Postoperative astigmatism and rotational stability after artisan toric phakic intraocular lens implantation

PURPOSE: To evaluate deviations in the axis (intended versus achieved) and postoperative astigmatism after implantation of an Artisan toric phakic intraocular lens (IOL). SETTING: University Eye Hospital, Mainz, Germany. METHODS: This prospective study comprised 29 eyes with high ametropia and astigmatism. All eyes had uneventful implantation of a toric phakic IOL through a superior scleral tunnel incision at 12 o'clock. After a minimum of 6 months, the uncorrected visual acuity (UCVA), best correct visual acuity, refraction, and astigmatism were analyzed in all eyes. A multivariate analysis of postoperative astigmatism was performed. RESULTS: After a follow-up of at least 6 months, 95% of eyes were within +/-1.00 diopter (D) of emmetropia and 85% of eyes has a UCVA of 20/30 or better. The difference between the mean intended cylinder axis and achieved cylinder axis was 3.9 degrees (median 3 degrees; range to 13 degrees). The difference between the mean intended axis and the achieved axis between miosis and mydriasis was 1.8 degrees (median 1.5 degrees; range 0 to 5 degrees). The mean postoperative astigmatism after 6 months was 0.56 D with an axis of 31 degrees. Doubled-angle scatterplot analysis showed a tendency toward more flattening in the vertical meridian. CONCLUSIONS: During the 6-month follow-up, no significant rotation was observed after implantation of Artisan toric phakic IOLs to correct high ametropia. A sutureless sclerocorneal superior approach for phakic IOL insertion resulted in moderate to low astigmatism. Induced astigmatism should be taken into consideration during preoperative planning.     

Artisan toric lens implantation for correction of postkeratoplasty astigmatism

PURPOSE: To determine the efficacy of Artisan toric iris-fixated lens implantation after penetrating keratoplasty to correct high ametropia and astigmatism. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Artisan toric lens implantation was performed in 16 eyes of 16 patients who were contact lens intolerant or were unable to wear glasses because of anisometropia, high astigmatism, or both. INTERVENTION: Sixteen eyes of 16 patients received Artisan toric lenses for postkeratoplasty astigmatism, anisometropia, or both. MAIN OUTCOME MEASURES: Manifest refraction, uncorrected and spectacle-corrected visual acuity, and corneal topography were performed before surgery and 1, 3, 6, 12, and 18 months after surgery. Efficacy, percent reduction of refractive astigmatism, topographical astigmatism, anisometropia of defocus, and the astigmatism correction index were determined. A patient satisfaction questionnaire and specular microscopy results were assessed. RESULTS: The mean +/- standard deviation of the preoperative refractive cylinder was -6.66+/-1.93 diopters (D; range, -4.0 to -10.0 D), which was reduced to -2.08+/-1.33 D, -2.14+/-1.76 D, -1.98+/-1.65 D, -1.84+/-0.77 D, and -1.42+/-0.78 D at 1 month, 3 months, 6 months, 12 months, and the final follow-up examination (8.4+/-4.9 months), respectively. Spherical equivalent was reduced from -4.90+/-5.50 D before surgery to -0.96+/-0.86 D at the final follow-up. The uncorrected and best-corrected visual acuities were >/=20/40 in 42% and 100% of eyes, respectively. There was no loss of best-corrected visual acuity and a gain of at least 2 lines in 50% of eyes. The percent reduction in refractive astigmatism, topographical astigmatism, and anisometropia of defocus were 78.0+/-11.5%, 20.3+/-34.9%, and 77.0+/-12.0%, respectively. The astigmatism correction index was 102.8+/-18.6%. Satisfaction increased from 3.2 to 8.3 after implantation. The endothelial cell loss was 7.6+/-18.9% at 3 months and 16.6+/-20.4% at the last follow-up. In 1 patient, a reversible graft rejection occurred. CONCLUSIONS: Artisan toric lens implantation after penetrating keratoplasty was effective for reduction of refractive astigmatism and ametropia. All patients were suitable for spectacle correction after implantation. A longer follow-up and a larger number of patients are needed to assess the safety and the effect of the lens on the corneal graft endothelium.     

Toric phakic intraocular lens for the correction of hyperopia and astigmatism

PURPOSE: To evaluate the Artisan toric phakic intraocular lens (pIOL) for the correction of hyperopia and astigmatism. SETTING: Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands, and Department of Ophthalmology, Sint Truiden, Belgium. METHODS: In this prospective study of 47 eyes of 28 patients with hyperopia and astigmatism, Artisan toric pIOLs were implanted between April 1999 and June 2004. Uncorrected visual acuity (UCVA), best corrected visual acuity, refraction, astigmatism, safety, and predictability were analyzed. Change in astigmatism was analyzed with vector analysis. Refractive cylinders are expressed in minus form. RESULTS: Mean preoperative spherical equivalent was +4.33 diopters (D) +/- 2.26 (SD). Mean follow-up was 11.1 months (range 6 to 36 months). A gain of 1 or more lines in best spectacle-corrected visual acuity (BSCVA) was seen in 36.2%. Safety index and efficacy index after 6 months were 1.06 and 0.87, respectively. The mean postoperative astigmatism at 6 months was 0.19 D at an axis of 144 degrees. At 6 months, about three quarters (76.6%) of the eyes had a UCVA of 20/40 or better. One eye lost 2 lines of BSCVA. In 1 eye, the lens position had to be changed because of a large axis misalignment. No serious complications developed in any of the treated eyes during follow-up. CONCLUSIONS: Artisan toric pIOLs can correct moderate to high hyperopia combined with astigmatism with good refractive results. In this study, there were no serious complications. However, the predictability of the refractive results appeared to be lower than those in the correction of myopia and astigmatism with toric Artisan lenses.     

高度角膜散光白内障患者植入Toric IOL的临床观察

目的:评估高度角膜散光患者植入高度数环曲面人工晶状体（AcrySof Toric intraocular lens,Toric IOL）术后的视力和屈光结果。 方法:对21例24眼高度角膜散光的白内障患者行回顾性系列研究,术前角膜散光≥2.5D,植入AcrySof Toric IOL(T6,T7,T8或者T9)。研究数据包括术前和术后3mo的裸眼远视力（uncorrected distance visual acuities,UCDVA）、最佳矫正远视力（best-corrected distance visual acuities,BCDVA）、术前角膜散光、术后残留散光和散光轴向的偏离情况。 结果:术后3mo的UCDVA中75%（18/24）患眼视力＞05,显著高于术前BCDVA,两组差异有统计学意义（χ2=50.12,P<0.05）。术前角膜散光是3.45±0.63D。术后3mo残留的散光是0.72±0.23D。两者差异具有统计学意义（t=0.128,P＜0.01）。术后67%（16/24）的眼残留散光＜0.75D,83%（20/24）的眼＜1.00D。术前预计矫正散光312±0.54D,术后实际矫正散光3.05±0.66D,两者差异无统计学意义（t=1.659,P＞0.05）。人工晶状体术后3mo和1wk之间的旋转度数是3.2°±2.1°。 结论:植入高度数Toric IOL是一种安全的、有效的和可预测的治疗白内障合并高度角膜散光的方法。     

Implantation of Artisan toric phakic intraocular lenses for the correction of astigmatism and spherical errors in patients with keratoconus

PURPOSE: To evaluate the correction of astigmatism and spherical ametropia in patients with keratoconus through implantation of an Artisan toric phakic intraocular lens (PIOL) (Ophtec, Groningen, The Netherlands). METHODS: Artisan toric PIOLs were implanted uneventfully in both eyes of three patients with keratoconus with clear central corneas and contact lens intolerance. RESULTS: Best spectacle-corrected subjective visual acuity after lens implantation was unchanged in one eye and improved in five eyes. Spherical equivalent refraction was significantly reduced in all eyes (P=.03). The safety index was 1.49. CONCLUSIONS: The implantation of an Artisan toric PIOL may be an alternative for treating astigmatism and myopia in contact lens intolerant patients with keratoconus with clear central corneas. Especially in patients with associated myopia, this procedure is worth considering before planning a penetrating keratoplasty.     

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.     

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.     

Iris-fixated toric phakic intraocular lens: Three-year follow-up

PURPOSE: To evaluate the 3-year safety, efficacy, predictability, and stability of iris-fixated toric phakic intraocular lens (pIOL) implantation for the correction of myopia or hyperopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg University, Mainz, and Department of Ophthalmology, University Clinic, Bochum, Germany. METHODS: A prospective clinical trial of 40 eyes of 23 patients with high ametropia and astigmatism was conducted. Best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity, refraction, astigmatism, intraocular pressure, slitlamp biomicroscopy, and indirect ophthalmoscopy were measured preoperatively and postoperatively. RESULTS: Of the 40 eyes, 28 were myopic and 12 were hyperopic. Three years postoperatively, 70% of eyes were within +/-1.00 diopter (D) of the targeted refraction. In the myopic group, mean preoperative BSCVA was 20/40 and improved postoperatively to 20/25. Sixty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.58 D +/- 1.26 (SD) preoperatively to -1.15 +/- 1.01 D postoperatively. In the hyperopic group, preoperative BSCVA was 20/25 and improved to 20/20 postoperatively. Thirty-six percent of eyes gained 1 or more lines from the preoperative BSCVA. The mean cylinder decreased from -3.37 +/- 0.88 D to -1.53 +/- 0.69 D postoperatively. The correction was stable in all eyes 3 years after surgery. No potentially sight-threatening complications occurred. CONCLUSION: The 3-year follow-up showed the iris-fixated toric pIOL was effective in correcting high ametropia and astigmatism.     

Evaluation of a toric intraocular lens with a Z-haptic

PURPOSE: To evaluate the efficacy and rotational stability of the MicroSil 6116TU foldable 3-piece silicone toric intraocular lens (IOL) (HumanOptics). SETTING: Department of Ophthalmology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom. METHODS: This prospective observational study included 21 eyes of 14 consecutive patients with more than 1.50 diopters (D) of preexisting corneal astigmatism having cataract surgery. Phacoemulsification was performed, and a MicroSil 6116TU toric IOL was inserted through a 3.4 mm temporal corneal incision. LogMAR uncorrected visual acuity (UCVA), best corrected visual acuity, refraction, keratometry, and cylinder axis of the toric IOL were measured. RESULTS: The mean preoperative refractive and keratometric astigmatism was 3.52 D +/- 1.11 (SD) and 3.08 +/- 0.76 D, respectively. Six months postoperatively, the logMAR UCVA in eyes without ocular comorbidity (n = 14) was 0.20 +/- 0.15 (Snellen 20/32). Seventy-nine percent (11 eyes) had a visual acuity of 0.24 (Snellen 20/35) or better. The mean refractive astigmatism at 6 months was 1.23 +/- 0.90 D. Vector analysis using the Holladay-Cravy-Koch method showed a mean reduction in refractive astigmatism of 2.16 +/- 2.33 D. The mean difference between intended and achieved cylinder axis at 6 months was 5.2 degrees (range 0 to 15 degrees). No IOL rotated more than 5 degrees during the follow-up period. CONCLUSIONS: The MicroSil 6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence. The IOL was stable in the capsular bag, showing no significant rotation up to 6 months postoperatively.     

Implantation of a toric phakic intraocular lens to correct high corneal astigmatism in a patient with bilateral marginal corneal degeneration

We present a patient with marginal corneal degeneration and corneal astigmatism of more than 10.0 diopters (D). A toric phakic intraocular lens (IOL) of 7.0 D cylindrical power was implanted in both eyes to correct the high astigmatism. An uncorrected visual acuity of 20/40 was achieved in both eyes, and the best corrected visual acuity improved by 4 Snellen lines to 20/20 in both eyes. Refraction and visual acuity remained stable at 1.5 years postoperatively. Implantation of a toric phakic IOL can be an option to correct high corneal astigmatism even when the full corneal astigmatism cannot be treated.     

Astigmatism correction with a foldable toric intraocular lens in cataract patients

PURPOSE: To determine the efficacy and rotational stability of a toric posterior chamber silicone intraocular lens (IOL) to correct preoperative astigmatism in cataract patients. SETTING: Department of Ophthalmology, University Hospital of Vienna, Vienna Austria. METHODS: Between 1993 and 1998, foldable toric single-piece plate-haptic silicone IOLs were implanted in 37 eyes (30 patients). The cylindrical IOL power was 2.00 diopters (D) (n = 29), 3.50 D (n = 7), or 4.00 D (n = 1). Phacoemulsification was performed through a scleral or a corneal sutureless self-sealing incision. Outcomes of Snellen visual acuity (without, with spherical, and with best correction), refractive and keratometric astigmatism, and IOL rotation after early postoperative (mean 15.9 days +/- 10.1 [SD]) and long-term (mean 20.3 +/- 16.6 months) follow-ups were evaluated. RESULTS: At last follow-up, 31 eyes (83.8%) had a spherically corrected and 34 (91.9%) a best corrected visual acuity of 0.5 (20/40) or better. Mean preoperative refractive and keratometric astigmatism was 2.68 and 2.70 D, respectively. At the last postoperative follow-up, mean refractive astigmatism was reduced to 0.84 D; keratometric astigmatism was 2.30 D. In 7 eyes (18.9%), the IOL axis was rotated a maximum of 25 degrees. In all 37 eyes, the axis of the toric IOL remained within 30 degrees of rotation. CONCLUSIONS: Early postoperative and long-term follow-ups showed effective and stable correction of astigmatism after implantation of a foldable toric posterior chamber silicone IOL.     

Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes

PURPOSE: To evaluate the change in contrast sensitivity after implantation of the Verisyse toric phakic intraocular lens (IOL) (AMO) for the correction of myopia with astigmatism. SETTING: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. METHODS: Eighteen eyes had implantation of an iris-supported toric phakic IOL to correct myopia with astigmatism. The mean preoperative spherical equivalent was -12.65 diopters +/- 3.6 (SD). The contrast sensitivity with best spectacle correction was determined before surgery and 3 months after surgery using the CSV-1000 HGT instrument (Vector Vision Inc.). RESULTS: Three months after IOL implantation, the mean contrast sensitivity had significantly increased from preoperatively at midrange spatial frequencies from 3.2 to 4.4 (6 cycles per degree [cpd]; P = .033) and from 2.4 to 3.7 (12 cpd; P = .032). The differences at spatial frequencies of 3 cpd and 18 cpd were not statistically significant (P = .59 and P = .086, respectively). CONCLUSIONS: Implantation of the Verisyse toric iris-claw lens in phakic eyes to correct high or moderate myopia with astigmatism has the potential to improve contrast vision. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels.     

Artisan phakic intraocular lens for myopia:short-term results of a prospective,multicenter study

PURPOSE: To evaluate the safety and efficiency of the Artisan iris-supported phakic intraocular lens (Ophtec BV, Groningen, Netherlands) for the correction of high myopia. STUDY DESIGN: Nonrandomized, prospective, multicenter trial conducted under a United States Food and Drug Administration (FDA) Investigational Device Exemption. PARTICIPANTS: One hundred fifty-five eyes of 155 patients with myopia from -5.5 to -22.5 diopters (D) underwent implantation of an Artisan lens, as part of a phase I, II, or III FDA trial. METHODS: Eyes were examined at 1 day (154 eyes), 2 weeks (142 eyes), 2 months (130 eyes), and 6 months (84 eyes). Intraocular pressure and presence of flare and cell on slit-lamp biomicroscopy were recorded at each visit. MAIN OUTCOME MEASURES: Achieved correction, stability of spherical equivalent refraction, change in astigmatism, postoperative uncorrected vision, change in best spectacle-corrected acuity, and change in endothelial cell count. RESULTS: Mean spherical equivalent manifest refraction stabilized on postoperative day 1. Mean difference between attempted and achieved correction at 2 months was -0.32 +/- 0.95 D (mean +/- standard deviation; range, -4.42 to +2.2 D). At 6 months, 85% of eyes saw 20/40 or better uncorrected, and 90% of eyes were within 1 D of the attempted correction. Refractive astigmatism increased in 4.8% of eyes and decreased in 17% of eyes at 6 months. At 2 months, six eyes (4.8%) lost two or more lines of best spectacle-corrected visual acuity; by 6 months, no eyes lost two or more lines of best-corrected visual acuity. Endothelial cell count was unchanged at 6 months compared with the preoperative count. Nonprogressive lens opacities developed in four eyes as a result of surgical trauma. Chronic inflammation was not detected in any eye by slit-lamp biomicroscopy, nor did any eye develop angle closure or glaucoma. CONCLUSIONS: Short-term results suggest that the Artisan lens is an accurate and safe method for the correction of high myopia. Surgical skill is important in avoiding lens opacities. Longer-term data are needed to assess the impact of the lens on the endothelium, the crystalline lens, and the iris.     

Evaluation of axis alignment and refractive results of toric phakic IOL using image-guided system

AIM: To evaluate accuracy of axis alignment and refractive results of toric phakic intraocular lens(IOL) implantation using a digital imaging system. METHODS: This retrospective study investigated toric implantable collamer lens(ICL) implantation in 30 eyes of 21 patients with myopic astigmatism more than 2.0 D guided with digital imaging system. Data were collected during the first week after phakic IOL implantation.RESULTS: Thirty eyes of 21 patients were included in our study. Patients includes 9 males and 12 females. The mean age of the patients was 26.5±7.1(range 21-44)y. The mean preoperative manifest astigmatism was 3.2±1.7(range from 2.25 to 4.75) D. The mean postoperative uncorrected distance visual acuity(UCDVA) were 0.07±0.07(range from 0.1 to 0.0) log MAR. The mean postoperative residual refractive cylinder was 0.25±0.29(range 0-0.75) D. Eyes with postoperative residual refractive cylinder of 0.5 D or less represented 80%(24 eyes). The mean postoperative toric IOL misalignment measured by the OPD scan III was 1.9°±1.45°(range from 0 to 5°). CONCLUSION: Image guided system allows accurate alignment of toric ICL. This is associated with good postoperative visual acuity and low residual refractive astigmatism which correlates with the precision of toric phakic IOL alignment.     

Toric intraocular lenses for correcting astigmatism in 130 eyes

OBJECTIVE: This study evaluated the results after implantation of toric intraocular lenses (IOLs) to correct preexisting corneal astigmatism in patients undergoing either cataract or clear lens extraction surgery. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred thirty eyes of 99 patients who underwent phacoemulsification and posterior chamber toric IOL implantation from January 1997 through February 1998 were included in the study. INTERVENTION: Implantation of a toric IOL was performed after cataract surgery (122 eyes) or clear lens extraction surgery (eight eyes). Both preoperative corneal cylinder and refractive cylinder powers were more than 1.50 diopters (D) for all the eyes included in this study. To provide a comparison, we also studied 51 eyes of 45 patients meeting the same preoperative criteria for degree of corneal and refractive cylinder who underwent implantation of a spherical (nontoric) IOL combined with limbal relaxing incisions. The data for both study and comparison groups were analyzed retrospectively. The selection for the two groups was arbitrary. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), mean spherical equivalent, residual refractive cylinder, and toric IOL axis. RESULTS: In the toric IOL group, 84% of eyes achieved 20/40 or better UCVA. In the spherical IOL group, 76% achieved 20/40 or better UCVA. The mean postoperative refractive cylinder was -1.03 +/- 0.79 D in the toric IOL group and -1.49 +/- 0.75 D in the spherical IOL group. CONCLUSIONS: Our results indicate that phacoemulsification and posterior chamber toric IOL implantation is a largely predictable new surgical option to correct preexisting corneal astigmatism in cataract or clear lens extraction surgery.     

Outcome after treatment of ametropia with implantable contact lenses

OBJECTIVE: To evaluate long-term results after insertion of implantable contact lenses (ICLs) in phakic eyes. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Seventy-five phakic eyes (65 myopic, 10 hyperopic eyes) of 45 patients aged 21.7 to 60.6 years were included. INTERVENTION: STAAR Collamer Implantable Contact Lenses (STAAR Surgical Inc., Nidau, Switzerland) were implanted for correction of high myopia and hyperopia. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were determined. Presence of lens opacification and the distance between the ICL and the crystalline lens were assessed by slit-lamp examination before surgery and at 1, 3, 6 months, and yearly after lens implantation. RESULTS: Preoperative mean spherical equivalent was -16.23+/-5.29 diopters (D) for myopic eyes and +7.88 +/-1.46 D for hyperopic eyes. After ICL implantation, mean residual refractive error was -1.77+/-2.17 D in myopic patients and +0.44+/-0.69 D in hyperopic patients. Preoperative mean UCVA was Snellen 0.03+/-0.03 for myopic patients and Snellen 0.12+/-0.16 for hyperopic patients. Preoperative mean BCVA was Snellen 0.49+/-0.23 for myopic patients and Snellen 0.82+/-0.23 for hyperopic patients. After ICL implantation, mean UCVA up to the end of individual observation time was Snellen 0.36+/-0.36 for myopic patients and Snellen 0.58+/-0.28 for hyperopic patients. Mean BCVA was Snellen 0.73+/-0.26 for myopic and Snellen 0.80+/-0.24 for hyperopic patients. Mean preoperative IOP was 14.2+/-2.7 mmHg, and mean postoperative IOP was 13.46+/-2.1 mmHg over all follow-up investigations. The main complication was the development of subcapsular anterior opacifications of the crystalline lens in 25 eyes (33.3%), 2 of which showed direct contact to the ICL. Eleven eyes (14.7%) were stable in opacification and 14 eyes (18.7%) had progressive opacifications. The median time to opacification was 27.1 months. In 8 patients (10.7%), the subjective visual impairment mandated cataract surgery. CONCLUSIONS: The most significant long-term complication after ICL implantation is the formation of opacifications of the crystalline lens with the risk of the necessity of subsequent cataract surgery (10.7%). Old age, female gender, and contralateral opacification are independent significant risk factors for early formation of opacifications in this patient group.     

Retinal detachment in phakic eyes with anterior chamber intraocular lenses to correct severe myopia

PURPOSE: To analyze the incidence and characteristics of retinal detachment in patients with severe myopia corrected by implantation of phakic anterior chamber intraocular lenses. METHODS: We studied retinal detachments in 166 consecutive eyes (98 patients) that underwent implantation of angle-supported phakic anterior chamber intraocular lenses (models ZB5M and ZB5MF; Domilens; Lyon, France) for the correction of severe myopia (follow-up +/- SD, 45.26 +/- 14.65 months; range, 20 to 84 months). RESULTS: Retinal detachment occurred in eight eyes (4.8%); four eyes belonged to men and four to women. The time between implanting surgery and retinal detachment was 17.43 +/- 16.4 months (range, 1 to 44 months). In all cases, retinal detachment was spontaneous. In seven eyes, the retina was reattached successfully during the first retinal detachment surgery. Mean best-corrected visual acuity after phakic anterior chamber intraocular lens implantation and before retinal detachment development was 20/50 (range, 20/100 to 20/25). After retinal detachment repair, best-corrected visual acuity was 20/73 (range, 20/2000 to 20/33). In these seven eyes, differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .898, paired Student t test). In one eye, a proliferative vitreoretinopathy was observed, which required additional treatment by vitrectomy and explantation of the phakic anterior chamber intraocular lens. A refractive change was observed after retinal detachment repair, from -1.1 +/- 0.7 diopters (range, 0.00 to -2.50 diopters) before retinal detachment and -2.8 +/- 1.1 diopters (range, -1.00 to -4.50 diopters) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: The implantation of a phakic anterior chamber intraocular lens as a correcting procedure for severe myopia was followed by a 4.8% incidence of retinal detachment. Conventional scleral surgery was successful in most cases, without causing significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after retinal detachment repair in these patients.     

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia

PURPOSE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. SETTING: Instituto Oftalmólogico de Alicante, Alicante, Spain. METHODS: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. RESULTS: At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. CONCLUSIONS: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.     

有晶状体眼后房散光型IOL植入矫正高度近视散光

目的：评价有晶状体眼后房散光型人工晶状体(TICL)植入术矫治高度近视散光的临床效果。

方法：选自2009-10/2011-11接受TICL植入的高度近视散光患者30例50眼,术前平均屈光度球镜-10.75±2.65D,柱镜-2.85±0.75D。随访观察术后3mo～2a裸眼视力、最佳矫正视力、屈光度、内皮细胞计数等情况,分析并发症的发生情况。

结果：术后裸眼视力：0.5～1.2(平均0.75±0.34)。术前最佳矫正视力：0.3～1.0(平均0.58±0.35),术后最佳矫正视力0.6～1.2(平均0.78±0.35)。达到术前矫正视力20眼(40%),超过术前最佳矫正视力30眼(60%),随访3mo～2a,视力无明显变化。术后屈光度数平均球镜-0.52±0.35D,柱镜0.52±0.25D。角膜内皮细胞计数术前3 026±250个/mm²,术后3mo为3 023±246个/mm²,差异无统计学意义(P<0.05)。未见严重影响视力的并发症。

结论：TICL植入矫治高度近视散光安全有效,是高度近视散光患者的理想治疗方法。对眼内的长期影响需要进一步观察。     

Visual improvement in high myopic amblyopic adult eyes following phakic anterior chamber intraocular lens implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1-5) numeric scale. RESULTS: The mean age of patients was 37.3 +/- 9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10 +/- 5.41 diopters (D). The postoperative mean refraction (SE) was -1.75 +/- 0.76 D at six months. The postoperative BCVA improved an average 3.92 +/- 1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.