pIOL Implantation Research Articles

Evaluation of impact of posterior phakic IOL implantation on biometry and effectiveness of concomitant use of anterior segment OCT on IOL power calculation for cataract surgery.

To evaluate the effects of phakic intraocular lens (pIOL) implantation on the intraocular lens (IOL) power calculation and subsequently to evaluate the effectiveness of concomitant use of anterior segment optical coherence tomography (AS-OCT) against biometric changes. Masayuki Ouchi Eye Clinic, Kyoto, Japan. Prospective consecutive case series. 100 patients (100 eyes) who underwent pIOL implantation were enrolled. In each eye, biometry was performed using partial coherence interferometry (PCI) and AS-OCT. Pre-pIOL and post-pIOL implantation IOL power calculation using SRK/T (S), Haigis (H), and Barret Universal II (B) formulas was compared. 100 patients (100 eyes) were included. Anterior chamber depth (ACD) was significantly shorter at post-pIOL implantation for both PCI (P < .001) and AS-OCT (P = .05). When using PCI, the crystalline lens surface was misidentified in 75% of eyes, and in these eyes, the ACD difference between pre-pIOL and post-pIOL implantation exceeded that with both PCI and AS-OCT. The estimated IOL power was significantly lower at post-pIOL implantation according to the H and B formulas (both P < .001) but remained unchanged by the S formula. However, no difference was observed when AS-OCT-derived ACD and lens thickness (LT) values were introduced in the H (P = .16) and B (P = .55) formulas. Misidentification of the lens surface occurs in many pIOL-implanted eyes with PCI measurements and could influence the power calculation with H and B formulas while leaving the S formula unaffected. AS-OCT-derived ACD and LT value substitution is recommended for H and B formulas.

Visual acuity, refractive error and regression outcomes in 169 children with high myopia implanted with two different IOLs

Reports of phakic IOL (pIOL) implantation performed on children to correct high myopia tend to be case reports or small series. Here we analyze outcomes in a large cohort of spectacle-aversive children treated by implantation of the Ophtec-Artisan or Visian pIOL.

Comparison between Foldable and Hard [PMMA] Iris Claw Phakic Intraocular Lens Implantation for Correction of High Myopia

Background:Iris claw phakic intraocular lens [PIOL] is one of the surgical techniques used for the correction of high myopia. This procedure reduces myopia with stable refractive results and preserves the accommodation. Aim of the Work:The aim of this study is to assess the outcome of foldable and hard [PMMA] iris claw PIOL implantation as one of surgical procedures in the management of high myopic young patients. Patients and Methods:A prospective comparative study having foldable and hard [PMMA] iris claw phakic intraocular lens [PIOL] for correction of high myopia. This study includes forty eyes [40 eyes] of twenty high myopic patients [20 pt.] with refraction range of [-10.0 D to -25.0 D] without or with cylinder not more than [-2.0 D]. The patients were divided to two groups [A] and [B], each group contains twenty [20] eyes, the first 20 eyes [group A] received a concave-convex foldable iris claw PIOL and the remaining 20 eyes [group B] received a biconcave optic hard PMMA iris claw PIOL. Result:The mean postoperative SE at 6 months in group [A] was [-0.30 ± 0.10 D] within ±1.00 D of emmetropia. In group [B] it was [- 0.50 ± 0.50 D] within ±1.0 D of emmetropia. The mean postoperative cylinder at 6 months was [-0.31 ± 0.10] in group [A], and [-0.51 ± 0.51] in group [B]. There was a statistically significant difference between preoperative UCVA and postoperative UCVA at 6 months were [p <0.001] in both groups. Postoperative BCVA [logMar] at 6 months was 0.11 ± 0.14 in group [A] and 0.27 ± 0.17 in group [B]. Conclusion: iris-claw phakic IOL implantation is frequently used for highly myopic cases. Compared to corneal refractive surgery, phakic IOLs favorably compete for the correction of high myopia, with increasing predictability, efficacy, safety, and quality of vision.

Comparison of the visual performance of iris-fixated phakic lens and implantable collamer lens to correct high myopia

BackgroundTo compare visual performance between the iris-fixated phakic intraocular len (pIOL) and implantable collamer len (ICL) to correct high myopia.MethodsTwenty-four eyes underwent iris-fixated pIOL implantation and 24 eyes underwent ICL implantation. At the 6-month follow-up, the best-corrected visual acuity (BCVA) and uncorrected distance visual acuity (UDVA) were compared between the iris-fixated pIOL and ICL groups. The objective scatter index (OSI), modulation transfer function (MTF) cutoff, and ocular aberrations were performed to evaluate postoperative visual quality between the two groups.ResultsNo significant difference was found in UDVA, BCVA, and spherical equivalent between the iris-fixated pIOL and ICL groups (P > 0.05). Six months after surgery, the following values were significantly higher in the ICL group than in the iris-fixated pIOL group: MTF cutoff, strehl ratio and optical quality analysis system values at contrasts of 9 %, 20 %, and 100 % (P < 0.01). The OSI in the iris-fixated pIOL group was higher than in the ICL group 6 months after surgery (P < 0.01). All high-order aberrations were slightly more severe in the iris-fixated pIOL group than in the ICL group 6 months after surgery, although only trefoil (P = 0.023) differed significantly in this regard.ConclusionsBoth iris-fixated lenses and ICLs can provide good visual acuity. ICLs confer better visual performance in MTF-associated parameters and induce less intraocular light scattering than iris-fixated pIOLs.

One-year follow-up of a new posterior chamber toric phakic intraocular lens implantation for moderate-to-high myopic astigmatism.

To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from - 4.50 to - 18.50diopters (D) and cylindrical refraction from - 0.50 to - 5.50D. This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from - 10.45 ± 2.74D preoperatively to - 0.34 ± 0.51D and - 0.40 ± 0.56D at 6 and 12months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00D and ± 0.50D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

Visual acuity, refractive error, and regression outcomes in 169 children with high myopia who were implanted with Ophtec-Artisan or Visian phakic IOLs

To analyze outcomes in a large cohort of spectacle-aversive children with high myopia who were treated by implantation of the Ophtec-Artisan or Visian phakic intraocular lens (pIOL). Outcome data were collated retrospectively in 78 children (115 eyes) implanted with the Ophtec-Artisan iris-enclaved anterior chamber pIOL and 91 children (154 eyes) implanted with the Visian ICL (intraocular collamer lens) sulcus pIOL. All children had difficulties with spectacle or contact lens wear. Mean age at surgery was 9.9years; mean follow-up was 3.9years (range, 0.6-14.1years). A total of 248 of 269 eyes (92%) were corrected to within ± 0.5 D of their target value. Spherical correction averaged 12.3±1.0 D. Refractive spherical regression was -0.04 D/year at last follow-up. Uncorrected distance visual acuity improved from an average logMAR 1.8 to 0.4; corrected distance visual acuity improved an average 0.3 logMAR. Of the treated children, 68% had a gain in binocular fusion. Neurobehavioral and/or visuomotor comorbidities were present in 87% of children. Five eyes (2%) developed retinal detachment an average 6years after implantation. Nine eyes (3%) implanted with the Ophtec-Artisan pIOL required repositioning after trauma. Implantation of pIOLs in children is an effective method for correcting high myopia in spectacle noncompliant children. Rates of myopic regression after pIOL surgery are substantially lower than those reported for children treated by excimer laser photorefractive keratectomy (PRK). The prevalence of major complications was relatively low in this high-risk population.

A Comparison of Two Foldable Phakic Intraocular Lenses Implanted in Different Anatomical Compartments: Artiflex Versus Eyecryl.

Objectives:The aim of this study was to compare the refractive results and safety of Artiflex (Ophtec BV, Groningen, Netherlands) and Eyecryl (BioTech Healthcare GmbH, Luzern, Switzerland) phakic intraocular lenses (pIOL).Methods:The medical records of patients who underwent implantation of Artiflex or Eyecryl pIOL were retrospectively reviewed. Patients with a follow-up of 3 years were included in the study. Manifest refractive error, uncorrected and corrected visual acuity, intraocular pressure (IOP) and central endothelial cell density (ECD) data were evaluated preoperatively and at 1 and 3 years after surgery.Results:In all 79 eyes (Artiflex group: 35 eyes; Eyecryl group: 44 eyes) were included in the study. The preoperative spherical equivalent (SE) of manifest refractive error was -11.53±3.46 in the Artiflex group and -13.08±3.01 in the Eyecryl group. Three years after the operation, the efficacy index was 1.06±0.55 and 1.15±0.85 in the Artiflex and Eyecryl groups, respectively. The safety index was in 1.32±0.49 and 1.46±0.95 the Artiflex and Eyecryl groups, respectively. The SE refractive error, efficacy index, safety index UDVA, CDVA, IOP, and ECD were not significantly different between groups during follow-up.Conclusion:Both the Artiflex and Eyecryl foldable pIOLs were found to be safe and effective up to 3 years after implantation. Prospective longitudinal studies are needed to assess and compare the rate of cataract formation.

Refractive outcomes and complications following angle supported, iris fixated, and posterior chamber phakic intraocular lenses bilensectomy.

The manuscript presents a review of published studies regarding the outcomes, causes, and complications of phakic intraocular lens (pIOLs) bilensectomy.All pIOLs will be explanted at some point, therefore is important to know the visual and refractive outcomes following bilensectomy. There are few publications about the outcomes following pIOL bilensectomy; in all of them, cataract remains the main cause of bilensectomy. Other causes are endothelial cell density loss and pupil ovalization. The mean time between pIOL implantation and bilensectomy is longer in eyes implanted with an anterior chamber pIOL than in eyes implanted with a posterior chamber pIOL. There is a significant improvement in uncorrected and corrected distance visual acuity after bilensectomy. Some sight-threatening complications like retinal detachment and low endothelial cell density (ECD) after surgery have been reported. Current publications suggest that endothelial cell density loss is more frequent in eyes that underwent bilensectomy for an anterior chamber pIOL. Good visual and refractive outcomes are achieved after bilensectomy, regular endothelial cell density measurements should be performed in all patients implanted with an anterior chamber pIOL to perform a safe bilensectomy.

Long-term longitudinal changes in axial length in the Caucasian myopic and hyperopic population with a phakic intraocular lens.

PurposeTo determine the long‐term longitudinal axial length changes in myopic and hyperopic adults with an iris‐fixated phakic intraocular lens (pIOL).MethodsThe medical records of patients aged ≥18 years with myopia or hyperopia who were treated with pIOL implantation between 1996 and 2011 for refractive correction with a minimum follow‐up of 5 years after pIOL implantation were analyzed. The main outcome measure was change in ocular axial length over time.Results149 eyes of 149 myopic patients and 27 hyperopic eyes of 27 patients were included in this study. Mean patient age was 37.1 ± 10.4 years (35% male) in the myopic group and 39.4 ± 9.4 years (4% male) in the hyperopic group. The eyes of the myopic patients showed a significant mean increase in axial length of 0.45 ± 0.61 mm after a mean follow‐up time of 144 ± 38 months (p < 0.001). In 26 eyes (17%), the axial length had increased by ≥1 mm. The mean annual axial length increase was 0.04 ± 0.06 mm. Axial elongation was associated with a higher degree of myopia (p < 0.001) and younger age (p = 0.02). The eyes of the hyperopic patients showed no change in axial length over time.ConclusionsMyopic eyes corrected with an iris‐fixated pIOL show continuous increase in axial length at an adult age. Although this study is limited to subjects with a pIOL, this is the first time myopization in Caucasian adults has been reported in a large long‐term longitudinal study.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault.

To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. Clinica Baviera, Madrid, Spain. Retrospective cross-sectional single-center study. Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 μm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 μm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 μm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Explantation of phakic intraocular lenses: causes and outcomes.

To describe reasons for explantation of anterior and posterior chamber phakic intraocular lenses (pIOLs), as well as outcomes of the surgery. The medical files of patients who underwent pIOL explantation due to complications were reviewed. All patients were divided into three groups based on the type of explanted pIOL: anterior chamber angle-supported (AS pIOL), anterior chamber iris-fixated (IF pIOL), and posterior chamber (PC pIOL). Sixty-two eyes of 41 patients were evaluated. There were 26 (41.9%), 16 (25.8%), and 20 (32.2%) eyes in the AS pIOL, IF pIOL, and PC pIOL groups, respectively. The mean interval between the implantation and removal of the pIOL (i.e., survival time) was 13.6 ± 8.1years (range 0.01-21.22years). The mean follow-up after the explantation was 22.5 ± 4.0months (range 11.3-28.7months). The main causes of explantation were cataract in the PC pIOL group (60%) and chronic endothelial cell loss in the AS pIOL group (53.8%) and IF pIOL group (56.2%). Overall, the procedure most often combined with pIOL explantation was phacoemulsification and implantation of a posterior chamber IOL (40.3%), followed by keratoplasty (9.6%). Intraoperative complications were significantly more common in the AS pIOL group than the other groups (p < 0.001). Explantation of anterior chamber pIOLs due to severe endothelial cell loss and the proportion of keratoplasty was more common in patients with a relatively long survival time. Therefore, patients with pIOL implantation should be monitored regularly after surgery.

Comparative study of small-incision lenticule extraction and phakic intraocular lens implantation for the correction of high myopia: 6-year results.

To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. University of Health Science Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey. Retrospective comparative case series. Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from -6.00 to -10.00 diopters (D) were included in the study. There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up.

To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up. Ophthalmology Department, Hospital Braga, Portugal. Retrospective cohort study. Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed. A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from -9.50 ± 2.93 diopters (D) to -0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD. The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.

Differences between Scheimpflug and optical coherence tomography in determining safety distances in eyes with an iris-fixating phakic intraocular lens

PurposeTo investigate the agreement and reliability of anterior segment optical coherence tomography (AS-OCT) and Scheimpflug imaging in measuring the distance from the anterior edge of an iris-fixated phakic intraocular lens (IF-pIOL) to the corneal endothelium.MethodsAnterior segment configuration was assessed in a total of 62 eyes of which 25 hyperopic and 37 myopic eyes, all corrected with an IF-pIOL. Measurements were performed by two independent observers using AS-OCT (Visante, Model 1000, Carl Zeiss Meditec Inc.) and Scheimpflug imaging (Pentacam HR, Oculus Optikgerate). The distance from the anterior edge of the pIOL to the endothelium was measured in five different positions using both modalities with their corresponding pIOL software. The measurements as well as the inter- and intra-observer reliability of the two imaging modalities were then compared.ResultsDistance measurements for all positions performed by AS-OCT were found to be significantly larger than those performed by Scheimpflug imaging, with mean differences ranging from 0.11 to 0.22 mm. Both instruments exhibited good inter- and intra-observer reliability.ConclusionAnterior pIOL edge to endothelium distance measurements by AS-OCT and Scheimpflug imaging have good intra- and inter-observer reliability. However, as AS-OCT provides larger measurements, these two modalities cannot be used interchangeably. Correction of this difference might be essential for proper decision-making during pre-operative screening for pIOL implantation and post-operative safety monitoring.

Safety and visual outcomes following Iris-claw phakic intraocular lens bilensectomy.

To evaluate the visual outcomes, safety, efficacy, and causes of bilensectomy for iris fixated phakic intraocular lenses (pIOLs). This was a two center consecutive retrospective study that included 43 eyes that underwent iris-claw pIOL bilensectomy. Patients with follow up less than 4 months were excluded from the study. Uncorrected, corrected visual acuity (UCVA, CDVA), refractive outcomes, efficacy, safety (number of eyes in which the postoperative CDVA was worse than the preoperative CDVA), endothelial cell density (ECD), causes of bilensectomy, the time between the implantation of the pIOL and bilensectomy, intra and postoperative complications were analyzed. There was a statistically significant improvement in UCVA and CDVA after surgery (p = 0.001). The efficacy index was 0.7, four eyes had a postoperative CDVA worse than the preoperative CDVA. The mean spherical equivalent 1 year after bilensectomy was -0.78 ± 1.70 D. There was a statistically significant endothelial cell loss after iris claw lens bilensectomy (p = .003). Cataract development and endothelial cell loss were the only reasons for bilensectomy. The mean time between pIOL implantation and bilensectomy was 12.2 ± 5.5 years. One patient had corneal edema 8 months after surgery and one had a retinal detachment 11 months after surgery. Bilensectomy was successful in improving UCVA and CDVA with an acceptable refractive outcome. Significant loss of ECD was found after surgery. The results recommend a larger ACD as selection criteria when choosing to implant an Artisan lens, and a close postoperative monitoring of the endothelial cell count.

Vault changes after cyclopentolate instillation in eyes with posterior chamber phakic intraocular lens

Posterior chamber phakic intraocular lens (pIOL) implantation is a common option for correcting moderate-to-high ocular refractive defects. Because this pIOL is implanted on ciliary sulcus, the distance between the back surface of the pIOL and the anterior surface of the crystalline lens, that it is known as vault, should be measured in different conditions to ensure the technique’s safety. Cyclopentolate is a drug that dilates the pupil and relaxes accommodation (cycloplegia). It is often used for different ocular examinations and for other medical purposes. However, there is no evidence of the effect of this drug on vault. This study quantified central vault changes associated with cyclopentolate instillation. We measured the vault under normal conditions (pre-cycloplegic instillation) and after instilling cyclopentolate on 39 eyes of 39 patients with implanted pIOL. Our results suggest that cyclopentolate instillation may induce changes to vault in eyes with implanted pIOL. These changes seem safe and are mainly associated with vault under normal conditions, but also with anterior chamber depth, pupillary diameter and pIOL size.

Phakic intraocular lenses: An overview.

Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.

Phakic intraocular lens: Getting the right size.

Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are unable to get refractive correction through laser platforms due to high refractive error or certain corneal contraindications. Phakic IOL's (PIOL) have their own set of complications and challenges, the most important being getting the sizing right. This paper attempts to solve the problem of accurate sizing of PIOL's. Parameters needed for calculating the ideal size of PIOL's have been studied in a step by step manner using all possible tools depending upon the availability and preference of the surgeon. The pros and cons of using a particular tool for measurements have been highlighted along with illustrative case examples to help surgeons who are starting PIOL implantation surgery.

Descemet Membrane Endothelial Keratoplasty for Corneal Decompensation Secondary to Phakic Intraocular Lenses.

Purpose To describe the surgical technique and clinical outcomes of bilensectomy (pIOL explant and phacoemulsification), followed by DMEK performed for bullous keratopathy secondary to pIOL. Methods Seven eyes of seven patients, who developed corneal decompensation after pIOL implantation, underwent bilensectomy followed by DMEK in a two-step procedure. Main outcome measures included uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), refraction, endothelial cell density (ECD) at 1, 3, 6, and 12 months, and intraoperative and postoperative complications. Results DMEK was performed at a mean time of 9.83 ± 8.23 months after bilensectomy. BCVA (log MAR) improved in all eyes, increasing from 1.11 ± 0.78 preoperatively to 0.54 ± 0.21, 0.28 ± 0.23, 0.21 ± 0.21, and 0.17 ± 0.17 at 1, 3, 6, and 12 months after DMEK. One year after surgery, mean spherical equivalent and cylinder were −0.70 ± 0.92 D and −1.50 ± 0.54 D, respectively. ECD decreased by 62 ± 4%, 69 ± 4%, 74 ± 4%, and 77 ± 3% at 1, 3, 6, and 12 months after DMEK. There was one case of primary graft failure and no other postoperative complications. Conclusions The two-step technique bilensectomy followed by DMEK is a feasible technique for the management of bullous keratopathy secondary to pIOL, providing a fast visual recovery with good visual and refractive results.

Long-term changes in visual outcomes and ocular morphometrics after myopic and toric phakic intraocular lens implantation: Five- and 10-year results

To evaluate the long-term refractive and visual, anterior chamber depth, and axial length (AL) changes and complications after rigid iris-fixated phakic intraocular lens (pIOL) implantation to treat myopia or astigmatism. University Eye Clinic Maastricht, Maastricht UMC+, the Netherlands. Prospective case series. The study evaluated patients who had implantation of an Artisan myopic or toric iris-fixated pIOL as of January 1998. Changes were measured annually and reported after 1, 5, and 10years postoperatively. The study comprised 460 eyes (250 patients; mean age 41.1years±10.7 [SD]). Over 10years, the mean myopization was -0.79 diopters (D) (P<.001), with 52% of eyes within ±1.0 D of target. The mean increase in the logarithm of the minimum angle of resolution (logMAR) corrected distance visual acuity (CDVA) over 10years was 0.05 (P<.001); 95% of eyes had a CDVA of 20/40or more and 7% lost 2 or more lines of CDVA. The mean logMAR uncorrected visual acuity (UDVA) increased by 0.14 over 10years (P<.001); 96% had a UDVA 20/40 or better. The AL increased by 1.14mm over 10years (P=.009). Ten percent of pIOLs were explanted because of cataract formation after amean of 97.9±34.9months. A higher preoperative age (hazardratio [HR], 1.08; P<.001) and longer AL (HR, 1.34; P<.001) were risk factors for shorter survival because of cataract formation. Ten years after rigid iris-fixated pIOL implantation, the CDVA and UDVA decreased significantly as a result of significant myopization caused by an increased AL unrelated to the pIOL.