Toric Phakic Intraocular Lens Implantation Research Articles

Femtosecond Laser Assisted Cataract Surgery in a Patient with Anterior Chamber Phakic IOL in situ

Introduction: Conventional phacoemulsification and intraocular lens (IOL) implantation for patients who already have a phakic IOL (PIOL) in situ can present challenges in IOL power calculation and the surgical procedure. Here we report a case of phacoemulsification with IOL implantation without removing the anterior toric PIOL. Patient and Clinical Findings: This 45-year-old male was referred to our clinic with mature cataract in the right eye, and a history of multiple corneal surgical procedures including radial keratotomy, LASIK, corneal cross-linking, and Artiflex toric PIOL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity were 20/2000. Diagnosis, Intervention, and Outcomes: Since CDVA was 20/25 after toric PIOL implantation and prior to the development of cataract, and the cornea was compromised, the toric PIOL was not removed. Using femtosecond laser assisted cataract surgery (FLACS) through the toric PIOL, capsulotomy and lens fragmentation were completed without modifying the device setting, and an IOL was inserted in the bag. At one year after surgery, right eye UDVA, CDVA, and refraction were 20/32, 20/25, and +1.25/-1.00*120ᵒ. Conclusion: In this case, FLACS was a successful technique for preserving the toric PIOL, and results were stable during the one year of postoperative follow up.

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.

An unusual case of a rotating toric phakic intra-ocular lens

<br>An accurately sized Phakic Intra-Ocular lens (PIOL) helps achieve adequate vault which in turn also provides for rotational stability. Toric PIOL implantation was done for a case with bilateral myopic astigmatism. Both eyes had similar spherical equivalent and ocular biometric parameters; thus, same sized PIOLs were implanted. Right eye post-operative course was uneventful but left eye repeated rotation was noted. An inadvertently placed smaller sized PIOL in left eye could explain rotation. Re-evaluation confirmed similar ocular and PIOL parameters in both eyes, but a shallow vault (444 μ) in left eye compared to right (602 μ). Post PIOL extraction, measurement confirmed the left PIOL size to be lesser (11.61 mm) than the expected size (12.75 mm).<br>

Phakic intraocular lens implantation in Keratoconus

AbstractPhakic intraocular lens implantation can be a highly predictable and successful method of refractive correction and functional visual rehabilitation in patients with grade II – III keratoconus who have a stable corneal shape and good spectacle corrected visual acuity. Effective refractive correction has been reported using several types of toric phakic IOLs in keratoconus and also for keratoconus patients with post‐keratoplasty ametropia. A four stage visual rehabilitation pathway for keratoconus has been described: gross shape correction with intracorneal ring segments followed by cross‐linking, toric phakic intraocular lens implantation, and then fine shape correction with topography‐guideded PRK as necessary. The aim of this presentation is to present an update on current indications, methods and outcomes of toric phakic intraocular lens implantation in keratoconus patients.

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.

Comparison between toric and spherical phakic intraocular lenses combined with astigmatic keratotomy for high myopic astigmatism

BackgroundTo compare the outcomes of a toric phakic intraocular lens (PIOL) and a spherical PIOL combined with astigmatic keratotomy (AK) for the correction of high myopic astigmatism.MethodsThis study enrolled patients with high myopic astigmatism, including 30 eyes (22 patients) that received a toric PIOL implantation (TICL group), and 32 eyes (24 patients) that received combined AK and a spherical PIOL implantation (AK+ ICL group). The outcomes were compared between the two groups before surgery, and at the following time points after surgery: 1 week, 1, 3, 6 months, and 1, 2 years.ResultsPreoperatively, the mean manifest spherical equivalent (SE) was −14.14 ± 2.12 D in the TICL group and −14.83 ± 2.79 D in the AK + ICL group (P = 0.28), and the mean manifest refractive cylinder, −2.87 ± 1.09 D and −2.58 ± 0.85 D, respectively (P = 0.28). Two years postoperatively, the mean safety index was 1.53 ± 0.55 in the TICL group and 1.60 ± 0.70 in the AK + ICL group (P = 1.00), and the mean efficacy index, 1.18 ± 0.45 and 1.38 ± 0.52, respectively (P = 0.86). The mean manifest refractive cylinder correction was 1.94 ± 1.07 D in the TICL group and 1.39 ± 0.71 D in the AK + ICL group (P = 0.02). The mean changes in SE and refractive cylinder from 1 week to 2 years were less than 0.50 D in both groups.ConclusionsBoth TICL implantation and AK + ICL implantation are a good alternative for correction of astigmatism in addition to high myopia. TICL implantation has better predictability in correction of high myopic astigmatism.Trial registrationNCT03202485

Three-year follow-up of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus

AimTo assess the clinical outcomes following the use of toric implantable collamer lenses (toric ICL, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus.MethodsThis retrospective study evaluated 21...

Current options in the management of pellucid marginal degeneration.

To review and evaluate current and future directions in the diagnosis and surgical management of pellucid marginal degeneration (PMD), including penetrating keratoplasty, full-thickness crescentic wedge resection (FTCWR), deep anterior lamellar keratoplasty (DALK), crescentic lamellar wedge resection (CLWR), crescentic lamellar keratoplasty, tuck-in lamellar keratoplasty (TILK), toric phakic intraocular lens (PIOL) implantation, intrastromal corneal ring segment implantation (ICRS), corneal collagen cross-linking (CXL), and combined therapies. This is the first review article looking at the literature specific to PMD. Review of published studies. Reported data for each treatment is presented. Penetrating keratoplasty is the treatment of last resort in PMD and is effective, but with considerable complications. DALK provides visual outcomes similar to penetrating keratoplasty without the risk of immune-mediated graft rejection, but its complexity and relative novelty limit its acceptance. FTCWR has good visual outcomes, but with significant astigmatic drift. CLWR is effective, but lacks long-term results. Crescentic lamellar keratoplasty and TILK are effective, but technically difficult and without long-term results. Toric PIOL implantation is effective, but ectasia progression is a concern. ICRS implantation can delay penetrating keratoplasty and improve contact lens tolerance, but does not treat the underlying process. CXL demonstrates effectiveness without complications, although data are limited and long-term results are needed. Combining treatments such as ICRS, CXL, toric PIOL implantation, and refractive surgery is promising, but additional studies are needed to investigate their efficacy and safety. Although little is understood about the etiology, pathophysiology, epidemiology, and genetics of PMD, new treatments are improving visual outcomes and reducing complications. Corneal collagen cross-linking is especially exciting because it halts disease progression. Combined treatments and improved screening could eliminate the need for surgical management in most cases of PMD.

Posterior Chamber Toric Phakic IOL Implantation for the Management of Pediatric Anisometropic Amblyopia

To report the outcomes of toric posterior chamber phakic intraocular lens (PIOL) implantation in children for the treatment of amblyopia due to anisometropia with astigmatism. Six eyes of 6 amblyopic patients aged 5 to 15 years underwent toric PIOL (Visian Toric ICL; STAAR Surgical Company, Monrovia, CA) implantation for refractory anisometropic amblyopia. Preoperative and postoperative clinical evaluation included slit-lamp microscopy, visual acuity, anterior/posterior segment examination, and cycloplegic refraction. After a mean follow-up of 23 months (range: 15 to 34 months), mean spherical equivalent cycloplegic refraction improved from -10.21 ± 4.62 diopters (D) (range -7.5 to -19.5 D) preoperatively to -0.42 ± 0.39 D (range: -0.625 to +0.125 D) postoperatively. Corrected distance visual acuity ranged from 20/40 to 20/200 preoperatively and 20/20 to 20/60 postoperatively. Five of the 6 eyes gained more than 3 lines of corrected distance visual acuity with a maximum gain of 8 lines in one eye. One eye showed an improvement of more than 2 lines (change in preoperative visual acuity of 20/100 to 20/60 postoperatively). No patients lost any lines of visual acuity. All eyes remained quiet. All PIOLs remained well centered throughout the follow-up period. Toric PIOL implantation may be a viable therapeutic modality in children with clinically significant anisometropic ametropia and astigmatism with secondary amblyopia who have been refractory to medical treatment including spectacles or contact lenses. Longer follow-up visits with larger sample populations will evaluate more effectively the long-term efficacy and late-onset of complications.

Three-Year Follow-Up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

PurposeTo assess the 3-year clinical outcomes of toric phakic intraocular lens (Visian ICL™; STAAR Surgical) implantation for moderate to high myopic astigmatism.MethodsThis retrospective study evaluated fifty eyes of 28 patients who underwent toric ICL implantation for the correction of moderate to high myopic astigmatism and who regularly returned for postoperative examination. Before, and 1, 3, and 6 months after, and 1, 2, and 3 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery in eyes undergoing toric ICL implantation.ResultsThe logarithm of the minimal angle of resolution (LogMAR) uncorrected visual acuity and LogMAR best spectacle-corrected visual acuity were –0.10 (corresponding to Snellen equivalents 20/16) ± 0.16 and –0.20 (corresponding to 20/12.5) ± 0.07, 3 years postoperatively, respectively. The safety and efficacy indices were 1.16 ± 0.20 and 0.94 ± 0.28. At 3 year, 82% and 98% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of –0.15 ± 0.31 D occurred from 1 month to 3 year. No vision-threatening complications occurred during the observation period.ConclusionsOn the basis of the clinical results of this study, toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopic astigmatism throughout a 3-year observation period.

Successful toric intraocular lens implantation in a patient with induced cataract and astigmatism after posterior chamber toric phakic intraocular lens implantation: a case report

IntroductionWe report the case of a patient in whom simultaneous toric phakic intraocular lens removal and phacoemulsification with toric intraocular lens implantation were beneficial for reducing pre-existing astigmatism and acquiring good visual outcomes in eyes with implantable collamer lens-induced cataract and astigmatism.Case presentationA 53-year-old woman had undergone toric implantable collamer lens implantation three years earlier. After informed consent was obtained, we performed simultaneous toric implantable collamer lens removal and phacoemulsification with toric intraocular lens implantation. Preoperatively, the manifest refraction was 0, -0.5 × 15, with an uncorrected visual acuity of 0.7 and a best spectacle-corrected visual acuity of 0.8. Postoperatively, the manifest refraction was improved to 0, -0.5 × 180, with an uncorrected visual acuity of 1.2 and a best spectacle-corrected visual acuity of 1.5. No vision-threatening complications were observed.ConclusionToric intraocular lens implantation may be a good surgical option for the correction of spherical and cylindrical errors in eyes with implantable collamer lens-induced cataract and astigmatism.

Vector Analysis of Corneal and Refractive Astigmatism Changes Following Toric Pseudophakic and Toric Phakic IOL Implantation

To determine the efficacy of the astigmatism correction following toric intraocular lens (IOL) and toric phakic IOL (pIOL) implantation in eyes with no previous ocular surgery and in postkeratoplasty (PKP) eyes. In addition, changes in corneal astigmatism were determined. Astigmatism was analyzed in 35 eyes with an AcrySof toric IOL, 35 eyes with an Artiflex toric pIOL, 50 eyes with an Artisan toric pIOL, and 40 PKP eyes with an Artisan toric pIOL. Refractive astigmatism was analyzed by using Alpins method. Surgically induced corneal astigmatism (SICA) was determined following a superior 2.2-mm, 3.4-mm, or 5.4-mm incision. Follow-up was 12 months. Following toric IOL implantation, the index of success was 0.14 and overall residual astigmatism, 0.37 diopter (D). Following toric pIOL implantation, the index of success was 0.32 (Artiflex) and 0.18 (Artisan), and overall residual astigmatism was approximately 0.60 D. In PKP eyes, Artisan pIOLs resulted in an index of success of 0.28 and overall residual astigmatism of 1.56 D. The SICA, following 2.2-mm, 3.4-mm, 5.4-mm (normal eyes), and 5.4-mm (PKP eyes) incisions, was -0.25 ± 0.42 D (P = 0.108), -0.31 ± 0.43 D (P < 0.001), -0.48 ± 0.55 D (P < 0.001), and -0.49 ± 1.48 D (P = 0.035), respectively. Toric IOLs and pIOLs provide an effective astigmatism correction. Incorporating the SICA into the toric IOL power calculation may further increase their effectiveness. Therefore, incorporation of 0 D, -0.30 D, or -0.50 D of SICA for a 2.2-, 3.4-, or 5.4-mm superior incision, respectively, is recommended.

One-Year Follow-up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

One-Year Follow-up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

Clinical outcomes of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus: 6-month follow-up

To assess the early clinical outcomes of toric implantable collamer lenses (toric ICL™, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus. This study evaluated 27eyes of 14 patients with spherical equivalents of -10.11 ± 2.46 D (mean ± standard deviation) and astigmatism of -3.03 ± 1.58 D who underwent toric ICL implantation for mild keratoconus. Before, and 1, 3 and 6months after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery. LogMAR uncorrected visual acuity (UCVA) and LogMAR best spectacle-corrected visual acuity (BSCVA) were -0.09 ± 0.16 and -0.15 ± 0.09 respectively, 6months after surgery. The safety and efficacy indices were 1.12 ± 0.18 and 1.01 ± 0.25. At 6months, 85% and 96% of the eyes were within ±0.5 and ±1.0 D respectively of the targeted correction. Manifest refraction changes of 0.00 ± 0.35 D occurred from 1week to 6months. No vision-threatening complications occurred during the observation period. Toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of spherical and cylindrical errors in eyes with early keratoconus throughout the 6-month follow-up period, suggesting its viability as a surgical option for the treatment of such eyes.

One-Year Follow-up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

To assess the 1-year clinical outcomes of toric Visian Implantable Collamer Lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation for moderate to high myopic astigmatism. Prospective, observational case series. Fifty-six eyes of 32 consecutive patients, with spherical equivalent errors of -4.00 to -17.25 diopters (D) and cylindrical errors of -0.75 to -4.00 D, who underwent toric ICL implantation. Before and 1 week and 1, 3, 6, and 12 months after surgery, the safety, efficacy, predictability, stability, and adverse events of the surgery were assessed in eyes undergoing toric ICL implantation. Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function also were evaluated before and 1 year after surgery. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), safety index, efficacy index, predictability, stability, adverse events, HOAs, and CS function. The logarithm of the minimum angle of resolution (logMAR) UCVA and logMAR BSCVA were -0.11 (corresponding to Snellen equivalent 20/16) ± 0.12 and -0.19 (corresponding to 20/12.5) ± 0.08 1 year after surgery, respectively. The safety and efficacy indices were 1.17 ± 0.21 and 1.00 ± 0.29. At 1 year, 91% and 100% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of -0.07 ± 0.27 D occurred from 1 week to 1 year. For a 4-mm pupil, fourth-order aberrations were changed, not significantly, from 0.05 ± 0.02 μm before surgery to 0.06 ± 0.03 μm after surgery (P = 0.38, Wilcoxon signed-rank test). Similarly, for a 6-mm pupil, fourth-order aberrations were not significantly changed, merely from 0.20 ± 0.08 μm before surgery to 0.23 ± 0.11 μm after surgery (P = 0.15). The area under the log CS function was significantly increased from 1.41 ± 0.15 before surgery to 1.50 ± 0.13 after surgery (P < 0.001). No vision-threatening complications occurred during the observation period. In the authors' experience, the toric ICL performed well in correcting moderate to high myopic astigmatism during a 1-year observation period, suggesting its viability as a surgical option for the treatment of such eyes.

Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens

To evaluate the changes in pupil size after implantation of an iris-supported toric phakic intraocular lens (TPIOL) for correction of myopia and hyperopia with astigmatism. Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Twenty-two myopic eyes and 9 hyperopic eyes were included in the study. The mean age of the 2 groups was 34 years and 40 years, respectively. The scotopic pupil size was measured with a handheld infrared pupillometer (Colvard, Oasis Medical) before and 6 months after implantation of the TPIOL. All examinations were performed under scotopic conditions after 2 minutes of dark adaptation with the fellow eye covered. Intraindividual comparisons were made between preoperative and postoperative pupil sizes. The relationship between implanted IOL power and postoperative pupil width in each group was studied to determine whether lens magnification could lead to misinterpretation of the results. The difference between horizontal and vertical postoperative pupil diameters was assessed in eyes with horizontally aligned IOLs to determine the potential mechanical effect of the TPIOL on pupil size. The mean scotopic pupil diameter decreased significantly from 4.7 mm (range 3.0 to 6.0 mm) preoperatively to 3.6 mm (range 2.0 to 5.0 mm) postoperatively in myopic eyes and from 5.0 mm (range 4.0 to 6.0 mm) to 4.0 mm (range 2.0 to 5.0 mm) in hyperopic eyes. No significant correlation between the power of the TPIOL and the postoperative pupil size diameter was found, confirming that the IOL did not distort measurements of pupil size. Comparing horizontal and vertical pupil diameters under medical mydriasis revealed reduced pupil size in the axis of enclavation. The scotopic pupil diameter decreased by a mean of 1.1 mm in myopic eyes and 1.0 mm in hyperopic eyes after implantation of the iris-supported TPIOL. Postoperative pupil size was not related to IOL power, patients' emotional states, or other factors. The slightly smaller pupil diameter in the axis of enclavation suggests that this fixation method restricts pupil size under scotopic conditions, which could reduce the incidence of postoperative photic phenomena.

Artisan toric phakic intraocular lens for the correction of high astigmatism

Purpose To evaluate efficacy, predictability, and safety of Artisan toric phakic intraocular lens (Ophtec, Groningen, The Netherlands) implantation for the correction of astigmatism higher than 2 diopters. Design Interventional case series. Methods This prospective study included 27 eyes of 16 patients with a mean preoperative spherical equivalent of –11.78 ± 6.24 diopters and a mean preoperative astigmatism of −3.43 ± 0.81. The Artisan phakic intraocular lens was inserted in the anterior chamber through a posterior corneal incision; the technique is similar to the implantation of the classical Artisan lens, but in these cases it is particularly important to secure the lens accurately in the correct axis. The main parameters evaluated in this study were uncorrected visual acuity, best-corrected visual acuity, refraction, and endothelial cell count. Results Twelve months after the implantation of the Artisan toric phakic intraocular lens, 62.90% of the eyes were within ±0.50 diopters. of emmetropia and 96.20% within ±1.0 diopters. Seventy percent of the eyes gained 1 or more Snellen lines from their preoperative best-corrected visual acuity, and 11.11% lost 1 Snellen line. Mean endothelial cell count increased 2.9%. Mean of the parallel and orthogonal components of cylinder correction were 1.97 diopters and 0.10 diopters, respectively, of the intended cylinder change. The mean of axis alignment error was 10.53 degrees. No serious complications were observed. Conclusion Artisan toric phakic intraocular lens implantation appears to be a safe and predictable method for the correction of high levels of astigmatism.

Postoperative astigmatism and rotational stability after artisan toric phakic intraocular lens implantation

Purpose To evaluate deviations in the axis (intended versus achieved) and postoperative astigmatism after implantation of an Artisan toric phakic intraocular lens (IOL). Setting University Eye Hospital, Mainz, Germany. Methods This prospective study comprised 29 eyes with high ametropia and astigmatism. All eyes had uneventful implantation of a toric phakic IOL through a superior scleral tunnel incision at 12 o’clock. After a minimum of 6 months, the uncorrected visual acuity (UCVA), best correct visual acuity, refraction, and astigmatism were analyzed in all eyes. A multivariate analysis of postoperative astigmatism was performed. Results After a follow-up of at least 6 months, 95% of eyes were within ±1.00 diopter (D) of emmetropia and 85% of eyes has a UCVA of 20/30 or better. The difference between the mean intended cylinder axis and achieved cylinder axis was 3.9 degrees (median 3 degrees; range to 13 degrees). The difference between the mean intended axis and the achieved axis between miosis and mydriasis was 1.8 degrees (median 1.5 degrees; range 0 to 5 degrees). The mean postoperative astigmatism after 6 months was 0.56 D with an axis of 31 degrees. Doubled-angle scatterplot analysis showed a tendency toward more flattening in the vertical meridian. Conclusions During the 6-month follow-up, no significant rotation was observed after implantation of Artisan toric phakic IOLs to correct high ametropia. A sutureless sclerocorneal superior approach for phakic IOL insertion resulted in moderate to low astigmatism. Induced astigmatism should be taken into consideration during preoperative planning.