Phakic posterior chamber lens implantation in children with high myopia

PURPOSE: To evaluate the anatomical and functional results after implantation of a phakic posterior chamber lens (implantable contact lens [ICL]) to correct high myopia with amblyopia in pediatric patients in whom conventional treatments had failed. SETTING: Department of Ophthalmology, Purpan Hospital, University of Toulouse, France. METHODS: An ICL was implanted in 5 eyes with amblyopic high myopia in 4 children aged 3 to 16 years. Mean preoperative spherical equivalent refraction was -12.8 diopters (D) (range -8.0 to -18.0 D) and best spectacle-corrected visual acuity (BSCVA) was counting fingers to 20/200. Mean follow-up was 11.8 months (range 4 to 21 months). RESULTS: Postoperatively, the ICLs appeared to be well tolerated, with no inflammatory reactions, stable intraocular pressure, and good positioning in all eyes. Predictability was +0.5 D (range -0.5 to +2.0 D) and BSCVA improved, with a gain of 3 or more Snellen lines with recovery of binocular vision in 2 cases and orthotropia in 3 patients. All parents reported an improvement in their children's quality of life. CONCLUSION: This preliminary study indicates that ICL implantation is a safe surgical procedure to correct amblyopia resulting from high myopia in children when conventional amblyopia treatments have failed. Longer follow-up of more patients is needed.     

Visian Collamer phakic intraocular lens in high myopic Asian eyes

PURPOSE: To evaluate the safety and efficacy of the Implantable Collamer Lens (Visian), a phakic intraocular lens (PIOL), in the correction of high myopia in Asian eyes. METHODS: This prospective study comprised 61 eyes in 40 Chinese patients with mean preoperative manifest spherical equivalent refraction of -14.54 +/- 3.61 diopters (D) (range: -7.00 to -24.75 D) who underwent Visian PIOL implantation from May 2002 to December 2004. The anatomical differences between Asian and Caucasian eyes were compared. RESULTS: Mean follow-up was 13.67 +/- 8.51 months (range: 1 to 32 months). Predictability of the manifest spherical equivalent refraction to within +/- 1.00 D was achieved in 88% of eyes and +/- 0.50 D in 72.5% of eyes. The mean postoperative manifest spherical equivalent refraction was -0.10 +/- 0.74 D, with 97% of eyes maintaining or gaining > or = 1 lines of best spectacle-corrected visual acuity (BSCVA). Two eyes lost 1 line of BSCVA. Retinal detachment developed in 1 eye 15 months after initial surgery. Because of the statistical differences in anterior chamber depth and white-to-white distance between Caucasian and Chinese eyes, the Visian PIOL size was more accurate if the calculation was modified so that 0.5 mm was added to the white-to-white measurement if the anterior chamber depth was < or = 3.0 mm and 1.0 mm to the white-to-white measurement if the anterior chamber depth was >3.0 mm. Initial incorrect sizing using the original nomogram led to the only cataract in our series. CONCLUSIONS: The implantation of the Visian PIOL for correcting moderate to high myopia in Asian eyes shows similar safety and efficacy to the FDA clinical trial of Caucasian eyes. Proper sizing of the Visian PIOL is important and differs slightly in Asian eyes.     

Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy

PURPOSE: To assess the safety and efficacy of intracorneal ring segment (Intacs, Addition Technology, Inc.) implantation in the management of keratoconus. SETTING: Department of Ophthalmology and Ophthalmic Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. METHODS: This prospective case series comprised 30 keratoconic eyes (22 patients) with a clear central cornea that had Intacs implantation. All patients were contact-lens intolerant. The main outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, keratometry, and pachymetry. Patients were examined before Intacs implantation as well as 1 week and 1, 3, and 6 months postoperatively. RESULTS: The mean age of the 5 women and 17 men was 25.9 years +/- 5.29 (SD). The mean UCVA improved from 0.60 +/- 0.311 logMAR preoperatively to 0.29 +/- 0.20 logMAR 6 months postoperatively (P<.001) and the mean BSCVA, from 0.25 +/- 0.16 logMAR to 0.13 +/- 0.14 logMAR, respectively (P<.001).The mean spherical equivalent improved from -6.93 +/- 3.52 diopters (D) preoperatively to -3.23 +/- 2.81 D at 6 months and the mean refractive cylinder, from -4.65 +/- 1.85 D to -3.90 +/- 1.70 D, respectively. The mean keratometry decreased from 49.84 +/- 3.58 D preoperatively to 47.90 +/- 3.58 D postoperatively (P<.001). Three eyes had ring exposure, and 1 eye had bacterial keratitis and ring exposure. CONCLUSION: Intacs implantation appeared to be effective in improving UCVA and BSCVA in patients with mild to moderate keratoconus and contact-lens intolerance.     

Comparison of implantable contact lens and laser assisted in situ keratomileusis for moderate to high myopia

PURPOSE: To compare the results of laser assisted in situ keratomileusis (LASIK) and implantable contact lenses (ICL) in the correction of moderate/high myopia. METHODS: Five hundred fifty-nine LASIK eyes from the Davis Duehr Eye Center, Madison, WI, and 210 ICL eyes from the 14-site U.S. FDA Clinical Trial for ICL for Myopia were compared. These series were concurrently operated on with 8 to 12 D of preoperative myopia and were examined at 1 day, 1 week, 1 month, 6 months, and 1 year postoperatively. The mean baseline myopia was slightly higher in the ICL group, (ICL: -9.8 +/- 1.7 D; LASIK: -9.1 +/- 0.97 D). BSCVA, UCVA, and refractions were collected prospectively in both series. RESULTS: Every index of BSCVA, UCVA, predictability of refraction, and stability of refraction studied favored the ICL over the LASIK procedure. All but one of the indices (UCVA % 20/40 or better) were statistically significant in at least half of the time periods studied. At 6-month follow-up, both the loss of two or more lines (ICL: 0%; LASIK: 2%; p = 0.05) and gain of two or more lines (ICL: 7%; LASIK: 3%; p = 0.04) of BSCVA were better with the ICL. Similarly, efficacy outcomes with the ICL were better with predictability (attempted versus achieved +/-1.0 D) of the ICL at 90%; 76% with LASIK (p < 0.001). In this highly myopic series, UCVA 20/20 or better was 50% with ICL compared with 35% with LASIK (p < 0.001). No serious complications occurred in either series of cases. CONCLUSIONS: The ICL was safer and more effective than LASIK and appears to be a viable alternative to corneal refractive excimer surgery in the treatment of moderate to high myopia.     

Single Intacs segment for post-laser in situ keratomileusis keratectasia

PURPOSE: To describe the visual outcome of implantation of a single Intacs segment (Addition Technology Inc.) in eyes with keratectasia after myopic laser in situ keratomileusis (LASIK). SETTING: Private refractive surgery center, Jerusalem, Israel. METHODS: This retrospective, noncomparative, interventional, consecutive, small case series studied 5 eyes of 5 patients with post-LASIK keratectasia from 3 refractive laser centers treated by Intacs implantation. Before and 9 months after Intacs implantation, the uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry, videokeratography, inferior-superior asymmetry, and patient questionnaires about visual function were assessed. RESULTS: Intacs implantation was performed 17 to 32 months post LASIK with no intraoperative complications and no loss of visual acuity. After implantation, the UCVA improved 8, 4, 3, 0.5, and 5 lines and the BSCVA, 2, 2.5, 1, 0.5, and 2 lines. The mean manifest refraction spherical equivalent improved from -1.60 diopters (D) +/- 1.67 (SD) to -0.80 +/- 1.05 D. The mean manifest astigmatic correction decreased from -3.9 +/- 2.96 to -2.46 +/- 2.77 D. Corneal topography showed improved inferior steepening and less irregular astigmatism. The mean inferior-superior asymmetry improved from 7.88 +/- 4.59 to 2.46 +/- 2.77 D. Self-reported visual symptoms improved significantly in Cases 1, 2, and 5 and slightly in Cases 3 and 4. CONCLUSIONS: Implantation of a single Intacs segment inferiorly appeared to improve progressive myopia and regular and irregular astigmatism in eyes with corneal ectasia after LASIK. With further study, this technique may prove to be an effective, relatively noninvasive approach.     

Implantable contact lens for high myopia.

PURPOSE: To evaluate the efficacy, safety, and biocompatibility of a collagen polymer implantable contact lens (ICL) (Staar Collamer) as a posterior chamber phakic intraocular lens (IOL) to correct high myopia. SETTING: Departments of Ophthalmology, Helsinki University Central Hospital, Helsinki, and Tampere University Hospital, Tampere, Finland. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 38 eyes of 22 patients with a mean age of 39 years (range 24 to 54 years). The mean preoperative myopia was -15.10 diopters (D) (range -7.75 to -29.00 D). Surgical implantation was performed through a 3.0 mm clear corneal sutureless incision using paraocular anesthesia. The patients were followed clinically up to 3 years. The mean follow-up was 13.6 months (range 6 to 24 months) for refractive data and 22.3 months (range 6 to 35 months) for complications. The possible inflammatory response to the ICL was measured using a laser flare meter in 12 eyes. RESULTS: Postoperatively, all eyes had a significant increase in uncorrected visual acuity, allowing all but 3 patients (5 eyes) to manage most activities without spectacles. The mean spherical equivalent refraction at the last examination was -2.00 D +/- 2.48 (SD) (range +0.13 to -13.00 D), within +/-1.00 D of the targeted refraction in 31 eyes (81.6%) and within +/-0.50 D in 27 eyes (71.1%). In eyes in which the preoperative myopia was less than -18.00 D (n = 28), the achieved refraction was within +/-1.00 D of the intended refraction in 27 eyes (96.4%) and within +/-0.50 D in 24 eyes (85.7%). The refraction remained stable with a statistically insignificant change (P >.05) at each interval during the follow-up. The best corrected visual acuity (BCVA) improved by 1 or more lines in 23 of 32 eyes (71.9%) at 1 year. Two eyes (6.3%) lost 1 line of BCVA. Laser flare photometry showed normal aqueous flare values (11.71 +/- 6.61 photon counts/ms) in the 12 eyes measured at least 6 months after ICL implantation. Pupillary block glaucoma requiring surgical intervention occurred in 3 patients (7.9%). One patient (2.6%) developed cataract 1.5 years after ICL implantation; both ICLs were removed, and the refractive errors were corrected by lensectomy and implantation of low-power posterior chamber IOLs. One patient (2.6%) showed progression of dry macular degeneration at 17 months. CONCLUSION: At 1 year, ICL implantation had good visual and refractive results with excellent biocompatibility. Long-term follow-up is required to confirm that significant complications do not occur in most patients over time.     

Custom-designed toric phakic intraocular lenses to correct high corneal astigmatism

PURPOSE: To analyze the results of a custom-designed posterior chamber toric phakic intraocular lens (PIOL). METHODS: A 40-year-old woman with high astigmatism and thin corneas underwent bilateral PIOL implantation with the toric Implantable Collamer Lens (ICL) custom-designed and manufactured by STAAR Surgical. The appropriate toric ICL power was calculated to be -8.00 +8.00 x 96 degrees for the right eye and -8.50 +7.50 x 86 degrees for the left eye. Optical zone was 5.5 mm and 6.875 mm at the corneal plane. RESULTS: At 3 and 6 months postoperatively, uncorrected visual acuity (UCVA) and best-spectacle corrected visual acuity (BSCVA) of both eyes had improved to 20/20 and 20/16, respectively. At 19 months, UCVA was 20/20 and 20/16 in the right and left eyes, respectively, and BSCVA had improved to 20/16 and 20/10, respectively. The subjective refraction was stable, with a change of -0.37 +/- 0.17 D from preoperative to 19 months postoperatively. Throughout the postoperative period, iridotomies remained patent and the corneas were clear. CONCLUSIONS: Bilateral implantation of the custom-designed toric ICL successfully corrected the patient's high astigmatism. Preoperative subjective refractive cylinder of -5.25 x 6 degrees in the right eye and -5 x 176 degrees in the left eye changed to -0.5 x 77 degrees and -0.5 x 115 degrees, respectively, after toric IOL implantation. There was almost no change in corneal astigmatism. This customized approach led to UCVA of 20/20 in the right eye and 20/16 in the left eye, and BSCVA of 20/16 in the right eye and 20/10 in the left eye. This is the first report of a toric PIOL being specifically manufactured to meet the refractive cylinder requirements of a specific patient.     

One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus

PURPOSE: To report the results of intrastromal corneal ring segment [ICRS] (KeraRing; Mediphacos, Belo Horizonte, Brazil) implantation using a femtosecond laser (IntraLase Corp, Irvine, California, USA) in keratoconic patients. DESIGN: Retrospective, noncomparative, interventional study. METHODS: Thirty-two keratoconic patients (50 eyes) who underwent ICRS insertion using a femtosecond laser for channel creation and completed at least one year of follow-up were included in this study. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, and adverse events were assessed. RESULTS: No intraoperative complications were demonstrated in this series of patients. At the first postoperative day, segment migration to the incision site was seen in three eyes (6%; early postoperative complication). To avoid melting, we repositioned the migrated segment away from the incision site. Serious second migration was not seen and we did not need to reposition any segment again. At the last postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared with that observed at the examination before implantation (mean +/- standard deviation, -5.62 +/- 4.15 diopters [D; range, -23.62 to 0.50 D] to -2.49 +/- 2.68 D [range, -11.12 to 3.5 D]; P < .001). The UCVA before implantation was 20/40 or worse in 47 eyes (94%; range, counting fingers to 20/30), whereas at the last follow-up examination, 14 (28%) of 50 eyes had a UCVA of 20/40 or better (range, counting fingers to 20/25). Nine eyes (18%) maintained the preimplantation BSCVA, whereas 39 eyes (68%) experienced a BSCVA gain of one to four lines at the last follow-up examination. Only in two eyes (4%; two patients) with advanced keratoconus (stage III) was there a decrease of up to two lines. Despite this deterioration in BSCVA, the patients did not want to remove the ICRSs, because there was an increase of UCVA. No late postoperative complications were observed during the follow-up period. CONCLUSIONS: ICRS (KeraRing) implantation using femtosecond laser for tunnel creation is a minimally invasive procedure for improving visual acuity (both UCVA and BSCVA) in keratoconic patients.     

Long-term follow-up of Intacs from a single center

PURPOSE: To evaluate the long-term visual results in patients having Intacs placement for the correction of mild myopia. SETTING: Department of Ophthalmology, Mount Sinai School of Medicine and the Mount Sinai Hospital of Mount Sinai NYU Health, New York, New York, USA. METHODS: Patients with mild myopia (spherical equivalent between -0.75 and -4.50 diopters [D]) were enrolled to have Intacs placement between May 1995 and March 1999 under United States Food and Drug Administration Phase II and Phase III clinical trials for intrastromal corneal ring segments (ICRS). Six insert thicknesses were evaluated: 0.21, 0.25, 0.30, 0.35, 0.40, and 0.45 mm. The long-term results evaluated were uncorrected visual acuity (UCVA), maintenance of best spectacle-corrected visual acuity (BSCVA), predictability and stability of the refractive effect, induced manifest refraction cylinder, slitlamp findings, self-reported visual symptoms, and maintenance of mesopic contrast sensitivity. RESULTS: One hundred fourteen eyes of 73 patients were enrolled; 113 eyes of 72 patients received Intacs. There were no serious intraoperative or postoperative complications. The mean follow-up was 17.5 months +/- 8.9 (SD). At the end of this period (number of eyes evaluated = 100), the UCVA was 20/40 or better in 95 eyes (95.0%), 20/20 or better in 72 (72%), and 20/16 or better in 41 (41%). None of the 113 eyes lost 10 or more letters or 2 or more lines of preoperative BSCVA. The mean change in the cycloplegic refraction spherical equivalent for the 6 insert thicknesses was as follows: -0.75 +/- 0.00 D for 0.21 mm; -1.17 +/- 0.42 D for 0.25 mm; -2.00 +/- 0.54 D for 0.30 mm; -2.59 +/- 0.53 D for 0.35 mm; -3.09 +/- 0.54 D for 0.40 mm; and -3.82+/-0.80 D for 0.45 mm. The refractive correction was within +/-1.0 D of the predicted outcome in 103 eyes (92.0%) and within +/-0.5 D in 72 eyes (63.7%). Intacs were removed from 6 eyes (5.3%). All 4 eyes for which data were available 3 months after removal returned to within +/-0.5 D of their preoperative manifest refraction spherical equivalent. Intacs were exchanged because of undercorrection in 2 eyes (1.8%). These eyes gained 3 and 5 lines of UCVA 12 months and 18 months, respectively, after the exchange procedure. Overall, 85.7% (36/42) of the patients were satisfied with the results of the Intacs procedure. CONCLUSION: Intacs safely and effectively corrected mild myopia. Placement is a brief, easy outpatient procedure. The refractive effect was predictable and stable over long-term follow-up. Results from a limited number of removal and exchange procedures indicate that Intacs are removable and adjustable.     

Refractive lens exchange with an array multifocal intraocular lens

PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL). METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO). RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 +/- 3.25 D (-1.75 to -15.50 D), and group B (n=26; hyperopia, average preoperative spherical equivalent refraction +3.04 +/- 1.04 D). Follow-up was 6 months in all eyes. Postoperatively, all eyes of both groups were within +/-1.00 D of target refraction. No eye in group A and three eyes in group B sustained a loss of one line of BSCVA. Forty-seven eyes (94%) remained unchanged or gained one or more lines of their preoperative BSCVA. In all eyes, postoperative UCVA was 20/40 or better. When compared to preoperative, uncorrected near visual acuity improved (statistically significant). All patients achieved uncorrected binocular visual acuity of 20/30 and J4 or better. Patient satisfaction was extremely high; no intra- or postoperative complications were reported. CONCLUSION: Six-month results of implantation of the AMO Array multifocal IOL for refractive lens exchange demonstrated safety, efficacy, and predictability in correcting high ametropia and significant improvement of uncorrected near and distance visual acuity.     

ICL植入术矫正超高度近视的临床效果观察

目的:评估有晶状体眼后房型人工晶状体(ICL)矫正超高度近视的疗效及安全性。方法:对超高度近视患者20例40眼接受普通型ICL或散光型后房型人工晶状体(TICL)治疗,术前屈光度球镜-10.0～-18.0D,柱镜-0.25～-3.00D,等效球镜-15.32D,术后随访12mo,观察指标包括UCVA,BCVA、角膜地形图、主观和客观验光、角膜内皮细胞计数、眼压测量、裂隙灯检查。结果:术后12mo,裸眼视力≥0.8者占80.0%(32眼)。30.0%(12眼)的术眼BCVA较术前提高1行,15.0%(6眼)的术眼BCVA较术前提高2行。术后12mo术眼屈光度在±0.50D者达70.0%(28眼)。术前患者平均眼压为16±2.8mmHg,术后6mo平均眼压为17±3.4mmHg,术前术后相比较差异无显著性(t=0.518,P=0.776),术前患者角膜内皮细胞计数平均为2823±243.6个/mm2,术后6mo平均为2709±273.2个/mm2,术前术后比较无显著性差异(t=0.794,P=0.422)。未发生继发性青光眼、视网膜脱离及并发性白内障。结论:ICL植入术矫正超高度近视具有良好的疗效和安全性,远期效果有待进一步观察。     

有晶状体眼后房型人工晶状体植入矫正高度近视的临床评价

目的评价有晶状体眼后房型人工晶状体植入矫正高度近视的有效性、安全性及稳定性。方法选取1997年1月至2005年12月在我院就诊高度近视患者113例（216只眼）,平均年龄30岁,均在球周麻醉及表面麻醉下经3．2mm透明角膜切口植入后房型人工晶状体（ICLV2型15例,ICLV4,美国STAAR公司）,随访术前及术后1d、1周及1、3、6、12、24、36个月,随访内容包括裸眼视力、最佳矫正视力、角膜地形图、屈光度数、裂隙灯显微镜检查、眼压、角膜内皮计数等。术前检查等效球面屈光度数（17．78±3．88）D,平均随访18．2个月后观察屈光状态,24．3个月后观察术后并发症。结果所有手术均顺利进行,所有患者裸眼视力均有明显提高,最后一次随访等效球面屈光度数为（-1．00±1．40）D,与预期屈光度数差别±1．00D以内者191只眼（88．4％）,±0．50D以内者165只眼（76．4％）。术前屈光度数在-20．00D以下的有151只眼,与预期屈光度数差别±1．00D以内者145只眼（96．0％）,±0．50D以内者128只眼（84．8％）。随访期间屈光度数差异无统计学意义（P〉0．05）,术后1年最佳矫正视力提高1行及以上168只眼（77．8％）,4只眼（1．85％）下降1行。4只眼（1．85％）发生需手术治疗瞳孔阻滞性青光眼,3只眼（1．39％）发生晶状体前囊下混浊,均行人工晶状体取出,晶状体摘除及人工晶状体植入术,术后最佳矫正视力无下降。结论有晶状体眼后房型人工晶状体植入矫正高度近视具有有效性、安全性及稳定性。（中华眼科杂志,2007,43：1000-1004）     

Toric phakic intraocular lens: European multicenter study

OBJECTIVE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after implantation of Artisan toric phakic intraocular lenses (TPIOLs) for the correction of myopia or hyperopia with astigmatism. DESIGN: Prospective, nonrandomized, comparative (self-controlled) multicenter trial. PARTICIPANTS: Seventy eyes of 53 patients (mean, 35 years; range, 22-59 years) with preoperative spherical equivalent between +6.50 and -21.25 diopters (D) and cylinder between 1.50 and 7.25 D. METHODS: Seventy eyes underwent implantation of a TPIOL with an optical zone of 5.0 mm (Artisan, Ophtec, Groningen, The Netherlands). The dioptric power of the intraocular lens was calculated by considering refraction, keratometry, and anterior chamber depth. The follow-up was 6 months in all cases. Lenses were available in powers ranging from +12.0 D to -23.5 D (spherical equivalent) in 0.5-D increments, with additional cylinder from 1.0 D to 7.0 D, also in 0.5-D increments. MAIN OUTCOME MEASURES: The main parameters assessed were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell count (ECC), intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, subjective complaints, and patient satisfaction. RESULTS: Eyes were divided into group A, myopia (n = 48), with an average preoperative spherical equivalent of -8.90 +/- 4.52 D, and group B, hyperopia (n = 22), with an average preoperative spherical equivalent of +3.25 +/- 1.98 D. No eyes in either group experienced a loss in BSCVA, and 46 eyes gained 1 or more lines of their preoperative BSCVA. In 62 eyes (88.6%), UCVA was 20/40 or better. There was a significant reduction in spherical errors and astigmatism in all cases after surgery. All eyes of both groups were within +/-1.00 D of target refraction, and 51 eyes (72.9%) were within +/-0.50 D of target refraction. There was a 4.5% mean total loss of ECC during the first 6 months. No serious complications were observed. Overall patient satisfaction was very high. CONCLUSIONS: Six-month clinical trial results demonstrate that implantation of the Artisan TPIOL safely, predictably, and effectively reduced or eliminated high ametropia and astigmatism with one procedure. The refractive effect was stable at 6 months after surgery.     

有晶状体眼后房型人工晶状体植入术矫正高度近视

探讨有晶状体眼后房型人工晶状体（phakic intraocular lens,PIOL）植入术矫正高度近视的有效性和安全性。 方法：本研究中高度近视患者17例33眼,术前屈光度-8.00～-24.00 (平均-15.46±6.26)D,眼轴长度25.33～33.77(平均30.22±2.55)mm。33眼植入后房型人工晶状体也称植入性接触镜（implantable contact lens,ICL& toric implantable collamer lens, TICL）。其中,22眼植入ICL,11眼植入TICL。术后观察视力、屈光度、眼压、人工晶状体位置等。 结果：所有病例均成功植入后房型人工晶状体。术后1wk,所有手术眼达到或超过术前最佳矫正视力,屈光度和眼压稳定。 结论：有晶状体眼后房型人工晶状体植入术治疗高度近视安全有效,适用屈光度范围广,术后屈光度稳定,视觉质量提高     

Comparison of patient outcomes after implantation of Visian toric implantable collamer lens and iris-fixated toric phakic intraocular lens

Purpose

We compared visual and refractive outcomes after implantation of Visian toric implantable collamer lenses (toric ICLs) and iris-fixated toric pIOLs (toric Artisans).

Patients and methods

A comparative retrospective analysis was performed. Toric ICLs were implanted into 30 eyes of 18 patients, and toric Artisans into 31 eyes of 22 recipients. We measured the logarithms of the minimum angle of resolution of uncorrected visual acuity (logMAR UCVA), logMAR of best spectacle-corrected corrected VA (logMAR BSCVA), MR, SE, and astigmatism (by the power vector method) before surgery and 1, 3, and 6 months thereafter. Differences between patients receiving each type of lens were compared by using a mixed model of repeated measures.

Results

Visual improvements were evident after operation in both groups. By comparing the attempted to the achieved SE values, we were able to confirm that correction of refractive error was similar in both groups. However, the logMAR UCVA was significantly higher in the toric ICL group at all postoperative time points. Although manifest cylinder power and astigmatism (calculated by using the power vector method) gradually decreased in the toric ICL group, cylinder power 1 month postoperatively increased from −2.62 to −2.75 D; astigmatism was also increased at this time in the toric Artisan group.

Conclusion

The two tested toric pIOLs were similar in terms of the ability to correct refractive error, as assessed 3 months postoperatively. However toric ICLs corrected astigmatism more rapidly and safely. Notably, the large difference in astigmatism level between the two groups 1 month postoperatively indicates that toric ICLs are more effective when used to correct astigmatism.     

Intacs for the correction of keratoconus: two-year follow-up

PURPOSE: To evaluate the long-term safety and efficacy of Intacs segments (Addition Technology, Inc.) for the treatment of keratoconus in terms of intraoperative and postoperative complications, visual outcome, restoration of contact lens tolerance, and inhibition of disease progression. SETTING: Service d'Ophtalmologie, CHU Pellegrin, Bordeaux, France. METHODS: This prospective, 2-year follow-up study comprised 100 keratoconic eyes with clear central corneas and contact lens intolerance. The best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), refractive error, keratometry, pachymetry, and slitlamp examination were assessed preoperatively and 1 and 2 years after Intacs implantation. RESULTS: At 2 years, the UCVA and BCVA improved in 80.5% and 68.3% of eyes, respectively (P<.001). The proportion of eyes with a BCVA >or=0.5 (20/40) increased from 22.0% at baseline to 51.2% and 53.7% at 1 year and 2 years, respectively (P<.001). The manifest refraction spherical equivalent improved from a mean of -6.93 diopters (D) +/- 3.91 (SD) preoperatively to -4.01 +/- 3.16 D at 1 year and -3.80 +/- 2.73 D at 2 years (P<.001). The mean keratometry readings decreased from 50.1 +/- 5.6 D preoperatively to 46.4 +/- 5.3 D at 1 year and 46.8 +/- 4.9 D at 2 years (P<.001). Contact lens tolerance was restored in over 80% of cases. Postoperative slitlamp observations revealed no clinically significant issues. The segments were removed from 4 eyes without complications or sequelae. CONCLUSION: Intacs implantation was a safe and efficacious treatment for keratoconus. Significant and sustained improvements in objective visual outcomes were achieved in most cases, with restoration of contact lens tolerance.     

Clinical results with the medennium phakic refractive lens for the correction of high myopia

PURPOSE: To evaluate the predictability, safety, stability, complications, and biocompatibility of the phakic refractive lens (PRL) as a posterior chamber intraocular lens to correct high myopia. METHODS: Fifty eyes of 31 patients who underwent posterior chamber PRL implantation were evaluated prospectively. Mean preoperative myopia was -12.54 +/- 4.22 diopters (D) (range: -4.50 to -23.50 D) and mean astigmatic refractive power was -1.38 +/- 1.24 D (range: -1.00 to -4.50 D). Surgical implantation was performed through a 3.0- to 4.0-mm clear cornea sutureless incision using parabulbar (sub-Tenon's) anesthesia. Intra- and postoperative complications were recorded. RESULTS: Three months after surgery, the mean spherical equivalent refraction was -0.21 +/- 0.42 D (range: +1.00 to -1.75 D). At 6 and 12 months, mean spherical equivalent refraction was -0.23 +/- 0.38 D (range: 0 to -1.25 D). At the last examination, uncorrected visual acuity was > or = 20/40 in 41 (82%) eyes and > or = 20/20 in 22 (44%) eyes. Best spectacle-corrected visual acuity (BSCVA) was > or = 20/40 in 42 (84%) eyes and > or = 20/20 in 27 (54%) eyes. Comparison of pre- and postoperative BSCVA at 12 months showed that 12 (36.4%) of 33 eyes gained > or =1 lines of BSCVA and 7 (21.2%) of 33 eyes gained > or =2 lines. One (2%) eye developed anterior subcapsular cataract requiring lens exchange, and 1 (2%) eye developed acute angle closure glaucoma requiring YAG-iridotomy. One (2%) eye developed macular hemorrhage. CONCLUSIONS: At 6 months and 1 and 2 years, PRL implantation yielded encouraging visual and refractive results with excellent biocompatibility. The efficacy, stability, and short-term safety of this lens was established. Serious complications, such as cataract and acute angle closure glaucoma, may occur, and long-term safety needs to be evaluated.     

Randomized prospective comparison of visian toric implantable collamer lens and conventional photorefractive keratectomy for moderate to high myopic astigmatism

PURPOSE: To compare the Visian Toric Implantable Collamer Lens (TICL), a toric phakic intraocular lens (IOL), and photorefractive keratectomy (PRK) in the correction of moderate to high myopic astigmatism. METHODS: This prospective, randomized study consisted of 43 eyes implanted with the TICL (20 bilateral cases) and 45 eyes receiving PRK with mitomycin C (22 bilateral cases) with moderate to high myopia (-6.00 to -20.00 diopters [D] sphere) measured at the spectacle plane and 1.00 to 4.00 D of astigmatism. All patient treatment and follow-up occurred at the Naval Medical Center San Diego. Study follow-up was 1 day, 1 week, 1, 3, 6, and 12 months postoperative. RESULTS: Mean best spectacle-corrected visual acuity (BSCVA), change in BSCVA, proportion of cases with improvement of 1 or more lines of BSCVA, proportion of cases with BSCVA and uncorrected visual acuity (UCVA) 20/12.5 or better, proportion of cases with BSCVA and UCVA 20/16 or better (6 months, 88% vs 54%, P=.002), and predictability +/-1.00 D (6 months, 100% vs 67%, P<.001) were all significantly better in the TICL group than the PRK group at all time periods studied postoperatively. Similarly, contrast sensitivity, tested at both the 5% photopic level and the 25% mesopic level, was significantly better at all postoperative time points in the TICL group. Mean spherical equivalent refraction was closer to emmetropia (0.28+/-0.41 vs 0.76+/-0.86, P=.005), and predictability +/-0.50 D and stability of manifest refraction (+/-0.50 D and +/-1.00 D) were significantly better in the TICL group at all postoperative visits through 6 months. Mean astigmatism correction at 6 months was not significantly different between the two groups (0.52+/-0.33 vs 0.46+/-0.35, P=.450). CONCLUSIONS: The TICL performed better than PRK in all measures of safety (BSCVA), efficacy (UCVA), predictability, and stability in this comparison, supporting the TICL as a viable alternative to existing refractive surgical treatments.     

Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal corneal degeneration

PURPOSE: To assess the outcomes of intrastromal ring segment (Intacs, Addition Technology) implantation using a femtosecond laser in patients with pellucid marginal corneal degeneration. SETTING: Kudret Eye Hospital, Ankara, Turkey. METHODS: In this retrospective noncomparative case series, 9 eyes of 6 patients with pellucid marginal corneal degeneration had implantation of Intacs segments by a femtosecond laser technique. Preoperative and postoperative evaluations included slitlamp examination, uncorrected (UCVA) and best corrected (BCVA) visual acuities, and keratometry by a Pentacam Scheimpflug camera (Oculus Opticgerate GmbH). All parameters were reviewed within 6 months. RESULTS: Intacs were successfully implanted in all eyes. The UCVA significantly improved from preoperatively to 6 months after Intacs implantation (mean 0.18 +/- 0.24 [SD] and 0.53 +/- 0.23, respectively). The mean difference between the preoperative and postoperative UCVA was 3.5 +/- 1.6 lines (P = .008). The BCVA also significantly improved from preoperatively to 6 months after implantation (mean 0.63 +/- 0.26 and 0.85 +/- 0.18 at 6 months, respectively). The Snellen BCVA was 1.0 in 5 eyes postoperatively. The mean difference between preoperative and postoperative BCVA was 2.3 +/- 51 lines (P = .011). The mean preoperative spherical refraction decreased from -3.86 +/- 2.91 diopters (D) to -2.77 +/- 1.43D (P = .091) and the mean cylindrical refraction, from -2.41 +/- 2.27 D to -0.94 +/- 1.07 D (P = .046). The mean central corneal curvature decreased from 48.20 +/- 4.19 D preoperatively to 46.90 +/- 5.00 D (P = .008) at 6 months and the mean posterior elevation, from 53.88 +/- 21.72 microm to 32.55 +/- 11.23 microm (P = .008). CONCLUSION: Intacs insertion using a femtosecond laser was safe and efficient in the correction of pellucid marginal corneal degeneration.