myopia Research Articles

Comparison of intraocular lens power formulas for negative-diopter intraocular lens implantation for high myopia.

To compare the accuracy of intraocular lens (IOL) power calculation formulas for myopic eyes requiring negative diopter powered IOLs. Retrospective case series. K… hospital and Y… Hospital, …, …. Sixty-one eyes that underwent phacoemulsification with implantation of a negative power IOL were investigated. The trueness, precision and accuracy of IOL power calculation were assessed for the Barrett Universal II (BUII), EVO 2.0, Haigis, Hoffer QST, Holladay 1 and SRK/T formulas using the Eyetemis online tool. The analysis was performed using 1) the ULIB IOL constants and 2) after constant optimization. With ULIB constants, the Haigis, Holladay 1 and SRK/T resulted in a hyperopic mean prediction error (PE) >1.00 diopter (D), which was significantly different from zero (adjusted p <0.05). The mean PE of the remaining formulas was closer to zero. The absolute PE was significantly higher with the Holladay 1 and SRK/T (adjusted p <0.05) with respect to the remaining formulas. After constant optimization, the outcomes of traditional formulas improved and no statistically significant differences were found among any of the formulas in terms of trueness, precision and accuracy. The percentage of eyes with an absolute PE within 0.50 D was low (<50%) even after constant optimization. With ULIB constants, the BUII, EVO 2.0 and Hoffer QST were more accurate than traditional formulas in eyes with negative-diopter IOLs. The results of IOL power calculation in these eyes remain poor even after constant optimization.

Effect of Phacoemulsification and Intraocular Lens Implantation on High Myopia with Cataract

Objective:To observe the clinical effect of phacoemulsification and intraocular lens implantation for high myopia with cataract. Results: To analyze 144 cases (152 eyes) of high myopia with cataract, male 78 cases (84 eyes), female 66 cases (68 eyes); age between 45~81 years old, average 65.26 years old; Axis oculi length 6.47~34.04mm, average 29.82mm. Nuclear lens opacities 86 eyes, Posterior subcapsular opacity 38 eyes, Cortical opacity 28 eyes; Nuclear hardness grading standards by Emery, 42 eyes nuclear grade Ⅱ, 72eyes nuclear grade Ⅲ, 34 eyes nuclear grade Ⅳ, 4 eyes nuclear grade V; Before the surgery, corrects defects of vision ≤0.1 in 120 eyes(79%), 0.1～0.2 in 32 eyes(21%), All patients under the topical anesthesia received the phacoemulsification and intraocular lens implantation. Results: After operation all the patients’ vision 0.5 in 78 eyes(51%), 0.2～0.4 in 56 eyes(37%), 0.1 in 18 eyes(12%), Compared with before operation, the enhancement of vision has a statistics significance(P0.01). Intraoperative, posterior capsule rupture is 2 cases(1.3%); No one has high intraocular pressure after operation, Cornea dropsy is 32 eyes(21%), after 3~7 d anti-SARS, just right for the illness treatments, cornea dropsy abates. After 3~6 months, no one has after-cataract in all patients. Conclusion: This is an effective treatment of phacoemulsification and intraocular lens implantation for high myopia with cataract and may improve the patients’ vision obviously and their quality of life.

Long-time follow-up results of phakic posterior chamber intraocular lens and iris-claw phakic intraocular lens implantation for high myopia

Background With the development of refractive surgery, phakic intraocular lens implantation (PIOL) for high myopia is proving its outstanding merits in short-term treating outcomes.However, its long-term safety and effectiveness were still in more attention. Objective This study was to evaluate and compare the long-term safety, stability and efficacy of Verisyse PIOL implantation with implantable contact lens (ICL) implantation for high myopia. Methods The clinical data of 18 eyes (9 patients) who received Verisyse iris-claw intraocular lens implantation for high myopia and matched 22 eyes (11 patients) who received ICL implantation for high myopia from 2009 to 2011 were retrospectively analyzed.The patients were followed-up for 2 years after surgery.Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalence (SE), axial length, corneal endothelial cell density (ECD), contrast sensitivity (CS), wave-front aberrations and postoperative complications were recorded during the following-up.The efficacy index, predictable and safety index were compared between the two groups. Results There was no significant difference in UCVA, BCVA and SE between Verisyse group and ICL group (t=0.92, 1.32, 4.32; all at P>0.05). Non-glare CS under the 1.5, 3.0, 6.0, 12.0 and 18.0 c/d spatial frequencies were insignificantly different between the two groups(Z=0.782, 0.956, 0.495, 0.874, 0.293; all at P>0.05), and the similar outcomes were found in glare CS (Z=0.985, 1.254, 0.896, 1.652, 0.492; all at P>0.05) in postoperative 2 years.Root meas square of total high order aberration (RMSh), vertical-trefoil, vertical-coma, horizontal-coma, spherical aberration(SA), were significantly elevated in the Verisyse group compared with the ICL group (Z=4.72, 4.24, 3.12, 3.65, 2.16; all at P 0.05). The mean safety index was 140.56±33.89 in the Verisyse group and 143.34±34.56 in the ICL group, with a significant difference between them (t=0.29, P>0.05). The mean predictable index was -0.25(-0.97, 4.23)in the Verisyse group and 0.98 (-1.44, 1.52) in the ICL group, and the difference was significant(Z=-2.68, P<0.05). Conclusions Both Verisyse PIOL implantation and ICL implantation for high myopia are safe, predictable and effective.The vusial quality and predictability of ICL implantation are much better than Verisyse PIOL implantation.A long-term effect should be observed for the further evaluation. Key words: Lens implantation, intraocular/methods; Myopia/surgery; Postoperative complications; Phakic eye; Retrospective studies; Safety; Treatment outcome, long-term

Clinical Features of Cataract Extraction with Negative-Power Intraocular Lens Implantation in High Myopia

Purpose: To evaluate the clinical features of high myopic eyes with cataracts implanted with negative power intraocular lenses (IOLs) at the time of cataract surgery. Methods: A retrospective chart review was conducted of 18 eyes of 14 patients who underwent cataract surgery with negative power IOLs and 10 eyes in 9 patients with low power IOLs. We investigated axial length, IOL power, preoperative and postoperative best-corrected visual acuity (BCVA) and preoperative and postoperative spherical equivalent (SE) refractive errors. Results: Mean BCVA showed significant improvement in both groups. We measured postoperative SE refraction and the difference between the mean intended and the mean achieved SE refractive errors in the negative power group (17 eyes) was +1.59 ± 1.34 D and +0.31 ± 0.50 D in the low power group. Conclusions: BCVA was significantly improved in the majority of eyes, although they had myopic macular degeneration or posterior staphyloma. However, the mean achieved postoperative SE refraction was more hyperopic than the predicted postoperative SE error. Additionally, hyperopic refractive error was greater in the negative power group than the low power group. Therefore, we recommend that postoperative hyperopic refractive error should be considered when performing cataract surgery in high myopic patients. J Korean Ophthalmol Soc 2016;57(6):898-904

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia.

To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia. This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred. Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit. Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.

Application of topical anesthesia in phacoemulsification for high myopia

Objective To explore the efficacy of topical anesthesia in phacoemulsification and intraocular lens implantation for high myopia.Methods 59 cases(71 eyes) of high myopia combined with cataract underwent phacoemulsification and intraocular lens implantation under topical anesthesia.Intraoperative complaints,surgical complications and clinical efficacy were observed.Results There were no pain in 61 eyes(85.92％ ),slight pain in 6 eyes(8.45％ ) and mild pain in 4 eyes(5.63％ ).Posterior capsular rupture occurred in one eye.No retinal detachment were found.The visual acuities were at ＞ 0.3 accounting for 67.6％ and at ＞ 0.5 accounting for 36.6％ at 3 months after the operation.Conclusion Phacoemulsification with intraocular lens implantation for high myopia under topic anesthesia is reliable and effective with less complications. Key words: Myopia,high; Anesthesia,topical; Phacoemulsification; Lens,intraocular

Three-year follow-up of iris-claw phakic intraocular lens implantation for high myopia

To investigate long-term efficacy and safety of an iris-claw phakic intraocular lens (ICPIOL) implantation for high myopia. A consecutive group of 86 eyes in 49 patients with -15.33±3.81 diopters (D) of myopia was implanted with the Artisan ICPIOL (Ophtec), and was evaluated preoperatively and 1, 2, 3 years postoperatively. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, intraocular pressure, and complications were evaluated. The implantation was successful in all of 86 eyes. Compared with preoperative data, UCVA, BCVA, and spherical equivalent (SE) were improved significantly (F=513.68, 20.88, 827.65; P<0.01). At 3-year postoperatively, UCVA in 85% eyes was 0.5 or better, in 35% was 0.8 or better; No loss of BCVA was found, 17% gained 1 line, and 59% gained 2 lines or more; SE in 81%, 54% eyes was within ±1.00 D, ±0.50 D of attempted, respectively. At 1-, 2-, 3-year follow-up, the corneal endothelial loss was 3.60%, 5.78%, 7.74%, respectively. There were 2 macular haemorrhages resulted from CNV, and 1 ICPIOL repositioning due to inappropriate iris capture. No other severe complications occurred. At 3-year follow-up, the implantation of the ICPIOL proved to be safe and effective for the correction of myopia in phakic eyes.

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。

Comparison of clear lens extraction and collamer lens implantation in high myopia

To compare the outcomes of clear lens extraction and collamer lens implantation in high myopia. Myopic patients younger than 40 years old with more than 12 diopters of myopia or who were not fit for laser-assisted in situ keratomileusis were included. Group 1 comprised patients undergoing clear lens extraction and Group 2 patients received the Visian implantable collamer lens. Outcome and complications were evaluated. Postoperative best corrected visual acuity was -0.61 +/- 0.18 in Group 1 and 0.79 +/- 0.16 in Group 2. In Group 1, 71.4% achieved a postoperative uncorrected visual acuity better than the preoperative best corrected visual acuity, while only 51.8% patients achieved this in Group 2. Intraocular pressure decreased by 12.55% in Group 1, and increased by 15.11% in Group 2. Corneal endothelial cell density decreased by 4.47% in Group 1 and decreased by 5.67% in Group 2. Posterior capsule opacification occurred in Group 1. In Group 2, lens opacification occurred in 11.11%, significant pigment dispersion in 3.7%, and pupillary block glaucoma in 3.7%. Clear lens extraction presents less of a financial load up front, and less likelihood of the need for a secondary intervention in the future. Clear lens extraction is a more viable solution in developing countries with limited financial resources.

Comparison of Contrast Sensitivity after Angle-Supported, Iris-Fixated and Posterior Chamber Phakic Intraocular Lens Implantation for High Myopia

Purpose: To evaluate the effects of angle-supported, iris-fixated and posterior chamber phakic intraocular lens (PIOL) implantation on contrast sensitivity (CS). Methods: This prospective study included 69 eyes of 41 consecutive cases of high myopia which received an angle-supported (Phakic-6H; 26 eyes), iris-fixated (Verisyse; 23 eyes) or posterior chamber PIOL [phakic refractive lens (PRL); 20 eyes]. Photopic, mesopic and mesopic with glare CS were evaluated preoperatively and at least 6 months postoperatively. Results: In the PRL group, the mean postoperative CS at all frequencies and across all lighting conditions increased. These changes were significant for 6, 12 and 18 cycles per degree (cpd) under both photopic and mesopic conditions (p < 0.01) and for all the tested frequencies under mesopic with glare condition (p < or = 0.01). The average CS was relatively low in the PRL group. These changes were significant for 6 and 12 cpd between the Verisyse and PRL group under photopic condition (p < 0.05), for 3 and 6 cpd under mesopic condition (p < 0.01, p = 0.01) and under mesopic with glare condition (p < 0.01, p < 0.05). Conclusions: Improvements in postoperative CS confirm that PIOL implantation is a promising alternative for correction of high myopia. In comparison to posterior chamber PIOLs, angle-supported and iris-fixated PIOLs seem to produce a better visual quality in terms of CS, which needs to be warranted by further investigations.

Severe endothelial cell loss following uneventful angle-supported phakic intraocular lens implantation for high myopia

Endothelial decompensation is a serious complication of phakic intraocular lens (pIOL) implantation and is a major concern during the postoperative period. We report 3 eyes in which the same foldable angle-supported pIOL was implanted to correct high myopia. Rapid and severe postoperative endothelial cell loss occurred in all 3 eyes. An over-sized pIOL that induced excessive vaulting into the anterior chamber was the main risk factor. In 2 eyes, the pIOL was explanted uneventfully; 1 eye required Descemet's stripping automated endothelial keratoplasty because of total endothelial decompensation. These cases illustrate the importance of accurate sizing of foldable angle-supported anterior chamber pIOLs to avoid excessive vaulting. They also highlight the importance of regular follow-up and preventive pIOL explantation as soon as significant endothelial cell loss is detected.

Long-Term Complications of Iris-Claw Phakic Intraocular Lens Implantation in Weill-Marchesani Syndrome

This study was designed to report the long-term complications of iris-claw phakic intraocular lens implantation in a patient with Weill-Marchesani syndrome. Case report and literature review. A 26-year-old man with a history of glaucoma had bilateral phakic lens implantation for high myopia 10 years previously. Two years later, the left implant dislocated and was repositioned. Slit-lamp examination of both eyes revealed phakic implants of the iris-claw variety. There were moderate iridocorneal adhesions in the areas in which the lens haptics pinched the iris in both eyes and moderate epithelial and stromal edema over the temporal one-third of the left cornea. The crystalline lenses were clear with 3+phacodonesis OU. Dilated fundus examinations revealed bilateral severe optic nerve cupping. Crystalline lens diameters were measured at 7.5mm in the right eye and 8 mm in the left. Anterior chamber depths were 2.63 mm OD and 2.40 mm OS. Specular microscopy revealed central endothelial cell counts of 1133 and 587 cells/mm OD and OS, respectively. Axial lengths were 23.3 mm OD and 25 mm OS. Gonioscopic examination revealed bilateral angle closure with marked peripheral anterior synechiae. Based on our findings of short stature, shortened and thickened fingers, relatively normal axial length, microspherophakia, high myopia, and glaucoma, we diagnosed the patient with Weill-Marchesani syndrome. Iris claw-lens phakic lenses may be an effective surgical alternative to correct high myopia in select patients; however, it may produce long-term complications in eyes with specific features.

Pupil Ovalization After Phakic Intraocular Lens Implantation Is Associated With Sectorial Iris Hypoperfusion

To investigate iris perfusion in patients with and without pupil ovalization after phakic intraocular lens implantation. Comparative retrospective randomized case series of 6 participants, each with a regular pupil, and 6 participants with pupil ovalization after phakic intraocular lens implantation for high myopia were included in the study. Indocyanine green angiography was performed between 20 and 40 months (mean +/- SD, 26 +/- 6.1 months) after lens implantation. Iris perfusion defects were found in 5 of 6 patients with pupil ovalization. No perfusion deficits were noted in patients with round pupils. Iris ovalization after phakic intraocular lens implantation may be associated with a lack of iris perfusion and with secondary ischemia. Patients with these lenses and pupil ovalization should be followed regularly.

Changes in contrast sensitivity after Artisan lens implantation for high myopia

To determine the effects of Artisan lens implantation on contrast sensitivity. Prospective consecutive interventional case series. Forty-nine eyes of 30 patients with myopia and myopia with astigmatism, who underwent implantation of the Artisan iris-fixated phakic intraocular lens. Preoperative testing served as the control. Implantation of the Artisan phakic intraocular lens to correct myopia. Refractive predictability and Snellen visual acuity were evaluated preoperatively and at least 4 months postoperatively. Additionally, photopic and mesopic contrast sensitivities were measured at 1.5, 3, 6, 12, and 18 cycles per degree, with and without glare testing. The mean preoperative spherical equivalent (SE) was -12.16 diopters (D) (range, -6.88 to -18.00). The mean postoperative SE was -0.46+/-0.58 D (range, +0.50 to -1.75). Ninety percent of eyes were within 1.00 D of the predicted result, and 39% gained > or =1 lines of best-corrected visual acuity (BCVA). When compared with preoperative measurements, postoperative contrast sensitivity was increased under photopic conditions and slightly decreased under mesopic conditions. Adverse events were one wound leak requiring resuturing in the immediate postoperative period and one subluxed lens after significant blunt trauma. No eyes lost > or =2 lines of BCVA. Artisan implantation for the correction of high myopia seems to be a predictable procedure. Increases in photopic contrast sensitivity values after implantation of this phakic intraocular lens stand in distinction to the decreases in photopic contrast sensitivity previously reported after LASIK correction of this degree of myopia.

Phacoemulsification and intraocular lens implantation in high myopia

目的 分析高度近视白内障超声乳化吸出及后房人工晶状体植入术的疗效.方法对50例(58眼)高度近视白内障行巩膜隧道切口晶状体超声乳化吸出及后房人工晶状体植入.眼轴长27～33.56 mm,平均29.35 mm.其中眼轴长≤30mm者40眼,眼轴长＞30 mm者18跟.植入折叠式人工晶状体,观察术中术后并发症及术后视力.结果眼轴长≤30 mm的40眼中术后视力≥0.4者35眼(87.5%);眼轴长＞30 mm的18眼中术后视力≥0.4者9眼(50.0%).术中后囊破裂1例,行前部玻璃体切除及人工晶状体睫状沟植入术.结论高度近视白内障超声乳化及人工晶状体植入能改善视力,但眼轴长＞30mm者术后视力恢复较差。

Laser in situ keratomileusis and photorefractive keratectomy for residual refractive error after phakic intraocular lens implantation.

To determine the visual and refractive outcome of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in eyes with prior posterior chamber phakic intraocular lens implantation for high myopia. We studied a series of 37 consecutive eyes of 31 patients who underwent LASIK or PRK for residual refractive error following collamer posterior chamber intraocular lens (IOL) (Staar Surgical Implantable Contact Lens) implantation into a phakic eye. Twenty-eight eyes had LASIK and nine eyes had PRK. Mean follow-up was 8.1 +/- 4.7 months after laser ablation (range, 3 to 18 mo). The preoperative mean spherical equivalent refraction prior to phakic posterior chamber IOL implantation was -17.74 +/- 4.89 D (range, -9.75 to -28.00 D). Following phakic IOL implantation and prior to LASIK or PRK, mean spherical equivalent refraction was -2.56 +/- 2.34 D (range, -0.25 to -8.75 D). One month following LASIK or PRK, mean spherical equivalent refraction was -0.24 +/- 0.52 D (range, -1.50 to +1.50 D), 3 months following LASIK or PRK, mean spherical equivalent refraction was -0.19 +/- 0.50 D (range, -1.50 to +1.00 D). The refraction was within +/-1.00 D of emmetropia in 36 eyes (97.2%) and within +/-0.50 D in 31 eyes (83.7%). Three eyes developed anterior subcapsular opacities several weeks after laser ablation, one eye developed macular hemorrhage 4 weeks after laser ablation, and one eye had corticosteroid induced ocular hypertension. LASIK or PRK can be used to treat the residual refractive error following posterior chamber phakic IOL implantation.

Phacoemulsifcation with intraocular lens implantation in high myopia

Purpose: To assess phacoemulsification and posterior chamber intraocular lens (IOL) implantation in highly myopic eyes and to compare the results of sutureless scleral tunnel incision and sutured scleral incision techniques.Setting: The Eye Institute of Utah, Salt Lake City.Methods: A series of 109 highly myopic eyes (axial length over 26.00 mm) were reviewed at a mean postoperative follow-up of 27 months.Results: Postoperative corrected visual acuity was 20/40 or better in 94% of eyes, and uncorrected visual acuity was 20/40 or better in 77% of eyes. Posterior capsule opacification developed in 50% of eyes; 95% of these had neodymium:YAG (Nd:YAG) laser capsulotomy. Cystoid macular edema occurred in two eyes, and one eye developed retinal detachment following Nd:YAG capsulotomy. Eyes that had sutureless scleral tunnel incisions attained earlier postoperative rehabilitation of visual acuity and stabilization of astigmatism than did patients who had sutured scleral incisions.Conclusions: The results of this study of highly myopic eyes indicate that treating retinal pathology preoperatively and using the sutureless procedure, phacoemulsification, and in-the-bag IOL placement lead to good visual outcome, a lower rate of retinal complications, and a more stable wound.

Refractive surgery in the United States.

In a mere 8 years, refractive corneal surgery in the United States has become a commonly practiced procedure. The major procedures being performed today are keratotomy for the correction of myopia and astigmatism and epikeratoplasty for the correction of aphakia. Current, on-going clinical studies involving intrastromal implantation of hydrogel materials have just begun. Clear lens extraction for myopia and intraocular lens implantation in high myopia at the time of cataract surgery are being used more commonly each day. Recognition of and modification of pre-existing corneal astigmatism at the time of cataract surgery has been able to provide patients with much improved visual acuity after surgery.