Rate of cataract formation in 343 highly myopic eyes after implantation of three types of phakic intraocular lenses

PURPOSE: To assess the feasibility of using phakic intraocular lenses (PIOL) to treat high myopia, and evaluate the incidence of cataract, comparing three different lens types. METHODS: From 1989 to 2002, we implanted three different phakic intraocular lenses (PIOL) in 343 eyes of 232 patients; 231 eyes recieved an Ophtec (Worst-Fechner model, iris-claw), 89 an Adatomed (silicone posterior chamber), and 23 a Staar (posterior chamber, models V2, V3, V4). Average follow-up was 96.2 months for the Ophtec group, 31.5 months for the Adatomed group, and 19.3 months for Staar group. Eyes that subsequently developed cataract were studied for clinical evolution and had PIOL explantation and cataract extraction. RESULTS: Nuclear cataract developed in 7 of 231 eyes (3.04 %) with an Ophtec lens. Anterior subcapsular cataract developed with the two types of posterior PIOLs (Adatomed group: 38/89 eyes, 42.69%; Staar group: 3/23 eyes, 13.04%). Anterior subcapsular cataract in the Adatomed group developed more rapidly compared to the Staar group. We explanted 7 lenses in the Ophtec group, 16 lenses in the Adatomed group, and 2 lenses in the Staar group (models V2 and V3 only). Patient age older than 40 years at implantation of PIOLs and axial length greater than 30 mm were factors significantly related to nuclear cataract formation and the Ophtec lens. However, these two factors had a weaker correlation with the posterior phakic lenses (Adatomed, Staar) for high myopia than with the Ophtec lens. Postoperative best spectacle-corrected visual acuity remained stable after explantation, phacoemulsification, and posterior chamber lens implantation. CONCLUSIONS: Delayed cataract development and cataract type (nuclear) in patients with an Ophtec lens and the variables of patient age (>40 yr) and axial length (>30 mm) may considered prognostic factors. Other factors such as lens design, material, and placement probably influenced cataract formation in patients with the Adatomed and Staar PIOLs. The lens styles used in this study are no longer manufactured.     

Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan

PURPOSE: To evaluate the feasibility and safety of using phakic intraocular lenses (IOLs) to correct high myopia by comparing 3 IOL models: Adatomed, Staar, and Artisan. SETTING: La Fe University Hospital, Department of Ophthalmology, and the Fundación Oftalmológica del Mediterráneo, Valencia, Spain. METHODS: In this prospective comparative study, a phakic IOL was implanted in 217 highly myopic eyes (118 patients). Fifty-nine eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. The mean preoperative spherical equivalent was -15.39 diopters (D) +/- 2.83 (SD), -16.00 +/- 5.05 D, and -16.17 +/- 2.75 D in the Adatomed, Staar, and Artisan groups, respectively. The mean follow-up was 32.4 months (range 19 to 46 months) in the Adatomed group, 18.3 months (range 11 to 21 months) in the Staar group, and 121.4 months (range 38.4 to 154.3 months) in the Artisan group. At the follow-up examinations, intraocular pressure (IOP), IOL pigment deposits, cataract formation, and visual acuity were evaluated. RESULTS: The best corrected and uncorrected visual acuities improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. The difference in mean IOP between preoperatively and the last follow-up examination was 1.5 mm Hg in the Staar group, 1.3 mm Hg in the Adatomed group, and 1.7 mm Hg in the Artisan group (P =.36, P =.26, and P =.32, respectively). The incidence of pigment deposits was similar in the Adatomed and Staar groups, with deposits in 32 eyes (54.23%) and 8 eyes (38.1%), respectively. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. CONCLUSIONS: There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.     

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.     

Long-term complications of bilateral posterior chamber phakic intraocular lens implantation

A 34-year-old woman had posterior chamber phakic intraocular lens (PCP IOL) implantation to correct high myopia in both eyes. Five years postoperatively, the patient presented with a decrease in visual acuity from central anterior subcapsular cataract formation in both eyes and IOL dislocation in the left eye. In vivo confocal microscopy of the cornea showed markedly decreased endothelial cell density in both eyes and the presence of bright endothelial microdeposits possibly related to pigmentary dispersion. Gonioscopy showed angle pigmentary deposits with no intraocular pressure increase. The patient was successfully treated by removing the PCP IOLs and performing phacoemulsification with in-the-bag IOL implantation in both eyes. This led to a recovery of visual acuity. This case report presents the rare occurrence and surgical management of cataract formation, IOL dislocation, and severe endothelial cell loss as a late complication of PCP IOL implantation.     

Myopic implant of the posterior chamber using a flexible Collamer lens

BACKGROUND: The purpose of this study was to report results, effectiveness and safety of implanting a negative collagen/HEMA copolymer posterior chamber phakic intraocular lens in moderate to highly myopic eyes. MATERIAL AND METHODS: 23 eyes from 12 patients with a mean preoperative spherical equivalent refraction of - 10.94 +/- 5.97 D underwent a refractive procedure with the Staar ICL trade mark posterior chamber phakic intraocular lens. The average follow-up was 12.9 +/- 7.4 months (range 4 - 24 months). Preoperative and postoperative uncorrected and best corrected visual acuity, subjective refraction, intraocular pressure, keratometry, ICL trade mark centration and anterior subcapsular opacities were evaluated. RESULTS: Postoperative uncorrected visual acuity improved in all eyes. The best corrected visual acuity increased from 0.82 +/- 0.39 preoperatively to 1.05 +/- 0.24 postoperatively. The gain in visual acuity was statistically significant (Student t-test, p = 0.0097). The mean postoperative spherical equivalent refraction was - 0.82 +/- 1.42 D (p < 0,0001). The mean postoperative intraocular pressure was 15.65 +/- 2.72 mm Hg. The intraocular contact lens remained well centred in all eyes and no anterior subcapsular opacities were observed. Three patients underwent transcient complication without affecting the visual outcome. CONCLUSION: The use of a posterior chamber phakic intraocular lens in myopic eyes is a safe procedure to correct moderate to high myopia. Long-term results are still unknown.     

Lens opacities after posterior chamber phakic intraocular lens implantation

PURPOSE: To describe a case series to determine the incidence of lens opacities after posterior chamber phakic intraocular lens (IOL) implantation (STAAR Surgical, Monrovia, CA) for very high ametropias. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fourteen eyes of 170 consecutive eyes with high ametropias in whom lens opacities developed after posterior chamber phakic IOL implant (PCPIOL). INTERVENTION: Posterior chamber phakic intraocular lens implant. MAIN OUTCOME MEASURES: Lens opacity appearance, localization, and clinical course. RESULTS: Fourteen eyes developed lens opacities 125 +/- 116 days after phakic IOL implant. All eyes had anterior subcapsular opacities, and two eyes also developed nuclear sclerosis. The anterior opacities did not extend posteriorly within the lens, and there were no posterior subcapsular cataracts. Seventy-one percent of opacities were first seen 相似文献   

高度近视可植入接触镜植入术的效果观察

目的观察高度近视可植入接触镜（ICL）的安全性和有效性。方法对77例（140眼）高度近视施行Staar Col-lamer单片式ICL植入。并在术前2周行激光周边虹膜切除术（少数病例在术中施行周边虹膜切除术）。平均年龄28岁（20-37岁）,角膜厚度0.463-0.582 mm,平均0.511 mm,屈光度-20.50D--8.50D,平均-15.50D。随诊观察0.5-2.5年,查视力,测眼压,验光。结果术后裸眼远视力全部较术前提高,70眼（50.00%）裸眼视力好于术前最佳矫正视力,60眼（42.86%）裸眼视力等于术前最佳矫正视力,10眼（7.14%）因高度散光（-3.00D）较术前矫正视力低。1眼（0.714%）术后出现前房纤维素样渗出,12眼（8.57%）出现一过性高眼压,用药后均正常,随诊观察0.5-2.5年,视力无回退,眼压,晶状体及角膜内皮情况较术前均无变化。结论 ICL治疗-8.00D--20.00D高度近视效果好,损伤小,恢复快,具有良好的安全性、有效性和可预测性。     

应用Pentacam三维眼前段分析仪对虹膜夹型人工晶状体植入术后的研究

目的 应用Pentacam术后追踪测量虹膜夹型有晶状体眼人工晶状体(PIOL)中央和周边部与角膜内皮和自然晶体之间的距离,倾斜度、偏心值以及前房深度的变化,评价其在前房的位置.方法 收集自2006年1月以来接受虹膜夹型人晶状体植入术的22例33只眼.术后6个月全部患者行Pentacam检查,测量VRSM50和VRSM60两组不同类型虹膜夹型PIOL中央和周边部与角膜内皮和自然晶体之间的距离,并测量术后1d、1、3及6个月人工晶状体的偏心量、倾斜度及前房深度值.结果 角膜内皮至PIOL光学部前表面距离为(1.94±0.36)mm.PIOL后表面与自然晶状体间的距离为(0.76±0.12)mm.分别比较各组在不同时期的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).在术后1d、1、3及6个月,比较2组的平均偏心量与平均倾斜度,差异无统计学意义(P>0.05).结论 Pentacam三维眼前段分析仪为PIOL植入术后提供高质量的Scheimpflug摄像,可以为有晶状体眼前房型人工晶状体提供精确的眼内定位,在这一方面具有重要的临床应用价值.     

Intraocular lens implantation in phakic rabbit eyes

Three sizes (13.5 mm, 17.5 mm, and 18.5 mm) of open loop, one piece, poly(methyl methacrylate) anterior chamber intraocular lenses (IOLs) were implanted in 12 phakic rabbit eyes to evaluate the effect of the IOL on the crystalline lens and the anterior chamber. Six eyes were used as a control group. Minimum follow-up was four weeks. All the IOLs touched the crystalline lenses, and on the first postoperative day, round subcapsular lens opacities were found in all eyes in the area of IOL contact. The lens opacities became more dense with time. Only one eye in the control group showed a subcapsular opacity, which was linear rather than round. Anterior chamber inflammation was 1+ to 2+ in ten eyes (80%) in the IOL group during the first and second weeks, whereas minimal inflammatory changes occurred in the control group. These results suggest that with current IOL technology, IOL insertion in the phakic eye to correct refractive errors results in a high incidence of cataract if IOL-to-lens touch occurs.     

囊袋张力环在半脱位晶状体的白内障手术中的临床应用

目的:评价囊袋张力环(capsular tension ring,CTR)在晶状体半脱位的白内障手术中的应用。方法:对15例15眼合并白内障的晶状体半脱位患者连续环形撕囊(continues curvilinear capsulorhexis,CCC)后植入CTR,然后行白内障超声乳化,及人工晶状体植入术。结果:所有15眼IOL正位,无倾斜及偏位,术后10～12mo观察矫正视力满意,未发现CTR引起的并发症。结论:CTR植入是治疗合并晶状体半脱位的白内障超声乳化的一种安全、有效的方法,可以防止人工晶状体偏位,减少手术并发症。     

Phakic toric intraocular lens implantation after flap decentration in laser in situ keratomileusis

We describe a patient with flap decentration after laser in situ keratomileusis (LASIK) and subsequent phakic toric intraocular lens (IOL) implantation. A 19-year-old man with mixed astigmatism had LASIK in the left eye complicated by flap decentration. Laser ablation was abandoned and implantation of a phakic toric IOL was done. Ten months after IOL implantation, the uncorrected visual acuity in the left eye was 20/25 and best corrected visual acuity was 20/20 with +0.25 -0.50 x 90. Simulated keratometry values were 44.30@150 and 42.00@60 before LASIK and 45.00@150 and 41.90@60 after IOL implantation. Phakic toric IOL implantation may be adequate treatment for flap decentration after LASIK in cases of mixed astigmatism.     

有晶状体眼后房型人工晶状体植入矫正中高度散光

目的评价有晶状体眼后房型人工晶状体植入矫正中高度散光的有效性、安全性及稳定性。方法选取高度散光105例（187眼）,植入带散光的后房型人工晶状体。随访观察3～36个月。结果裸眼视力均有明显提高,3个月后裸眼视力≥术前最佳矫正视力者182眼占97.33%,散光度数在±1.00D以内者占91.27%,残留散光平均为（-0.56±0.3）D,矫正者占89.72%,术前与术后差异有统计学意义（P〈0.01）。术后2眼（1.07%）发生晶状体前囊下浑浊。结论有晶状体眼后房型人工晶状体植入矫正中高度散光具有有效性、安全性及稳定性。     

Visual outcome and complications in 287 intraocular lens implants (Federow) compared with 290 intracapsular cataract extractions

In 287 consecutively intracapsular cataract extracted eyes with a Federow intraocular lens implant (IOL) and 290 eyes with consecutively performed intracapsular cataract extractions (ICCE) the final visual outcome and complications were examined in a retrospective study. The average observation time was 31 months in the IOL group and 37 months in the ICCE group. Seventy-five per cent in the IOL group and 77% in the ICCE group achieved a visual acuity greater than or equal to 0.5. The main cause of a visual acuity less than 0.5 was maculopathy pre-operatively recognized. A visual acuity less than 0.5 due to post-operative complications occurred more frequently in the IOL group (28 eyes) compared with the ICCE group (13 eyes) - P less than 0.01. Twelve intraocular implants (4.3%) had to be removed. The most important cause was dislocation of the IOL (9 eyes). During our first 12 months of IOL implantation 8 dislocations occurred out of 56 implanted eyes (14.3%). The remaining 6 dislocations occurred among the last 231 IOL eyes (2.6%). It is concluded that complications are few, but often serious in intraocular lens implant surgery. Careful pre-operative examination and surgical experience are mandatory.     

非球面人工晶状体植入术后视功能的临床研究

目的:评价Canon Staar KS—3Ai非球面人工晶状体(IOL)对提高年龄相关性白内障患者术后视功能的作用。方法:年龄相关性白内障患者98例(126眼)随机分成两组。在白内障超声乳化吸除术后,观察组52例(65眼)植入非球面IOL(Canon Staar KS—3Ai),对照组46例(61眼)植入球面IOL(Allergan Sensor AR40e)。观察患者术后的裸眼视力(uncorrected visual activity,UCVA)、最佳矫正视力(best corrected visual activity,BCVA)、屈光状态、对比敏感度(contrast sensitivity,CS)、波前像差的均方根(root mean square,RMS)值。随访时间为术后6mo。结果:术后6mo两组UCVA、BCVA、屈光状态差异无统计学意义。无眩光环境下12,18c/d空间频率和眩光环境下6,12,18c/d空间频率上观察组CS明显优于对照组。在瞳孔直径6mm时,观察组4阶像差、4阶球差、总高阶像差RMS值低于对照组。在瞳孔直径6mm时3阶像差、5阶像差RMS值及瞳孔直径3mm时两组高阶像差RMS值差异无统计学意义。结论:非球面IOL眼视觉质量明显优于球面IOL眼。     

有晶状体眼后房型人工晶状体植入术后的视觉质量

对有晶状体眼植入后房型人工晶状体是矫正屈光不正的有效方法,植入的后房型人工晶状体目前主要有可植入式接触镜(implantable contact lens,ICL)和有晶状体眼屈光性晶状体(phakic refractive lens,PRL)。对术后患者主观视觉质量(视力、对比敏感度)、客观视觉质量(波前像差、点扩散函数、斯特尔比率及光学传递函数)的研究显示,主观视力的提高也伴随着客观视觉质量的改善,但部分患者术后出现光晕及眩光症状。本文主要对ICL和PRL植入术后主观及客观视觉质量的临床研究做一综述,对可影响视觉质量的术后并发症如晶状体前囊膜下混浊、青光眼及角膜内皮功能异常等需进一步远期随访。     

囊袋张力环在晶状体半脱位白内障超声乳化手术中的应用

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在晶状体半脱位白内障超声乳化手术中的应用效果。方法:对13例(13眼)合并晶状体半脱位的白内障患者行白内障手术,术中连续环形撕囊后植入CTR,然后行超声乳化及后房型折叠人工晶状体囊袋内植入。结果:13眼的人工晶状体均处于正位,无明显偏位及倾斜。术后矫正视力>0.8者4眼;0.4~0.7者8眼;0.1者1眼,为老年性白内障合并黄斑区脉络膜新生血管患者,未见由CTR引起的并发症。结论:在超声乳化治疗晶状体脱位的白内障手术中运用CTR,能提高手术安全性,防止人工晶状体偏位,减少手术并发症,是一种良好的白内障手术辅助工具。     

有晶状体眼后房型人工晶状体植入术治疗超高度近视的临床研究

观察分析有晶状体眼后房型人工晶状体植入术（ ICL）治疗超高度近视的临床疗效。方法选择分析我院2011年6月至2013年6月行有晶状体眼后房型人工晶状体植入术治疗超高度近视患者14例（25只眼）。术前常规检查视力、最佳矫正视力,进行各项检查后,行单眼或者双眼有晶状体眼后房型人工晶状体植入术,术后观察视力、眼压及内皮细胞计数变化情况。结果术后视力0．3-1．0。术后2例（3只眼）出现早期眼压升高,经降眼压治疗,3-4 d后眼压正常。结论有晶状体眼后房型人工晶状体植入术治疗超高度近视及散光疗效确切,患者满意度好,预测性好,手术安全。     

有晶状体眼Verisyse人工晶状体植入术矫正超高度近视眼

目的：探讨有晶状体眼Verisyse人工晶状体植入术矫正超高度近视眼的有效性、安全性及可预测性。 方法：超高度近视眼患者10例13眼植入Verisyse人工晶状体。术后观察患者的视力、屈光度数、眼压、角膜内皮细胞计数、对比敏感度、晶状体位置、眩光敏感度、手术并发症及视觉不良症状。 结果：术后患者裸眼视力及最佳矫正视力均有明显的提高。术后3mo及术后1a患者最佳矫正视力≥0.5者占100%,患者最佳矫正视力≥0.8者占85%。患者术后屈光度稳定,术后1mo～1a,屈光状态变化无明显差异。患者术后1a内各时间点眼压均无明显异常升高。术后角膜内皮计数均有所下降,但其差异无统计学意义。术后3mo时,各频段对比敏感度和眩光敏感度较术前均明显提高。Verisyse人工晶状体与角膜内皮和晶状体均保持了有效的安全距离。术后3mo时,2眼可见Verisyse人工晶状体表面炎性反应物沉积,1眼瞳孔呈轻度椭圆形。患者均无明显不适,满意程度较高。 结论：Verisyse人工晶状体矫正超高度近视眼具有良好的有效性、安全性及可预测性,是补充角膜屈光手术不足的有效眼内屈光手术,但其远期效果有待进一步观察。     

青光眼白内障联合术植入不同材料人工晶状体效果评价

目的比较青光眼白内障联合术中植入不同材料人工晶状体（IOL）的临床效果。方法回顾性分析行青光眼白内障联合术70例（76眼），其中植入PMMA IOL30例（36眼），硅胶IOL23例（23眼），丙烯酸酯折叠IOL17例（17眼）。对治疗效果进行评价，平均随访期限为10．5月。结果3组间术后眼压和最佳矫正视力差异无统计学意义。前房纤维素样渗出物和IOL表面沉积物发生率，硅胶组高于PMMA组和丙烯酸酯组，但差异无统计学意义。后发障发生率，丙烯酸酯组和硅胶组显著低于PMMA组，差异有统计学意义。结论行青光眼白内障联合术植入PMMA，硅胶与丙烯酸酯IOL在降眼压和提高视力方面具有相似的效果。但硅胶IOL的前房纤维素样渗出物及IOL表面沉积物发生率高于PMMA和丙烯酸酯IOL。丙烯酸酯和硅胶IOL的后发障发生率低于PMMA IOL。     

Visual acuity, contrast sensitivity, reading speed, and wavefront analysis: pseudophakic eye with multifocal IOL (ReSTOR) versus fellow phakic eye in non-presbyopic patients

PURPOSE: To compare the visual performance in the pseudophakic eye and the phakic eye in four patients who underwent unilateral intraocular lens (IOL) implantation. METHODS: Four patients presenting with unilateral cataract underwent ReSTOR (Alcon Laboratories, Ft Worth, Tex) IOL implantation in their nondominant eye, targeting emmetropia. RESULTS: Uncorrected near visual acuity was >20/32 in all operated eyes and best spectacle-corrected distance visual acuity was 20/16 for two eyes, 20/25 for one eye, and 20/32 for one eye. Reading speed was similar between the eyes, but not for critical print size. Contrast sensitivity was lower in the pseudophakic eyes. Wavefront analysis showed no considerable difference in total high order aberrations, coma, and spherical aberration between eyes for all patients. CONCLUSIONS: In young patients with unilateral cataract surgery, unilateral multifocal IOL implantation provides satisfactory visual acuity and may be considered an alternative treatment option in this patient population.