Phakic Intraocular Lens Surgery Research Articles

Moxifloxacin-associated acute pigment dispersion and iris transillumination after phakic lens surgery

Introduction: Acute pigment dispersion and elevated intraocular pressure (IOP) were found after phakic intraocular lens surgery where 0.5% moxifloxacin was used. While scattered reports can be found in the literature, to the authors' knowledge, this is the first time it has been linked to intracameral 0.5% moxifloxacin. Patient and Clinical Findings: A 23-year-old man experienced symptoms of unilateral eye pain, increased IOP, diffuse pigment dispersion, transillumination defects, and mydriasis after successful bilateral Starr Visian EVO implantable collamer lens implantation. Diagnosis, Intervention and Outcomes: Intracameral moxifloxacin (0.5%) was given at the time of the procedure and was suspected to be the cause of this patient's postoperative findings. These findings are consistent with iris toxicity associated with systemic moxifloxacin. Supportive care was given, however, the resulting pigment dispersion and mydriasis are permanent. Conclusions: Although generally safe for intracameral use, moxifloxacin has the potential to be toxic to the iris. Patients with phakia may be at higher risk of this toxicity, and lower concentrations of intracameral moxifloxacin should be considered in these patients.

Optimization of the lens sizing for the second eye based on the vault obtained in the first eye in bilateral myopic collamer phakic intraocular lens surgery

Abstract Purpose To assess vault and the decision-making process involved in selecting the size of the lens for the fellow eye in a series of patients who received bilateral phakic collamer intraocular lens (pIOL) implants with central hole for correction of myopia. Methods The study sample included all patients who underwent bilateral insertion of a different size pIOL from a pool of 269 patients who underwent sequential bilateral insertion of a pIOL from March 2012 to May 2015 in our institution. Procedures were separated in time to assess the value of the vault and select the pIOL size in second eyes. Vault was analyzed objectively using optical coherence tomography. Results The decision to change the size of the pIOL in the fellow eye was taken in 25 patients. A smaller pIOL was implanted in the second eye in 9 patients, whereas a lens that was 1 size larger was necessary in 16 patients. Implantation of a larger lens led to a mean increase in vault of 251 ± 180 μm; implantation of a smaller size lens led to a mean decrease in vault of 542 ± 187 μm. In five patients, the pIOL implanted in first eye was rotated vertically to reduce lens vault. No lenses had to be explanted. Conclusions Vault in fellow eyes can be improved in patients receiving bilateral myopic pIOL implants by modifying the pIOL size based on the vault value obtained in the first eyes.

Biometric evaluation of myopic eyes without posterior staphyloma: disproportionate ocular growth.

To evaluate changes in the anterior segment of myopic eyes and assess anterior biometry as a function of axial length (AL). Retrospective investigational study. Patients evaluated for phakic intraocular lens surgery at a tertiary eye care centre. Patients with corrected visual acuity >20/40 and AL>24.5mm were included in the study. Posterior staphyloma and maculopathy were ruled out in all the patients, and 176 eyes were included for analysis. AL was measured with partial coherence interferometry, while keratometry, central corneal thickness (CCT), anterior chamber depth (ACD), and horizontal white to white (WTW) were measured with slit-scanning topography. Group 1 included 55 eyes with AL<26.5mm, group 2 had 57 eyes with AL between 26.5 and 28.5mm while group 3 had 64 eyes with AL>28.5mm. Correlation of AL with anterior biometry. The mean AL of the study eyes was 27.88+2.14mm. The mean values of ACD (2.99mm), CCT (0.52mm), WTW (11.68mm), and keratometry (43.62D) were within the normal range. Overall, very weak correlations could be established between AL and CCT (R=0.17, p=0.02), AL and keratometry (R=-0.28, p<0.001), and AL and WTW (R=0.22, p=0.002), while ACD did not relate to AL significantly. The ACD and CCT did not relate significantly to AL in any of the three groups. Keratometry had a weak negative relation with AL in groups 1 and 2, while WTW had a weakly positive relation with AL in group 2 only. No variable had any significant relation with AL in group 3. There is disproportionate elongation of the eyeball in myopic patients with very weak or no correlation between anterior biometry and AL. This discord is more in longer eyes. Such a scenario can be challenging to a refractive surgeon treating highly myopic eyes and needs further evaluation.

Incidental discovery of retinal pathology on preoperative assessment of implantable contact lens candidate patients: diagnosis and management

Purpose The aim of this study was to analyze retinal pathologies incidentally discovered on preoperative preparation of implantable contact lens (ICL) candidate patients. Patients and methods We retrospectively analyzed all data concerning preoperative retinal examination in 304 eyes prepared for posterior chamber phakic intraocular lens surgery. This was a multicenter study conducted between May 2012 and January 2014. This was a retrospective case series. Results The study enrolled 297 of 304 eyes subjected to preoperative screening before the ICL implantation procedure. We encountered 23 (7.56%) eyes with a variety of retinal pathologies on preoperative assessment, which included stage 3 macular hole, myopic choroidal neovascular membrane scar, white without pressure, perforated lattice degeneration, peripheral retinal flat holes that required laser retinopexy, nonproliferative diabetic retinopathy, peripapillary old toxoplasma scar, and active myopic choroidal neovascular membrane. In no case did rhegmatogenous retinal detachment occur following the ICL procedure. Conclusion Preoperative retinal assessment of ICL patients is crucial to detect undiagnosed myopic retinal changes and other latent pathologies not related to myopia.

Efficacy of a novel moist cool air device in office workers with dry eye disease

To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED). In this prospective single-centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best-corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded. In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial. Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.

Pediatric phakic intraocular lens surgery: review of clinical studies

To report on the accumulating peer-reviewed data of phakic intraocular lens (pIOL) implantation in the pediatric population. I evaluate and compare the published peer-reviewed articles for the reported efficacy and complications of phakic intraocular lens implantations in children for correction of clinically significant high refractive errors. Multiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment. In the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials should focus on children of various age groups to assess the variables of visual acuity gain or loss, stereopsis, contrast sensitivity, high-order aberrations, corneal physiology, and long-term complications to accurately and properly address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.

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.

Metaanalysis of cataract development after phakic intraocular lens surgery

We performed a systematic literature review to determine the incidence of and predisposing factors for cataract after phakic intraocular lens (pIOL) implantation. Of the 6338 eyes reported, 4.35% were noted to have new-onset or preexisting progressive cataract. The incidence of cataract formation was 1.29%, 1.11%, and 9.60% with anterior chamber, iris-fixated, and posterior chamber (PC) pIOLs, respectively. In the PC pIOL group, early cataract formation was related to surgical trauma and late-onset cataract was related to IOL-crystalline lens contact. Analysis of cataract progression in eyes with preexisting cataract showed a progression rate of 29.5% after pIOL surgery. These results suggest that cataract formation is most likely to occur after PC pIOL implantation. Patients with preexisting progressive cataract should be informed about the possibility of cataract progression and possible need for cataract surgery after pIOL implantation. Cataract surgical intervention resulted in restoration of visual acuity.

Measurement of Combined Corneal, Internal, and Total Ocular Optical Quality Analysis in Anterior Segment Pathology With the OPD-Scan and OPD-Station

To show the clinical use of the NIDEK OPD-Scan wavefront aberrometer and OPD-Station software in anterior segment surgery and pathology. Case examples are presented along with discussion about the relevant clinical data obtained from the OPD-Scan and OPD-Station software. Six case examples including cataract surgery, secondary IOL implantation, phakic intraocular lens surgery, pterygium surgery, contact lens fitting, and multifocal ablations are discussed. A complete understanding of the optics of the eye facilitates a better clinical comprehension of a variety of conditions in anterior segment surgery and pathology.

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.

Angle-supported phakic intraocular lenses followed by laser-assisted in situ keratomileusis for the correction of high myopia

Purpose To evaluate the safety, effectiveness, predictability, and stability of the combination of angle-supported phakic intraocular lens (PIOL) implantation and laser-assisted in situ keratomileusis (LASIK) for the correction of high myopia. Design Noncomparative interventional case series. Methods At the Instituto Oftalmológico de Alicante, Spain, 24 consecutive eyes of 12 patients with a preoperative spherical equivalent between −9 and −26 diopters were studied. Implantation of an angle-supported PIOL was done as the first surgery. Laser-assisted in situ keratomileusis was performed at least 6 months after PIOL surgery, once stability of topography and refraction were proved. Main outcome measures were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, applanation tonometry, and corneal endothelial study (cell density, hexagonality, and coefficient of variation), with a minimum follow-up of 12 months after LASIK. Results The mean spherical equivalent refraction decreased from −15.17 ± 5.15 diopters before PIOL implantation to −1.33 ± 1.18 diopters after PIOL surgery and to 0.01 ± 0.53 12 months after LASIK. Uncorrected visual acuity was 0.39 ± 0.12 after PIOL surgery, increasing to 0.65 ± 0.23 12 months after LASIK. There was an increase in 20/40 or better UCVA from 16.6% after PIOL surgery alone to 83.3% after addition of LASIK. At final follow-up, spherical equivalent was within ± 1 diopter of emmetropia in 22 eyes (91.7%) and in 18 eyes (75%) within ± 0.50 diopters. Vector analysis demonstrated that astigmatic components of refractive error after PIOL surgery were well corrected by LASIK. At final follow-up the mean endothelial cell loss was 4.88% ( P < .001). There were no statistically significant differences between mean endothelial cell count, percentage of hexagonality, or coefficient of variation before LASIK and 12 months after LASIK, suggesting that no corneal endothelial damage was produced by LASIK itself. No sight-threatening complications occurred through the follow-up period. Conclusion The combination of angle-supported PIOL implantation and LASIK appears to be a safe, effective, predictable, and stable procedure for the correction of high myopia. This paper emphasizes the benefits of adding LASIK to the use of PIOL alone.

Long-Term Endothelial Cell Loss Following Phacoemulsification: Model for Evaluating Endothelial Damage After Intraocular Surgery

Newer concepts of phakic intraocular lens (IOL) surgery present concerns as to their long-term deleterious effect on the endothelium. We examine the behavior of the endothelium for up to 6 years following uneventful phacoemulsification surgery, to establish a baseline for what might be an acceptable level of endothelial cell loss due to intraocular surgical trauma. Ninety-three eyes undergoing phacoemulsification surgery who had multiple endothelial specular microscopy examinations for up to 6 years were examined. Central endothelial specular photomicrographs were analyzed in all cases and the percent of endothelial cell loss as a function of time was calculated. Cell density calculations were corrected for the normal endothelial cell loss as a function of age. Routine uncomplicated phacoemulsification surgery demonstrated a 9% endothelial cell loss 1 year postoperatively. This is in marked contrast to the 16% average endothelial cell loss cited in the literature after phakic AC-IOL surgery. In general, anterior chamber IOL surgery following cataract removal compares unfavorably to posterior chamber IOL insertion long term (20% cell loss versus 12% cell loss). A model is proposed to look at the rate of endothelial cell loss that would be significant enough to create the threat for corneal edema long term following refractive intraocular surgery in young patients. Suggestions for critical comparisons between the observed endothelial aging seen with phakic IOLs and values for more routine IOL surgery are proposed to predict the long-term threat for endothelial cell loss and corneal decompensation, which might result many years after phakic refractive IOL surgery.