Ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for myopia

PURPOSE: To study the intraocular position and anatomic relationships of PRL-III (phakic refractive lens) (PRL) posterior chamber phakic intraocular lens (PCP IOL) for high myopia using ultrasound biomicroscopy (UBM). SETTING: Centro Oftalmológico Real Vision, and Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain. METHODS: Sixteen phakic myopic eyes that had had PRL implantation were examined by UBM 1 month after surgery. The PRL position, PRL-crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. RESULTS: Both haptics were on the zonule in 6 eyes, in the ciliary sulcus in 5 eyes, and impacted in the ciliary body in 1 eye. In the 4 remaining eyes, the haptics were in mixed positions. The mean PCP IOL crystalline lens peripheral distance in the minor axis was 588.1 microm +/- 232.5 (SD), and the mean PCP IOL-endothelium central distance was 2082.8 +/- 277.6 microm. CONCLUSIONS: Phakic refractive lens implantation should be done carefully because of the sulcus location of the haptics in many cases. This, with the iris-PRL contact, suggests caution for the long-term outcome.     

超声生物显微镜在有晶状体眼后房型人工晶状体植入中的应用

超声生物显微镜(UBM)是一种高频超声波成像技术,对活体眼的眼前节结构进行实时观察、测量,可提供高清晰的眼前节图像。近年来UBM在有晶状体眼后方型人工晶状体植入中的应用逐渐成为研究的热点。本文着重就UBM在有晶状体眼后房型人工晶状体植入术中睫状沟直径、前房深度测量以及人工晶状体位置观察等方面的应用进展做一综述。     

Ultrasound biomicroscopy examination of posterior chamber phakic intraocular lens position

OBJECTIVE: To better elucidate the in vivo position of the Collamer posterior chamber phakic intraocular lens (PCPIOL) and its relationship to the iris and the crystalline lens and to analyze possible variations over time. DESIGN: Prospective observational case series. PARTICIPANTS: Eighteen eyes of nine patients were included. INTERVENTION: A Staar Collamer implantable PCPIOL was implanted for the correction of high myopia. MAIN OUTCOME MEASURES: The eyes were studied with a 50-MHz ultrasound biomicroscopy UBM 840. The exact PCPIOL position and the distances between it and the crystalline lens were measured at 3, 6, and 12 months after surgery. RESULTS: There were no intraoperative complications. In 13 eyes (72.22%), contact between the PCPIOL and the crystalline lens was found at some time during follow-up. In 3 eyes (16.6%), central contact could be demonstrated. We also observed that the contact zone and its extension can vary over time. In 2 eyes, rotation of the lens was observed. CONCLUSIONS: We found contact between the PCPIOL and the crystalline lens in a high percentage of cases. There was also mobility of the lens in the posterior chamber, especially in the anteroposterior plane, and, as a consequence, both the contact zone and its extension would vary over time.     

Posterior chamber phakic intraocular lens for hyperopia.

PURPOSE: A Phase I U.S. FDA clinical study of a plate haptic posterior chamber phakic intraocular lens (STAAR Surgical Implantable Contact Lens) for treatment of hyperopia was conducted at 4 sites in the United States. The purpose of this report is to assess the short-term safety and efficacy. METHODS: Ten patients with hyperopia between +2.50 and +10.875 D were implanted in one eye each with the posterior chamber plate phakic intraocular lens and were examined at baseline and 1 day, 1 week, 1, 3, and 6 months after surgery. Mean baseline hyperopia was +6.63 D. RESULTS: At 6 months postoperatively, 7 of 10 eyes (70%) had an uncorrected visual acuity of 20/20 or better and 10 of 10 (100%) had 20/40 or better. Eight of ten eyes (80%) had a spectacle-corrected visual acuity within 1 line of baseline; the other two eyes (20%) had an improvement of 3 lines. Mean 6-month postoperative spherical equivalent refraction was +0.20 +/- 0.61D (range, -0.50 to +1.50 D), a reduction of 6.025 D from baseline. Eight of 10 eyes (80%) were within +/-0.50 D of emmetropia, 9 eyes (90%) were within +/-1.00 D, and all eyes (100%) were within +/-1.50 D. No operative or postoperative complications or adverse reactions were observed. CONCLUSIONS: Results support the short-term safety, efficacy, and predictability of the STAAR Surgical Implantable Contact Lens (plate haptic posterior chamber phakic intraocular lens) in the treatment of hyperopia.     

有晶状体眼后房型人工晶状体植入术治疗高度近视术后UBM观察

目的 通过UBM在活体状态下观察有晶状体眼后房型人工晶状体(posterior chamber phakic intraocularlens,PCPIOL)植入术后PCPIOL与虹膜、睫状体和晶状体的位置的关系及变化.方法 取高度近视患者33只眼接受有晶状体眼后房型人工晶状体植入及术后检查,手术在表面麻醉下进行,作透明角膜隧道式切口,可植入式接触镜(implantablecontactlens,ICL)置于透明晶状体与虹膜之间,术中1点位作虹膜周切口.每只眼术前及术后进行全面的眼部检查,在术后1,3,6个月进行UBM检查观察ICL位置.结果 33只眼术前裸眼视力和最好矫正视力分别为0.04±0.06,0.5±0.3;术后分别提高为0.5±0.2,0.8±0.2,术后裸眼和矫正视力均明显好于术前视力(P＜0.05).术后第6个月前房深度为(2802±297)μm,ICL的拱度为329μm,小梁虹膜夹角29.2°.UBM显示所有ICL均与虹膜表面有摩擦,22只眼中两个襻在晶状体悬韧带上;7只眼中一只襻在悬韧带上;另一只襻在睫状突上;4只眼中两只襻在睫状突上.20只眼中PCPIOL的两个襻顶点放置在睫状沟位置;6只眼中PCPIOL发生了旋转.结论 有晶状体眼后房型人工晶状体植入术对高度近视的治疗是一种安全、有效地方法.寻找新的、准确的方法测量睫状沟水平直径对减少因为不合适的ICL长度造成的并发症具有重要意义.

Abstract：

Objective To observe the position of posterior chamber phakic intraocular lens and its relationship to the iris and the crystalline in vivo through UBM. Methods There were 33 eyes with high myopia who accepted surgery treatment All surgeries were performed using topical anesthesia and clear corneal incision. The posterior chamber phakic intraocular lens manufactured with STAAR collamer was implanted between transparent lens and iris. During the course of the surgery, iridectomy was done at one clock. Each eye was examined carefully before and after surgery. The position of ICL was observed at 1, 3 and 6 months. Result All eyes of preoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA)were 0.04± 0.06, 0.5± 0.3 respectively and postoperative were 0.5± 0.2, 0.8± 0.2 respectively. At sixth month of postoperative the anterior chamber depth was 2802± 297 m and ICL central vault was 329 m. UBM verified the contact between ICL and iris. Both haptics were supported by zonula in 22 eyes; one haptic was supported by zonula and other haptic by ciliary body in 7 eyes; Both haptics were supported by ciliary body in 4eyes. The extreme tip of two haptic was at sulcus in 20 eyes. In 6 eyes, rotation of the lens was observed. Conelusions Thephakic IOLs are a safety and effective treatment for the correction of high myopia. It is important that looking for a new and accurate method to measure sulcus diameter in order to reduce complication resulted by inaccurate ICL vault.     

有晶状体眼后房型人工晶状体植入术后前房及前房角的超声活体显微镜观察

目的 应用超声活体显微镜(UBM)评价有晶状体眼后房型人工晶状体(ICL)植入术后前房及前房角的变化.方法 前瞻性系列病例研究.分析15例(30只眼)高度近视患者术前及ICL植入术后1周、1、3、6个月及1年的眼压变化;末次随访(术后1年)时行UBM检查,测最中央前房深度(ACD)、ICL后表面与晶状体之间的距离、小梁虹膜夹角,ICL周边部与晶状体之间的距离.小梁虹膜夹角比较则采用非参数检验;ICL周边部与晶状体之间的距离采用One-way ANOVA分析;术前术后各时间点的眼压比较采用重复测量方差分析和Bonferroni检验;中央ACD比较采用配对t检验.结果 术前眼压为(13.75±2.27)mm Hg(1 mm Hg=0.133 kPa),术后1周、1个月、3个月、6个月及1年时眼压分别为(14.27±1.70)mm Hg、(14.70±2.07)mm Hg、(14.07±2.24)mm Hg、(14.00±2.69)mm Hg和(13.97±2.95)mm Hg,术前及术后各次眼压间进行比较,发现仅术后1个月时眼压与术前、术后3个月时眼压比较差异有统计学意义(t=-3.706、3.898,P<0.05).UBM检查发现中央角膜内表面与晶状体之间的距离为(2.97±0.11)mm,中央角膜内表面与ICL之间的距离为(2.24±0.21)mm,两者之间差异有统计学意义(t=20.63,P<0.01).小梁虹膜夹角在钟表位12:00、3:00、6:00、9:00位差异无统计学意义,仅55.8%手术眼的小梁虹膜夹角>30°,ICL周边部与晶状体之间的距离在钟表位12:00、3:00、6:00、9:00位差异无统计学意义.ICL后表面与晶状体之间的距离为(0.63±0.16)mm,ICL与晶状体无接触.结论 ICL植入术后ICL位于晶状体前,致使术后中央ACD变浅、部分手术眼前房角宽度变窄.ICL与晶状体无接触,与虹膜后表面接触.     

UBM量化观察有晶状体眼后房型人工晶状体植入术前后眼前节形态的变化

目的 应用超声生物显微镜(UBM)对比观察有晶状体眼后房型人工晶状体(ICL)植入术前后的多项眼前节指标变化,旨在评价ICL的安全性及稳定性。方法 前瞻性研究。收集2008年9月至2010年8月实施ICL植入矫正高度近视眼的患者30例（30只眼）,利用UBM观察并测量手术前、术后3个月及术后1年的中央前房深度(ACD)、小梁与虹膜夹角(TIA)、前房角开放距离（AOD500）、小梁与睫状体距离(TCPD)和虹膜与睫状体距离(ICPD),同时记录术后ICL距晶状体中央前表面的距离、ICL周边部距晶状体的距离及眼压等数据,并用裂隙灯显微镜随访检查。ICL周边部距晶状体的距离采用One-way ANOVA处理,余手术前后数据采用重复测量单因素方差分析及Bonferroni检验处理。结果 术前与术后3个月、术后1年ACD分别为(3.16±0.08) mm、(2.76±0.13) mm、(2.74±0.14) mm;AOD500分别为(0.45±0.04) mm、(0.41±0.04) mm、(0.41±0.03) mm;TIA(12点位)分别为35.0°±3.24°、32.47°±3.56°、32.40°±3.23°,三者术前与术后两时段相比差异均有统计学意义(P＜0.05);术后两时段相比差异无统计学意义(P＞0.05),TCPD、ICPD 术前、术后3个月和术后1年相比差异均无统计学意义(F=0.49,F=0.57;P＞0.05)。结论 应用UBM观察到的ICL手术前后眼前节形态结构的变化主要表现在ACD变浅、TIA及AOD的变窄,但尚在安全范围内,且经过1年多随访观察显示ICL术后眼前节形态结构的变化稳定且未发生相关并发症,但远期效果尚有待进一步随访。     

Ten-year follow-up of a ciliary sulcus-fixated silicone phakic posterior chamber intraocular lens

In 1992, a ciliary sulcus-fixated, silicone, phakic posterior chamber intraocular lens (PPC IOL) (Adatomed, Fyodorov type) was implanted in both eyes of a 42-year-old white woman to correct high myopia (right eye, -17.0 diopters [D]; left eye, -11.5 D). In the right eye, localized cortical opacification was present in the anterior part of the natural lens preoperatively but did not progress during a 10-year follow-up period. With Scheimpflug photography, it was possible to detect a space between the natural lens and the IOL that was not evident on slitlamp examination. Maintenance of space between an IOL and the natural lens appears to be an important factor in preventing cataract formation after PPC IOL implantation.     

有晶状体眼的人工晶状体植入术

目的观察有晶状体眼的人工晶状体（ICL）植入术矫正高度近视的临床效果。方法22例（39只眼）高度近视患者,近视度数-7．00- -23．00 D,平均（-11．48±3．70）D。术前裸眼视力（UCVA）0．02-0．3,平均0．05±0．03,术前最佳矫正视力（BCVA）0．8-1.2,平均0．90±0．27;角膜内皮密度2000-3961个／mm^2,平均（2735．13±464．50）个／mm^2;所有患者随访12个月。结果术后裸眼视力显著提高,术后1d,1周11、3、6和12个月的裸眼视力较之术前差异有统计学意义（P=0．0000）。结论有晶状体眼的人工晶状体植入术治疗高度近视临床效果确切,特别适宜于无法选择角膜屈光手术者,其远期并发症还有待进一步观察。     

Posterior chamber collamer phakic intraocular lens for myopia and hyperopia.

PURPOSE: To assess the feasibility of correcting refractive errors using a foldable posterior chamber phakic intraocular lens. METHODS: Thirty-four foldable posterior chamber phakic intraocular lenses (STAAR Collamer intraocular lens) were consecutively implanted by the same surgeon (PMP) in 19 myopic eyes and 15 hyperopic eyes. In myopic eyes, mean preoperative spherical equivalent refraction was -16.65 +/-3.37 D (range, -8.12 to -21.25 D). In hyperopic eyes, mean preoperative spherical equivalent refraction was +7.77+/-2.08 D (range, +4.75 to +11.75 D). Mean follow-up was 12 months (range, 6 to 18 mo). Two hyperopic eyes were not included in the data analysis because of removal of the intraocular lens due to pupillary block. RESULTS: Myopic eyes (n=19)-Mean spherical equivalent postoperative refraction was -1.51+/-1.37 D (range, -5.50 to+0.38 D). Postoperative refraction was within +/-0.50 D in 4 eyes (21.05%) and within +/-1.00 D in 8 eyes (42.10%). Uncorrected visual acuity was 20/40 or better in 12 eyes (63.15%) and 20/25 or better in 3 eyes (15.78%). No eye had an uncorrected visual acuity of 20/20 or better. Spectacle-corrected visual acuity was 20/40 or better in all eyes, 20/25 or better in 12 eyes (63.15%), and 20/20 or better in 1 eye (5.26%). Spectacle-corrected visual acuity was unchanged in 10 eyes (52.63%) and improved in 9 eyes (47.36%). A retinal detachment developed in 1 eye (5.26%). Hyperopic eyes (n=15)-Mean spherical equivalent postoperative refraction was +0.02+/-0.64 D (range, -1.00 to +1.50 D). Postoperative refraction was within +/-0.50 D in 9 eyes (69.25%) and +/-1.00 D in 12 eyes (92.30%). Uncorrected visual acuity was 20/40 or better in 6 eyes (46.15%) and 20/25 or better in 3 eyes (20.25%). No eye had an uncorrected visual acuity of 20/20 or better. Spectacle-corrected visual acuity was 20/40 or better in 7 eyes (53.84%), 20/25 or better in 6 eyes (46.15%), and 20/20 or better in 2 eyes (15.38%). Spectacle-corrected visual acuity was unchanged in 10 eyes (76.92%), significantly improved in 2 eyes (15.38%), and worse in 1 eye (7.69%). Two of 15 eyes (13.33%) developed a severe pupillary block necessitating removal of the implants. One eye (7.69%) developed an anterior subcapsular cataract. CONCLUSIONS: Refractive predictability appears better for hyeropia than for myopia using the STAAR Collamer foldable posterior chamber phakic intraocular lens. In hyperopic eyes, development of pupillary block may occur.     

Posterior chamber phakic intraocular lens for moderate myopia and hyperopia.

BACKGROUND: As part of the United States Food and Drug Administration Phase III clinical trial, patients were implanted with the STAAR posterior chamber phakic intraocular contact lens (ICL). The trial is designed to test the safety and efficacy of this new lens for the treatment of moderate-to-high myopia and hyperopia. METHODS: Data were collected from 20 hyperopes--mean preoperative spherical equivalent, +5.55 D, and 65 myopes-mean preoperative spherical equivalent, -8.42 D, who were implanted with ICLs in our clinic, from November 1998 to March 2000. RESULTS: Postoperatively, 40% of the hyperopic eyes were 20/20 or better without correction and 80% of the eyes 20/40 or better without correction, with a mean spherical equivalent of +0.06 D. One hyperopic lens was explanted and no adverse events were reported. Postoperatively, 52.31% of the myopic eyes were 20/20 or better without correction and 92.3% of the eyes were 20/40 or better without correction, with a mean spherical equivalent of -0.31 D. No lenses were explanted and one was treated for angle closure. CONCLUSIONS: The STAAR Collamer ICL is a reasonably safe and effective procedure for the treatment of moderate-to-high refractive errors.     

UBM在前房型有晶状体眼人工晶状体治疗高度近视中的应用

目的应用超声生物显微镜(UBM)观察高度近视患者植入有晶状体眼6H2型前房型人工晶状体(PAC-IOL)的位置及与邻近结构的解剖关系。方法15例(29眼)高度近视患者植入PAC-IOL。术前应用UBM测量前房深度,术后3个月,观察IOL襻的位置,测量中央及周边6点、12点处IOL与角膜内皮的距离,IOL与晶状体的距离,IOL边缘与虹膜的距离。结果术前前房深度为3.11～3.52mm。术后3个月,IOL襻均位于前房角,中央及周边6点、12点处IOL与角膜内皮的距离分别为(2.341±0.116)、(1.601±0.025)、(1.601±0.028)mm;IOL中央与晶状体的距离为(0.841±0.140)mm;IOL边缘与虹膜的距离为(0.346±0.046)mm。结论Phakic6H2PAC-IOL与角膜内皮和晶状体保持有效的安全距离。其弹性支撑襻均位于前房角。IOL襻向后作用于虹膜和前房角,有可能导致临床上发生瞳孔变形。     

Tuck-and-pull technique for posterior chamber phakic intraocular lens explantation

The tuck-and-pull technique was developed for practical and safe explantations of posterior chamber phakic intraocular lenses (PCPIOLs). In this technique, after the creation of a side port, viscoelastic (or OVD [ophthalmic viscosurgical device]) is initially injected behind the PCPIOL to widen the space between PCPIOL and the crystalline lens. The old incisions can be used after recent implantations rendering the enlargement of the main incision unnecessary. After additional OVD over and under the PCPIOL, the haptic is tucked by a chopper and pulled through the main incision with a single maneuver. The haptic is grasped by two suture forceps and explanted with a “hand-to-hand” maneuver. The tuck-and-pull technique provided high protection of the corneal endothelium, crystalline lens, anterior chamber structures, and the PCPIOL itself. This technique is a practical, easy, and safe approach for explantations of all PCPIOL types, whatever the reason for its explantation may be.     

超声生物显微镜在有晶状体眼后房型人工晶状体植入术中的应用

目的 研究传统测量角膜水平直径方法和超声生物显微镜(ultrasound biomicroscopy,UBM)方法测量睫状沟水平直径来选择后房型人工晶状体(implantable collamer lenses,ICL)的长度,比较两种方法对有晶状体眼ICL术后拱高的影响.方法 回顾性研究2009年5月至2010年12月在我科行ICL植入手术的103例(191眼)近视散光患者,根据术前选择ICL长度的不同分为常规方法组和UBM方法组,分剐测量两组术后6个月的ICL拱高,并对数据进行比较和相关性分析.结果 术前两组一般资料比较差异均无统计学意义(均为P＞0.05).术后6个月常规方法纽ICL平均拱高为(444.63±202.00)μm,UBM方法组为(463.67±226.00)μm,两组比较差异无统计学意义(P=0.094);拱高在理想范围(250～750μm)者,常规方法组占76.1％(70眼),UBM组占77.8％(77眼),两组差异无统计学意义(x2=0.0769,P=0.782);常规方法组ICL拱高和ICL度数相关系数r1=0.002(P1=0.677),UBM组ICL拱高和ICL度数的相关系数r2=0.011(P2=0.349),两组拱高均和ICL度数不相关.结论 在现有检查设备的条件下,通过UBM测量睫状沟的水平距离能够选择更理想的ICL,通过传统方法测量角膜水平直径(白到白的距离)来估算ICL的长度也是可行的.     

Decentration and cataract formation 10 years following posterior chamber silicone phakic intraocular lens implantation

PURPOSE: To report a 10-year follow-up for bilateral implantation of a Chiron Adatomed silicone posterior chamber phakic intraocular lens (PIOL). METHODS: A 32-year-old man presented with bilateral blurred vision and monocular diplopia in the left eye of 2 years' duration. RESULTS: Slit-lamp microscopy showed bilateral anterior subcapsular cataract and temporal PIOL decentration, and no visible space between the PIOL and crystalline lens in the right eye. After explantation of the posterior chamber PIOL, lens aspiration, and IOL implantation, uncorrected visual acuity improved to 20/15 in the right eye. Scanning electron microscopy examination showed denser deposits on the central portion of the back surface when compared with the edges. CONCLUSIONS: Long-term follow up of certain designs of posterior chamber PIOLs may reveal late occurrence of complications. Cataract formation may be related to direct contact between the implanted and crystalline lenses.     

Secondary glaucoma and severe endothelial damage after silicone phakic posterior chamber intraocular lens implantation

We report a patient who developed secondary glaucoma 1 year after phakic posterior chamber intraocular lens implantation.