Artisan aphakic intraocular lens implantation in cases of subluxated crystalline lenses due to Marfan syndrome

PURPOSE: To assess implantation of an Artisan aphakic intraocular lens (IOL) in cases with subluxated lenses due to Marfan syndrome. METHODS: Retrospective study of a small case series comprised of seven eyes (two children and three adults) with subluxated lenses due to Marfan syndrome that underwent lens extraction and Artisan aphakic IOL implantation. Best spectacle-corrected visual acuity and endothelial cell status were the key elements of follow-up examinations. RESULTS: No complications occurred during surgery. Visual acuity was improved by > or = 4 Snellen lines in all seven eyes. These results were maintained at the last follow-up. Endothelial cell status remained constant in all cases at 6-month follow-up. CONCLUSIONS: In seven eyes with a subluxated crystalline lens due to Marfan syndrome, implantation of an Artisan aphakic IOL improved visual acuity while preserving anterior chamber status.     

Artisan虹膜夹持型人工晶状体植入治疗马凡综合征晶状体半脱位

目的探讨Artisan 虹膜夹持型人工晶状体（IOL）植入术治疗马凡综合征晶状体半脱位的有效性和安全性。方法 回顾性病例研究。2007年12月至2011年7月在广东省人民医院眼科确诊的马凡综合征晶状体半脱位患者16例（25眼）,行连续环形撕囊后,完成晶状体吸除、晶状体囊膜切除、前段玻璃体切割、Artisan IOL前房虹膜夹持固定和虹膜周边切除术。比较手术前后裸眼视力（UCVA）、最佳矫正视力（BCVA）、眼压、角膜内皮细胞计数,记录术后虹膜夹持型IOL位置、角膜内皮细胞丢失率,术中、术后并发症情况。随访时间6个月。采用非参数检验（Wilcoxon 检验）对手术前后UCVA和BCVA进行比较。结果 术后6个月UCVA和BCVA均较术前明显提高,术前和术后6个月UCVA（logMAR）分别为1.05±0.26和0.46±0.29,两者相比差异有统计学意义（Z=-4.530,P<0.01）。术前和术后6个月BCVA（logMAR）分别为0.68±0.32和0.27±0.22,两者相比差异具有统计学意义（Z=-2.208,P<0.01）。术后所有患眼虹膜夹持型IOL位置居中,单眼复视症状消失。术后2眼出现一过性高眼压,1眼出现脉络膜脱离,1眼出现视网膜脱离,未发生IOL移位、角膜失代偿等严重并发症。术后6个月平均角膜内皮细胞丢失率为5.6%。结论 Artisan虹膜夹持型IOL植入治疗晶状体严重脱位可提高视力,消除单眼复视且安全有效。     

Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children

Purpose:

To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children.

Setting:

Tertiary care setting

Materials and Methods:

We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO).

Results:

Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL.

Conclusions:

Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation     

Artisan虹膜固定型人工晶状体在无晶状体眼患者中的应用

目的 观察Artisan虹膜固定型人工晶状体（IOL）在无晶状体眼患者中的应用.方法 回顾性病例系列研究.2008年1月到2010年5月间行Artisan IOL植入术且临床资料完整的无晶状体眼患者46例（46眼）,年龄为21～56岁,平均（32.8±5.2）岁,其中男28例,女18例.所有患者均在神经阻滞麻醉下行Artisan前房虹膜固定型IOL植入,术后随访3～10个月.对手术所需时长、患者裸眼视力、最佳矫正视力、手术源性散光、瞳孔散大直径、角膜内皮计数和术后并发症等指标进行分析,对手术的疗效和安全性进行评估.手术前后裸眼视力、最佳矫正视力和眼压的比较采用配对t检验.结果 植入Artisan IOL所需手术时间平均为（19.8±6.6）min.患者裸眼视力均较术前有明显提高（0.49±0.23 vs1.21±0.22）,与目标屈光状态的差值平均为0.27 D;最佳矫正视力与术前相比无明显差异,手术源性散光为1.45 D.植入IOL后瞳孔直径最大可散至6.77 mm;角膜内皮细胞丢失率为3.6%.术后出现一过性高眼压的有4眼（8.7%）;虹膜萎缩有3眼（6.5%）;IOL脱位1眼（2.2%）.结论 Artisan虹膜固定型IOL在无晶状体眼治疗中具有较好的疗效和较高的安全性,是无晶状体眼患者理想的IOL选择之一.     

Pigment dispersion and Artisan phakic intraocular lenses: crystalline lens rise as a safety criterion

PURPOSE: To validate the theory that crystalline lens rise can be used as a safety criterion to prevent pigment dispersion in eyes with an Artisan phakic intraocular lens (IOL) (Ophtec BV). SETTING: Monticelli Clinic, Marseilles, France. METHOD: A comparative analysis of crystalline lens rise in 9 eyes with pigment dispersion and 78 eyes without dispersion was performed. All eyes had previous implantation of an Artisan IOL. Anterior segment imaging was done using an anterior chamber optical coherence tomography (AC OCT) prototype. Crystalline lens rise was defined by the distance between the anterior pole of the crystalline lens and the horizontal plane joining the opposite iridocorneal recesses. RESULTS: The study confirmed that crystalline lens rise can be considered a safety criterion for implantation of Artisan-type phakic IOLs. The higher the crystalline lens rise, the greater the risk for developing pigment dispersion in the area of the pupil. This complication occurred more frequently in hyperopic eyes than in myopic eyes. Results indicate there is little or no risk for pigment dispersion if the rise is less than 600 microm; 67% of eyes with a rise of 600 microm or more developed pupillary pigment dispersion. In some cases in which the IOL was loosely fixated, there was no traction on the iris root and dispersion was prevented or delayed. CONCLUSIONS: Crystalline lens rise should be considered a new safety criterion for Artisan phakic IOL implantation and should also be applied to other types of phakic IOLs. The distance remaining between the crystalline lens rise and a 600 microm theoretical safety level allows one to calculate how long the IOL can safely remain in the eye.     

Vertical placement of aphakic Artisan intraocular lens in a patient with traumatic localized aniridia

We report a 50-year-old patient who had secondary implantation of an aphakic Artisan (Ophtec) intraocular lens (IOL) that was placed vertically in the anterior chamber. The patient had had a perforating injury to the cornea that required corneal wound repair, lensectomy, and anterior vitrectomy. Because of the localized traumatic aniridia, the Artisan IOL could not be placed horizontally. Three months after surgery, the best corrected visual acuity was 0.9 and there were no complications.     

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM: To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A:25 eyes received Artisan iris-claw IOL implantation. Group B:20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.     

Scleral-fixated intraocular lens implantation in unilateral aphakic children

OBJECTIVE: To assess the feasibility of scleral-fixated intraocular lens (IOL) implantation as an alternative form of optical correction in aphakic children intolerant of contact lenses and whose anterior segments lack capsular support. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: A total of 11 eyes of 11 unilateral aphakic children in the age group 4 to 9 years (mean, 6.45 years) were included in the study. INTERVENTION: Secondary scleral-fixated IOL implantation was performed in all cases. The patients underwent anterior vitrectomy at the time of IOL implantation. Amblyopia therapy in the form of patching was given post-IOL surgery. The follow-up ranged from 4 to 18 months (mean, 10.90 months). MAIN OUTCOME MEASURES: Postoperative best-corrected visual acuity (BCVA) in comparison to preoperative visual status and complications from the procedure were analyzed. RESULTS: Postoperative BCVA remained within 1 Snellen line of the preoperative visual status in six eyes, or 54.5% of patients; it improved by more than 1 Snellen line in three eyes, or 27.2% of patients, and decreased by more than 1 Snellen line in two eyes, or 18.1% of patients. The complications encountered were suture erosion through the conjunctiva in two eyes (18.18%), marked postoperative anterior chamber reaction in two eyes (18.18%), IOL decentration in one eye (9.09%), glaucoma in one eye (9.09%), and cystoid macular edema in one eye (9.09%). CONCLUSION: Secondary scleral-fixated IOL implantation was successful in achieving BCVA comparable to preoperative BCVA. However, a longer follow-up is required to document any further complications.     

Penetrating keratoplasty and Artisan iris-fixated intraocular lens implantation in the management of aphakic bullous keratopathy

OBJECTIVE: To evaluate the safety and efficacy of aphakic bullous keratopathy (ABK) management with combined PK, anterior vitrectomy, angle synechiolysis, and Artisan intraocular lens implantation. METHODS: Fourteen eyes of 11 patients underwent the procedure. Mean follow-up was 12-36 months (mean 24) for visual acuity (Va), refractive error (RE), intraocular pressure (IOP), tonography, graft clarity, intraocular lens centration, and any complications. RESULTS: The postoperative mean values were: Va improved from 20/400 to 20/50, spherical RE was -2.65 diopters, IOP was 17.5 mmHg, tonography improved by 55%, all grafts were clear; no IOL decentrations or serious complications were noted. CONCLUSIONS: This iris-fixated intraocular lens appears to offer simplicity in implantation and may be combined with PK, anterior vitrectomy, and angle synechiolysis. It may be a safe and effective alternative with PK in the management of ABK.     

Outcome of iris fixation of subluxated intraocular lenses

Background

The aim of this study was to evaluate the efficacy of iris fixation of subluxated intraocular lenses (IOLs).

Methods

A retrospective study of 44 consecutive cases of subluxated IOLs that underwent iris fixation of the IOL. Demographic information, data regarding surgery, and follow-up were retrieved from patient files. All eyes were operated on in a similar fashion by the same anterior segment surgeon (A.M.) utilizing the McCannel suture technique and/or the Siepser slipknot technique. The main outcome measures were visual acuity improvement, surgically induced astigmatism, and assessment of complications.

Results

Ten eyes had a documented complication during primary cataract extraction. Pseudoexfoliation was present in 11 eyes (25?%). History of ocular trauma and high myopia were present in six eyes (each). Excluding eyes with macular disease and very low visual acuity, visual acuity improved from 0.4 (± 0.05) logMAR to 0.24 (± 0.05) logMAR (p?=?0.047). Eyes with low pre-operative astigmatism did not worsen post-operatively (R square linear?=?0.8, p?Conclusions In this study of 44 eyes, iris fixation was proven to be a an effective method for treating subluxated IOLs.     

Cupid fixation for repositioning subluxated intraocular lens

We describe the cupid fixation technique, which allows safe repositioning of a subluxated intraocular lens (IOL). Under subconjunctival anesthesia, the body of the subluxated IOL is perforated with a 10-0 polypropylene suture on a straight needle. The IOL is then centered and fixated at the sclera overlying the ciliary sulcus; the knot is tied beneath a previously created limbal intrascleral pocket. No intraoperative complications occurred in 24 cases in which the technique was performed, and successful IOL centration was achieved.     

Experience with the Artisan phakic intraocular lens in Asian eyes

PURPOSE: To investigate the efficacy and safety of implantation of an iris-claw phakic intraocular lens (PIOL), Artisan Myopia, in Asian eyes. SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: Forty-four eyes of 32 Japanese patients and 1 Korean patient with high myopia had Artisan Myopia lens implantation to correct their refractive errors. Lens models, 5/8.5 or 6/8.5 (optic diameter/overall diameter), were chosen as standard lens model. A smaller lens model (5/7.5-Artisan Myopia Small) was implanted in eyes with corneal diameter less than 11.0 mm. Postoperative examinations were performed on 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, corneal endothelial cell counts, intraocular pressure, and complications were evaluated. RESULTS: Artisan Myopia Small lenses were implanted in 4 eyes (9.1%) and 8.5 mm diameter lenses were implanted in 40 eyes. Preoperative UCVA (logMAR) improved from 1.57 to 0.09 at 1 month after surgery and no regression was observed thereafter. Postoperative manifest refraction was -1.02 +/- 0.87 D (-3.25 to -0.00 D), and within 1.0 D in 20 eyes (55.6%), within 2.0 D in 32 eyes (88.9%) at 1 month after surgery, and stable during the follow-up period. The final BCVA decreased 2 lines in 2 eyes (4.5%) due to progression of age-related cataract. No serious complications such as angle closure or progressive endothelial cell loss were observed. CONCLUSION: Implantation of an Artisan iris-claw PIOL implantation may be a safe and effective procedure for Asian eyes.