A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and artisan phakic lens

OBJECTIVE: To compare refractive performance and safety of laser in situ keratomileusis (LASIK) and Artisan phakic intraocular lens (PIOL) for moderately high myopia. DESIGN: A prospective, randomized trial with paired eye control. PARTICIPANTS: Twenty-five patients with myopia ranging from -8.00 to -12.00 diopters (D). INTERVENTION: For each patient, one eye received LASIK and the other one was implanted with an Artisan phakic intraocular lens. The treated eye and the surgical technique were randomized. MAIN OUTCOME MEASURES: Primary outcome measure was spherical equivalent refraction. Main secondary outcome measures were the change of two or more lines and safety index (ratio postoperative to preoperative best-corrected visual acuity). RESULTS: One year after surgery, the mean spherical equivalent refraction was -0.74 +/- 0.67 D for LASIK-treated eyes and -0.95 +/- 0.45 D for Artisan-treated eyes, and the majority of LASIK-treated eyes (64%) and Artisan-treated eyes (60%) were within +/-1.00 D of the intended result. At 1 month, the mean spherical equivalent refraction was -0.28 +/- 0.71 D for LASIK and -1.07 +/- 0.59 D for Artisan (P < 0.01). The changes of two or more lines were in favor of Artisan (P < 0.05). The safety index was significantly better for Artisan (1.12 +/- 0.21) than for LASIK (0.99 +/- 0.17) at 1 year (P < 0.02). CONCLUSIONS: In cases of moderately high myopia, LASIK and Artisan phakic intraocular lenses seemed to produce a similar predictability. The best-corrected visual acuity and subjective evaluation of quality of vision were better for Artisan.     

硬性和可折叠前虹膜固定人工晶状体植入治疗亚洲眼高度近视的疗效比较

目的：比较Artisan和Artiflex有晶状体眼人工晶状体(PIOL)矫正亚洲人群高度近视的屈光度和安全性。

方法：历史队列研究。回顾2016/2020在印度尼西亚日惹市Yap眼科医院接受PIOL植入术的81例高度近视眼。根据植入PIOL分为Artisan组43眼,Artiflex组38眼。分别记录术前及术后1d、1、3mo的视力、角膜生物显微镜参数和眼压,包括术前前房深度。

结果：Artisan和Artiflex组的平均随访时间分别为9.64±6.93mo和8.96±4.28mo(P=0.736)。Artisan组的疗效指数为1.03±0.47,Artiflex组为1.02±0.17(P=0.119); 安全性指数分别为1.10±0.45和1.05±0.21(P<0.001)。Artisan组的平均等效球镜度(SE)为-0.64±0.996D,Artiflex组为-0.22±0.58D(P=0.076)。两组术后内皮细胞密度(ECD)较术前均显著下降(P<0.05),累积ECD缺失率为7.44%和5.79%(P=0.418)。

结论：Artisan和Artiflex矫正亚洲人高度近视的屈光效果相当。与Artiflex相比,Artisan的安全指数略高,而两组的疗效指数和累积ECD缺失率相似。     

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM: To compare Visian lens (model V4c) and Artiflex lens regarding quality (contrast sensitivity) and quantity (efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation (model V4c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia (higher than 6.0 D) and stable refraction (<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1d, 1wk and 1, 3, 6 and 12mo. Selection of the type of phakic intraocular lens for patients was based on surgeons’ preferences, which was no specific selection criteria. RESULTS: After 12mo of follow up, difference in uncorrected and corrected distant visual acuity (CDVA) between both groups was statistically insigni?cant (UDVA for VisianV4c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses (safety index was 1.67 for VisianV4c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant (P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4c and Artiflex lenses are safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.     

前房虹膜夹型人工晶状体矫正高度近视疗效观察

目的探讨前房虹膜夹型人工晶状体（AC—PIOLS）植入矫正高度近视的远期疗效和安全性。方法回顾性病例分析研究。对资料齐全的18例30眼行AC—PIOLS植入的高度近视患者随访2a,分别于术前,术后1、6、12、24个月检测裸眼视力（UCVA）、最佳矫正视力（BCVA）、等效球镜屈光度（SE）,眼压、角膜内皮计数、前房深度（ACD）、对比敏感度（CSF）、眩光敏感度和波前相差等,并分别将术前与术后1a和术后2a的检查结果进行比较。所有患者术前均签署知情同意书。结果术后1a,14眼（46．7％）近视力较术前提高;术后2a,19眼（63．3％）较术前提高,与术前相比差异有统计学意义（χ^2=26．779,P=0．031）。术后1a,BCVA较术前提高≥1行者为56．7％（17／30）,术后2a为60．0％（18／30）,差异有统计学意义（χ^2=117．412,P〈0．01）。术后2a SE明显降低,差异有统计学意义（P〈0．05）。术后各频段的CSF均较术前明显提高,尤其在低中频段,差异有统计学意义（P〈0．05）。术后高阶像差较术前增高,球差、彗差与术前比较差异均有统计学意义（P〈0．05）。术后随访2a,各时间点间眼压、角膜内皮细胞计数的差异均无统计学意义（P〉0．05）。术后5眼瞳孔轻度变形,6眼虹膜夹持部出现轻度虹膜色素脱失,4眼主诉眩光和光晕感。结论AC—PIOLS植入术治疗高度近视安全、有效,并且具有良好的可预测性和稳定性,但远期效果尚需进一步观察。     

有晶状体眼后房型人工晶状体植入术矫正高度近视的临床观察

目的 观察有晶状体眼后房型人工晶状体(PPC-ICL)植入术矫正高度近视的有效性、安全性和视觉质量.方法 前瞻性研究.选择拟行PPC-ICL植入的患者28例(50眼),其中男10例(14眼),女18例(36眼),平均球镜度(-8.26±2.15)D,等效球镜度(SE)(-9.88±2.39)D,其中36眼接受了散光型PPC-ICL植入.术前与术后6个月分别进行视力、波前像差检测;术后6个月进行视觉质量问卷评分.采用配对t检验进行统计分析.结果 术前、术后1d、术后1周、术后6个月UCVA(标准对数视力表)分别为3.82±0.08、4.76±0.26、5.02±0.13、5.03±0.10.术后6个月UCVA较术前增加(t=72.88,P＜0.05).术后6个月UCVA与术前BCVA相比等于、提高1行、提高2行及以上分别为16眼、26眼、4眼,占全部眼数的92％.术后6个月残余度数在±0.50 D以内的眼数占96％.术前全眼总高阶像差、球差、彗差、三叶草均方根(RMS)值分别为(0.309±0.098)、(-0.008±0.111)、(0.197±0.103)、(0.142±0.076) μm;术后6个月分别为(0.320±0.152)、(-0.114±0.117)、(0.026±0.534)、(0.204±0.122) μm.术后全眼总高阶像差与球差较术前有增加但差异无统计学意义,全眼彗差较术前减少(t=-3.454,P＜0.05),全眼三叶草像差较术前增加(t=2.556,P＜0.05).在视觉质量问卷方面:全部28例(50眼)均对白天远视力和手术整体效果表示满意,其他视觉质量评分由高到低依次为(分数越高越满意):白天骑车/开车容易度、白天近视力、夜间视力、电脑、近距离阅读、夜间骑车/开车容易度、视物疲劳、光晕、眩光、眼干.结论 PPC-ICL植入术是矫正高度近视的一种安全有效的手术方法,患者术后UCVA明显提高,彗差减少,与术前比较有更好的视觉质量.     

Accommodation in the implantation of phakic intraocular lenses for the correction of high myopia

Implantations of 67 phacic intraocular lenses (IOL) in myopia ranging from 8 to 17 d were analyzed. The postoperative refraction was -0.97 +/- 0.45 d. The accommodation response, as a sharp reaction, and accommodation tracing were investigated in all patients. The "Nidek" AA2000 lens accommodograph was made use of. An inhibition and a higher threshold in the rapid accommodation response were registered in 86% of cases, tonic phase inhibition was found in 72% of cases and a limited maximal amplitude was noted in 45% of cases in accommodation tracing performed within examinations made 1 week after surgery. Inhibited accommodation response (86%), and stage-type relaxation in accommodation tracing (49%) were stated in examinations 3 weeks later. The implantation of phacic IOL for the correction of high myopia can bring about an accommodation dysfunction. The accommodation time of the "accommodation-IOL" system ranges from 1 to 3 months. Such adaptation is associated with an intensified accommodation reflex.     

Iris-claw phakic (Artisan) lens to correct high myopia

PURPOSE: To assess the safety and efficacy of the iris claw phakic (6mm Artisan lens) in patients with high myopia. METHODS: Twenty-five eyes with myopia of -7.50 to 16D were implanted with a 6mm artisan lens and followed for 24 months. RESULTS: The mean preoperative spherical equivalent refraction was 13.08+/-3.44D at one year. Mean operative spherical equivalent refraction was 0. 77+/-0.57D and 81.8% of eyes had a spherical equivalent refraction within +/-1.00D. Best spectacle-corrected visual acuity was maintained or improved in 62.5% of cases. No iritis or cataract or glaucoma was observed. CONCLUSION: Implantation with the 6mm Artisan lens is an effective method for reducing or correcting myopia up to -16D. Gains in spectacle corrected visual acuity were common, and results suggested good predictability. Because of the incomplete follow up, we cannot draw conclusions about the long term safety of the 6mm Artisan lens.     

Subclinical inflammatory reaction induced by phakic anterior chamber lenses for the correction of high myopia

To ascertain the potential that phakic anterior chamber lenses (PACL) used for the surgical correction of high myopia have for the induction of chronic subclinical inflammatory reaction, the authors have studied prospectively in one year of surgery the presence of subclinical inflammation in the anterior chamber in 18 clinically controlled cases. Nine of them were implanted with the Baik off ZB5M Domilens type and nine with the Fechner-Worst iris claw type. Clinical follow-up and objective measurements were taken with the Laser Flare Cell Meter Kowa FC-1000. In one year of an uncomplicated follow-up flare measurements were 722.52 ± 639.21 (range 0 to 1557.6) for the iris claw and 42.38 ± 91.67 (range 0 to 228.7) for the ZB5M lens (p < 0.01, Mann-Whitney test). Cell measurements were 34.52 ± 22.08 (range 5 to 54.8) for the iris claw and 9.3 ± 11.74 (range 0 to 31.8) for the ZB5M type (p < 0.05 Mann Whitney test). It is concluded that the PACL model ZB5M type is well tolerated in one year of surgery with the induction of marginal levels of flare and cell levels. The Fechner-Worst iris claw type induces unacceptable levels of chronic intraocular inflammation and does not seem suitable for the surgical correction of high myopia. This is the first study that shows that subclinical intraocular inflammation may be present in some models of PACL.     

高度近视儿童配戴硬性透气性角膜接触镜临床观察

目的探讨6岁以下高度近视儿童配戴硬性透气性角膜接触镜(rigid gas permeable contact lens,RGPCL)2a的临床应用效果。方法在角膜地形图指导下对16例(32眼)3～6岁高度近视儿童进行RGPCL配戴,观察患儿的RGPCL配戴和适应情况,比较最佳框架眼镜和RGPCL矫正视力。随访2a观察并发症的发生情况、屈光度发展及视力提高情况。结果配戴框架眼镜矫正视力与RGPCL比较差异有统计学意义(t=-4.558,P<0.05);配戴RGPCL2a前后矫正视力差异有统计学意义(t=6.027,P<0.05),2a后屈光度增长(-0.17±0.42)D、眼轴长度增长(0.07±0.02)mm。所有患儿均1次配戴成功,配戴试戴镜5min后患儿能正常视物、玩耍,1周内均能适应全天日戴。随访期间,1例患儿因家长没有时间为孩子配戴而弃戴,其余均能日戴,镜片需患儿家长清洗、为患儿配戴,5例患儿能独立摘镜片;所有病例均未发现角膜缘新生血管,无角膜擦伤或角膜溃疡等严重并发症。结论近视性屈光参差及高度近视儿童配戴RGPCL矫正屈光不正安全、有效。     

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

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.Noncomparative interventional case series.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.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.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.     

Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation

OBJECTIVE: To assess the safety of posterior chamber phakic intraocular lens (PCPIOL) implantation in patients with high myopia. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Twenty eyes of 10 patients were included. INTERVENTION: Staar Collamer Implantable Contact Lens PCPIOLs were implanted for the correction of high myopia. MAIN OUTCOME MEASURES: Intra- and postoperative complications were recorded. Specular microscopy, lens fluorophotometry, laser flare-meter, and ultrasound biomicroscopy were performed before surgery and at different stages of the follow-up period to evaluate endothelial cell density, crystalline lens transmittance, aqueous flare, and anatomic relations of the implanted lenses with the other structures of the anterior segment. RESULTS: There were no intraoperative complications. One patient experienced pupillary entrapment by the lens in the immediate postoperative period, which was resolved without incident. Pigmentary dispersion or cataracts did not appear during the postoperative period. All the lenses remained correctly centered, and no patient reported night halos or glare. Anterior chamber depth showed a statistically significant reduction, between 9% and 12%. Central endothelial density was significantly decreased after surgery. The percentages of cell loss after 3, 6, 12, 18, and 24 months were 4.41%, 4.83%, 5.17%, 5.46%, and 6.57%, respectively. Aqueous flare increased by 49.19% in the first postoperative month in relation to preoperative values. Afterward, it decreased and then remained above preoperative values for the entire follow-up period (33.76% at month 3, 27.81% at month 6, 27.65% at month 12, 23.39% at month 18, and 27.27% at month 24). Crystalline lens transmittance decreased by 0.72% at month 3, by 1.44% at month 6, by 1.95% at month 12, by 2.25% at month 18, and by 2.24% at month 24. Finally, by ultrasound biomicroscopy it was observed that the PCPIOL and the crystalline lens were in contact on the peripheral level in 12 patients (60%) and in the center in another three patients (15%) during at least one checkup. In all the patients, contact between the PCPIOL and the posterior iris surface could be observed. CONCLUSIONS: Posterior chamber phakic IOL implantation for the surgical correction of high myopia is a safe procedure with regard to immediate visual and refractive results. The short-term clinical benefit and lack of immediate surgical complications are impressive. However, the increase in flare, the endothelial cell loss, the decrease in crystalline lens transmittance, and the iris-PCPIOL and crystalline lens-PCPIOL contact are findings that suggest caution regarding the long-term safety of this lens implant.     

虹膜固定型有晶状体眼人工晶状体植人术矫治高度近视29例疗效观察

目的探讨高度近视眼行虹膜固定型有晶状体眼人工晶状体植入术的安全性和有效性。方法选取在本中心接受虹膜固定型有晶状体眼人工晶状体植入术29例（54眼）。术前矫正屈光度数为-10．00～-23．00D,最佳矫正远视力0．1—0．8。术中植入虹膜固定型人工品状体,术后平均随访12个月。观察指标包括：术前及术后的裸眼视力、矫正视力、眼压、瞳孔形态及角膜内皮计数,并对获得的数据进行统计学分析。结果术后1年裸眼视力为0．2～1．0,最佳矫正远视力为0．3-1．2,和术前最佳矫正远视力相比差异有统计学意义;4例诉有眩光,3眼瞳孔轻度变形,2眼术后2d切口渗漏,无视网膜脱离、晶状体脱落或跟内炎等。结论虹膜固定型有晶状体眼人工晶状体植入术治疗高度近视安全、有效,具有良好的预测性。     

透气硬性角膜接触镜的临床观察

目的 评价透气硬性角膜接触镜(RGP)的临床矫正效果及舒适程度。方法 对102例(185只眼)在我院配戴RGP的患者首先作(主觉 他觉)验光后观察其配戴框架眼镜的矫正视力，然后观察其配戴RGP后的矫正视力，并观察在配戴RGP后不同时期对镜片的适应性及舒适感等。结果 配戴RGP矫正视力≥1．0者为58．4％，0．6—0．9者为31．4％，0．5及以下者为10．3％，RGP矫正效果明显优于框架眼镜，RGP的处方度数均明显低于框架眼镜度数。戴镜1月后均感觉适应舒适，镜片中心位置及活动度好，仅少数患者偶有干涩、痒感，滴用眼液后改善。结论 RGP能矫正各种散光，具有透氧透气性，故有良好的临床矫正效果及较好的舒适感及安全感。     

虹膜夹型与房角支撑型有晶状体眼人工晶状体矫正高度近视对比观察

目的 观察虹膜夹型(IC-PIOL)和房角支撑型(AS-PIOL)有晶状体眼人工晶状体植入术矫正高度近视的临床疗效,探讨两者的安全性、有效性等情况.方法 应用手术植入IC-PIOL组23例35只眼,等效球镜(SE)(-9.38～-24.13)D;植入AS-PIOL组22例31只眼,SE(-9.88～-22.25)D.术后随访18个月,比较两组的裸眼视力(UCVA)、最佳矫正视力(BCVA)、屈光状态、眼压、角膜内皮、瞳孔、人工晶状体等情况.结果 术前IC-PIOL组和AS-PIOL组UCVA,BCVA,SE和散光差异无统计学意义.与术前相比,两组组内UCVA、BCVA和SE均显著改善,术后7d至18个月两组组内和组间差异无统计学意义.术后18个月时IC-PIOL组和AS-PIOL组结果分别如下,安全性系数(术后BCVA/术前BCVA):1.018±0.017和1.019±0.022,有效性系数(术后UCVA/术前BCVA):0.983±0.024和0.979±0.036,两组组内和组间差异无统计学意义;角膜内皮细胞丢失率:4.41%和4.46%,手术前后和两组间差异无统计学意义;瞳孔阻滞:1只眼和1只眼;瞳孔形态异常:8只眼(药物散瞳下)和4只眼;人工晶状体位置异常:2只眼和3只眼;光晕或眩光:2只眼和8只眼;未见其他严重并发症.结论 IC-PIOL和AS-PIOL矫正高度近视18个月内均安全、有效,远期效果和并发症需进一步长期观察.     

Posterior chamber phakic intraocular lenses to correct high myopia: a comparative study between Staar and Adatomed models

PURPOSE: To determine the feasibility of using posterior chamber phakic intraocular lenses (PIOLs) to treat high myopia, comparing two different models, Staar and Adatomed. METHODS: Twenty-four eyes from 12 patients were studied prospectively. A phakic Staar IOL was implanted in one eye of each patient, and the other eye received a phakic Adatomed IOL. Patients with uveitis or ocular trauma prior to ocular surgery, diabetic retinopathy, or capsular pseudoexfoliation were excluded. The mean preoperative spherical equivalent refraction was -16.00 +/- 5.05 D for the Staar group and -15.39 +/- 2.83 D for the Adatomed group. Average follow-up was 32.4 months (range, 19 to 46 mo) for the Adatomed group and 18.3 months (range, 11 to 21 mo) for the Staar group and included evaluation of intraocular pressure, intraocular lens pigment deposits, lens decentration, anterior subcapsular cataract, and visual acuity. RESULTS: Spectacle-corrected and uncorrected visual acuity improved in all eyes in both groups. No statistically significant differences in visual acuity gain were observed with the two materials (Student t-test, P = .08 for the Staar group and P = .6 for the Adatomed group), although the gain in visual acuity was somewhat greater with the Staar PIOLs. The difference in mean intraocular pressure before surgery and at last follow-up was 1.5 mmHg for the Staar group and 2.3 mmHg for the Adatomed group (P = .36). The incidence of lens pigment deposits was the same in both groups (41.66%), with deposits in 5 of the 12 eyes in both groups. The incidence of lens decentration was higher in the Adatomed group (5/12; 41.66%) than in the Staar group (2/12; 16.7%). Anterior subcapsular cataract was higher in the Adatomed group (4/12; 33.3%) than in the Staar group (3/12; 25%). CONCLUSIONS: There was a higher incidence of lens decentration and anterior subcapsular cataract in the Adatomed group than in the Staar group.     

Optical quality of the eye with the Artisan phakic lens for the correction of high myopia.

PURPOSE: To evaluate the optical quality of the eye before and after the insertion of an Artisan phakic intraocular lens for the treatment of high myopia. METHODS: Consecutive patients implanted with the Artisan lens by a single surgeon between June 2001 and April 2002 were enrolled prospectively. One eye per subject was tested. The wavefront aberration was calculated from images recorded with a Hartmann-Shack sensor. This wavefront aberration was expressed as a Zernike polynomial expansion from the third up to the seventh order. Root mean square wavefront error was used as a parameter of optical quality. Point-spread function and modulation transfer function were also computed from the wavefront aberration. RESULTS: The mean age of the four patients (four eyes) was 46 +/- 11 years. The preoperative mean spherical equivalent was -14.13 +/- 3.19 D (range, -20.50 to -9.75 D), with a best-corrected visual acuity of 20/25 or better in three of the four eyes. No complications were encountered. Postoperatively, the mean spherical equivalent was -0.22 +/- 0.30 D (range, -0.75 to +0.38 D). An uncorrected visual acuity of 20/40 or better was observed in three eyes. Overall, for each combination of order (third, fourth, and fifth to seventh) and pupil size (3, 4, and 5 mm), the mean postoperative root mean square values for the four subjects were lower than the mean preoperative values. However, because of the small size of the study population (four patients), this improvement did not reach a statistically significant level. CONCLUSIONS: Preliminary data using the Hartmann-Shack wavefront sensor have not revealed a tendency toward deterioration of the optical performance after the insertion of an Artisan lens for the treatment of high myopia. The Hartmann-Shack sensor was a useful tool for the objective assessment of the image optical quality of eyes with a phakic intraocular lens.     

Correction of high myopia with different phakic anterior chamber intraocular lenses: ICARE angle-supported lens and Verisyse iris-claw lens

Purpose To evaluate the efficacy, predictability and safety of implanting two models of anterior chamber IOLs for high myopia. Comparison of the refractive results between two groups of patients implanted with different IOLs.Materials and methods Forty eyes were implanted with phakic IOLs. The ICARE myopia lens was implanted in 20 eyes of 12 patients with preoperative myopia that ranged from −21.875 to −10.0. The mean patients‘ age was 30 years. The Verisyse IOL was implanted in 20 eyes of 12 patients with spherical equivalent of the refractive error from −21.625 to −10.375D, and the mean patients’ age was 32.25 years. The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up period was 12 months.Results Twelve months after surgery, the mean refractive error (SE) was −0.19D (100% of eyes were within ±1.0D of the target refraction) in the ICARE group, and −0.86D (95% of eyes were within ±1.0D of the target refraction) in the Verisyse group. The postoperative refraction remained stable during the entire follow-up period. The mean uncorrected visual acuity was 0.7 in the ICARE group, and 0.69 in the Verisyse group 1 year postoperatively. There was no loss in visual acuity 1 year after surgery in the ICARE implanted eyes, one patient in the Verisyse group lost 1 line of BCVA as compared to the preoperative state. Mean endothelial cell density loss was 6.12% and 6.79% in the ICARE and Verisyse groups, respectively. There were no statistically significant differences regarding the analyzed outcome parameters between the two study groups.Conclusion The implantation of both anterior chamber phakic intraocular lenses to correct high myopia resulted in a stable and predictable refractive outcome. Efficacy and safety of surgery for both implanted lens models are very high.This material was previously presented at the American Academy of Ophthalmology Annual Meeting in New Orleans, October 2004.The authors have no financial interest in this study. This was prospective randomized clinical trial.     

Posterior capsule opacification after extra capsular cataract extraction in Indian rural population: foldable acrylic vs poly (methyl-methacrylate) intraocular lenses a randomized clinical trial

PURPOSE: To compare the performance of single-piece acrylic vspoly (methylmethacrylate) intraocular lenses (IOL) on the development of posterior capsule opacification (PCO) after conventional extra capsular cataract extraction (ECCE). MATERIALS AND METHODS: One hundred and eighty-two eyes of 91 patients with bilateral senile cataract undergoing ECCE were prospectively randomized to receive a single-piece Alcon AcrySof SA60AT IOL or a single-piece EPOCH polymethylmethacrylate IOL in the first eye to have surgery. At 1, 6 and 12 months post-operative follow-up, digital retro illumination images of the posterior capsule were taken for PCO assessment semi-objectively using PCO (POCO automated analysis software) system. Relationship of anterior capsule contact (total off and partial cover) on optic for PCO was analyzed. RESULTS: The AcrySof IOL was associated with less PCO than EPOCH lens at 6 months (10.01+/-8.75% vs 32.26+/-27.44%; P<0.001) and 1-year (11.65+/-10.55% vs 38.38+/-29.62%; P<0.001) follow-up. The EPOCH IOL showed a remarkably significant difference on development of PCO with anterior capsule overlap on IOL optic (total off and part on) 1 year (P<0.039), whereas no such difference was observed with the AcrySof IOL (P=0.197). CONCLUSION: The AcrySof IOL led to significantly less PCO than the EPOCH IOL post-operatively after extracapsular cataract extraction.