Piggyback intraocular lens implantation to correct myopic pseudophakic refractive error after penetrating keratoplasty

PURPOSE: To determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct myopic pseudophakic refractive error after penetrating keratoplasty (PKP). SETTING: Department of Ophthalmology, Toronto Western Hospital, Toronto, Ontario, Canada. METHODS: In this retrospective case series, 6 eyes of 6 post-PKP pseudophakic patients had a second piggyback IOL implantation to correct a residual myopic refractive error. The uncorrected visual acuity (UCVA) and the best corrected visual acuity (BCVA) were measured at regular intervals during a 7-month follow-up. Efficacy was determined by the achieved refractive correction and Snellen UCVA measurements. Safety was measured by loss of BCVA and complications (intraoperative and postoperative). RESULTS: The UCVA improved in all cases. Five patients achieved a BCVA of 20/40 or better postoperatively. Before surgery, the mean spherical equivalent (SE) was -8.08 diopters (D) (range -6.13 to -12.00 D). After surgery, the mean SE was -0.94 D (range -2.38 to +0.25 D). Four patients were within +/-1.50 D of emmetropia. There were no intraoperative or postoperative complications. CONCLUSION: Implanting a piggyback IOL was a safe and effective means of correcting myopic pseudophakic refractive error post PKP.     

Implantation of an ARTISANtrade mark toric phakic intraocular lens to correct high astigmatism after penetrating keratoplasty

BACKGROUND: Visual outcome after penetrating keratoplasty is often Iimited by residual astigmatism. Sometimes conservative treatment modalities like glasses or contact lenses fail to correct the keratoplasty-associated astigmatism. Refractive options are arcuate keratotomy, photorefractive keratectomy or laser in situ keratomileusis. The implantation of an ARTISAN toric intraocular lens presents an additive option to correct corneal astigmatism in phakic eyes. This toric intraocular lens (IOL) has an optical zone of 5.0 mm with a sphericaI front and a toric back. The torus of the IOL is available up to 7 D in half dioper steps. CASE REPORT: A 27-year old female presented with a bestcorrected visual acuity of 20/32. Penetrating keratoplasty was performed in 1997 because of a decompensated keratoconus. Despite a clear allgraft visual acuity was limited because of a keratoplasty-related high astigmatism of 7.6 D/124 degrees, which could not be sucessfully treated with glasses or contact lenses. An ARTISAN toric intraocular lens with - 3 D spherical and 7.0 D/0 degrees cylindrical power (individually manufactured) was implanted via a sclerocorneal tunnel incision into the anterior chamber. Postoperatively an optimal graft clarity with a well-centered and stable-positioned IOL was found. After 3 months uncorrected visual acuity was 20/25. Six months after implantation the IOL was still well-centered and uncorrected visual acuity was 20/20. CONCLUSION: Implantation of an ARTISAN toric intraocular lens in phakic eyes is an alternative and new option to correct higher astigmatism. In contrast to the keratorefractive option minor manipulation on the allograft can be expected. For a final conclusion of the endothelial cell loss longer follow-up is necessary.     

Effectiveness of LASIK to correct refractive error after penetrating keratoplasty

OBJECTIVE: Refractive errors may invalidate the good results of penetrating keratoplasty (PK). The Authors evaluate the effectiveness of excimer laser in situ keratomileusis (LASIK) in the correction of refractive error after PK. MATERIALS AND METHODS: Four patients, a 26-year-old woman, a 54-year-old man, a 19-year-old man, and a 51-year-old woman, showed refractive errors: -11 = -4.5 x 85 ; -8, -4.5 = -11 x 95 ; and -4.5 = -4 x = 1200, with a clear graft at least 20 months after penetrating keratoplasty secondary to keratoconus. However, they underwent the LASIK procedure with a nasal-hinged flap of 160 um. No sutures were placed. RESULTS: At follow-up, 24, 18, 12, and 12 months, respectively, the graft remained clear and the endothelial cells were unchanged. The uncorrected visual acuities were 20/50, 20/25, 20/50, and 20/25, respectively with an unchanged best corrected visual acuity (20/20) for all patients. No significant complications were observed. CONCLUSIONS: LASIK procedure seems to be an effective technique to correct refractive error after successful penetrating keratoplasty.     

Piggybacking intraocular implants to correct pseudophakic refractive error

ObjectiveTo determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct pseudophakic refractive error.DesignNoncomparative, prospective, consecutive case series.ParticipantsEight eyes of eight normal pseudophakes and seven eyes of seven postpenetrating keratoplasty (PK) pseudophakes were included in the study.InterventionA second intraocular lens (IOL) was implanted anterior to the first in each eye in the study.Main outcome measuresEfficacy was determined based on the achieved refractive correction and Snellen uncorrected visual acuity measurements. Safety was determined based on loss of best-corrected visual acuity and operative and postoperative complications.ResultsBefore surgery, spherical equivalents ranged from −5.12 diopters (D) to 7.5 D, with a mean absolute deviation from emmetropia of 3.38 D (1.62). After surgery, spherical equivalents ranged from −2.75 D to 0.5 D, with a mean absolute deviation from emmetropia of 1.21 D (0.90). Before surgery, only 7% of patients had 20/40 or better uncorrected vision, whereas after surgery, 50% had that level of vision.ConclusionsImplanting a second IOL is a viable option for correcting pseudophakic refractive error.     

Retinal detachment in myopic eyes after phakic intraocular lens implantation

PURPOSE: To analyze the risk of retinal detachment in highly myopic patients who underwent implantation of phakic intraocular lenses (PIOLs). METHODS: In a retrospective, non-comparative, interventional case series, the occurrence of retinal detachment was analyzed in 522 consecutive highly myopic eyes (323 patients) that underwent PIOL implantation. Treatment and results were reviewed. Parameters evaluated were best corrected visual acuity before and after retinal detachment surgery and time between refractive surgery and retinal detachment. RESULTS: Fifteen (2.87%) eyes presented with retinal detachment after PIOL implantation, with a mean time between surgery and detachment of 24.4 +/- 24.4 months (range: 1 to 92 months). The risk of retinal detachment in patients with high myopia corrected by PIOL implantation was 0.57% at 3 months, 1.64% at 12 months, 2.73% at 36 months, and 4.06% at 92 to 145 months (Kaplan-Meier analysis). A comparative study between the group of patients with retinal detachment and the remaining patients without retinal detachment was performed. Differences were found in axial length (30.65 +/- 1.97 vs 29.51 +/- 2.02; P=.028, one factor-analysis of variance test). CONCLUSIONS: The risk of retinal detachment in eyes implanted with phakic lenses for the correction of high myopia is higher in eyes with axial length >30.24 mm.     

Choroidal neovascularization in myopic eyes after phakic refractive lens and iris-claw lens implantation

PURPOSE: To describe the appearance of choroidal neovascularization (CNV) in two myopic patients after implantation of a phakic refractive lens (PRL) and an iris-claw lens. METHODS: A PRL was implanted in the left eye of a 35-year-old myopic man. Five weeks later, he reported decreased best-corrected visual acuity (BCVA). Fluorescein angiography revealed juxtafoveal CNV Photodynamic therapy with Visudyne (PDT) was successfully performed, achieving closure of the membrane. BCVA was 20/40 3 months afterwards. An iris-claw lens was implanted in the left eye of a 24-year-old myopic man. BCVA after surgery was 20/40 (SE -0.75). Three years later subfoveal CNV was diagnosed. PDT was performed, achieving complete closure of CNV BCVA was 20/100 3 months after treatment. CONCLUSIONS: The appearance of CNV in myopic eyes corrected by phakic intraocular lens implantation is a possible complication that must be considered.     

Macular choroidal neovascularization in myopic eyes after phakic intraocular lens implantation

PURPOSE: To analyze the development and characteristics of choroidal neovascularization in highly myopic patients corrected by the implantation of phakic intraocular lenses (PIOLs). METHODS: This retrospective, noncomparative interventional case series studied the development of choroidal neovascularization in 522 consecutive highly myopic eyes (spherical equivalent refraction >-6.00 diopters [D] and/or axial length >26 mm) (323 patients) corrected by the implantation of PIOLs, the treatment performed, and the results obtained. Parameters evaluated were best spectacle-corrected visual acuity (BSCVA) before and after treatment of choroidal neovascularization, and the interval between refractive surgery and the development of choroidal neovascularization. RESULTS: Follow-up ranged from 12 to 145 months (mean: 60.4 +/- 39.1 months). In 12 (2.29%) eyes, choroidal neovascularization developed after PIOL implantation at a mean interval time of 33.7 +/- 29.6 months (range: 1 to 87 months). Using Kaplan-Meier analysis, the risk of choroidal neovascularization in patients with high myopia corrected by PIOL implantation was 0.57% at 5 months, 0.81% at 18 months, 1.31% at 24 months, and 3.72% at 87 to 145 months. No statistically significant differences were found between patients with and without choroidal neovascularization in the following parameters: axial length (P=.826), age (P=.296), initial BSCVA (P=.085), spherical equivalent refraction (P=.663), and follow-up (P=.955). CONCLUSIONS: Phakic intraocular lens implantation for the correction of high myopia does not play a role in the development of choroidal neovascularization.     

Retinal detachment after phakic intraocular lens implantation in severe myopic eyes

Background

To report the incidence, clinical presentation, and surgical outcomes of retinal detachment in highly myopic patients corrected by implantation of phakic intraocular lenses (PIOLs).

Methods

This is a retrospective interventional non-comparative case series. A total of 530 highly myopic eyes that underwent PIOLs implantation were included in the study. All patients completed at least a 2-year follow-up after PIOL implantation. The incidence of retinal detachment (RD) and subsequent treatments were reviewed. The refractive errors, axial lengths, time between refractive surgery and RD detection, vitreoretinal findings, rate of retinal reattachment, and the pre- and postoperative best-corrected visual acuity (BCVA) were analyzed.

Results

The overall incidence of RD was 1.5?% (eight eyes of seven patients) with a mean time between PIOL implantation and detachment of 23.63?±?18.12?months (range, 2?days–51?months). Mean spherical equivalent (SE) before PIOL implantation was ?17.53?±?3.86 diopters (D) (range, ?11.5D to ?23.5D). Six patients underwent bilateral PIOL implantation. Five eyes were implanted with anterior chamber PIOLs and the other three received posterior chamber PIOLs. A traumatic history was presented before RD detection in four cases. Horseshoe tears, atrophic holes, or giant retinal tears were found in four (50?%), two (25?%), and two (25?%) eyes, respectively. Two eyes (25?%) underwent scleral buckling surgery, five eyes (62.5?%) underwent pars plana vitrectomy surgery, and one eye (12.5?%) underwent both procedures. Anatomical retinal attachment was achieved after first RD surgery in seven eyes. Mean BCVA after PIOL implantation and before RD was 20/40 (decimal refraction, 0.51?±?0.31) compared to that of 20/80 (decimal refraction, 0.26?±?0.12) after the RD surgery. Mean follow-up after RD surgery was 20.63?±?12.93?months (range, 8–42?months).

Conclusions

The incidence of RD after PIOLs implantation is low. Its characteristics do not differ significantly from the natural history of RD in high myopic eyes. PIOL implantation for surgical correction of severe myopia does not seem to increase the risk of RD. Good visual prognosis can be obtained with early surgical intervention.     

Implantation of an Artisan phakic intraocular lens for the correction of high myopia after penetrating keratoplasty

We report 2 cases in which an Artisan phakic intraocular lens (IOL) (Ophtec) was used to successfully treat high myopia after penetrating keratoplasty (PKP). The first case was a 43-year-old man who had a manifest refraction of -13.75 +3.00 x 50 with a best corrected visual acuity (BCVA) of 20/40(-2) after PKP in the left eye. Approximately 9 months after implantation of the Artisan IOL, the manifest refraction was -2.00 +2.50 x 60 with a BCVA of 20/30(+2). The second case was a 31-year-old man who had a manifest refraction of -10.75 +2.25 x 122 and a BCVA of 20/40 after corneal transplantation in the right eye. Ten months after implantation of the Artisan IOL, the manifest refraction was -2.75 +4.75 x 80 with a BCVA of 20/40. Endothelial cell density did not change significantly in either patient after surgery. The Artisan phakic IOL may provide an alternative method to correct high myopia after PKP.     

有晶状体眼前房人工晶状体植入术矫正高度近视的临床分析

目的:探讨有晶状体眼Verisyselens(虹膜固定型前房人工晶状体)植入术矫正高度近视的临床疗效及安全性。方法:我院于2004-11始开展了Verisyselens(虹膜固定型人工晶状体)植入术,4例(6眼)高度近视(度数-13.5～22.0D之间),密切观察术后眼压、屈光改变、视力及角膜、虹膜情况,随访1a以上。结果:大部分超过术前最佳矫正视力1～2行,术前裸眼视力0.02～0.2,最佳矫正视力由0.25～0.5,恢复到术后裸眼视力0.5～0.6。并发症较轻、较少,恢复快,仅1例为晶状体偏中心并眩光发生,经再次手术调整晶状体正位后,眩光消失,1眼一过性眼压升高,1眼角膜轻度水肿,1眼虹膜少许脱色素,本组中另3眼出现晶状体表面尘样色素附着,(虹膜未见脱色),但均未影响视力,眼压不高。均未见严重并发症。结论:虹膜固定型前房人工晶状体植入术矫正高度近视,术后视力效果好,屈光度稳定,可预测性强,短期随访,安全性高,但国人为有色人种,术后虹膜持续为晶状体夹持,导致少量而持续脱色素,可能引发严重并发症,尚需注意长期随访。     

Toric intraocular lens to correct high astigmatism after penetrating keratoplasty in a pseudophakic eye - a case report]

BACKGROUND: After penetrating keratoplasty residual astigmatism can be treated with various options. Correction with spectacles or contact lenses, methods such as radial keratotomy, photorefractive keratectomy (PRK) or Laser-in-situ keratomileusis (LASIK) are limited only to mild and moderate astigmatism. In laser ablation a sufficient corneal thickness must be ensured. On the other hand surgical correction is performed on transplanted tissue which can increase the risk of allograft rejection. In pseudophakic eyes the implantation of an individually designed toric intraocular lens (IOL) according to keratometry and biometry with a cylindrical power up to 12 D provides an alternative method for correcting higher astigmatism. This individually designed IOL can be implanted additionally to the existing IOL. CASE: A 66-year-old patient presented after penetrating keratoplasty and implantation of an IOL 4 years ago with a visual acuity of 20/160 and residual astigmatism of - 10 D x 151(o). After biometry an individually manufactured toric PMMA-IOL of + 12 D cylindrical and - 9.5 D spherical power was implanted via a sclerocorneal tunnel incision additionally to the existing IOL into the ciliary sulcus. Postoperatively a well centered and stable positioned IOL was found. One year after implantation of the toric IOL the position was still unchanged and the graft had remained clear. Spherical equivalent refraction was + 1,5 D - 3,0 D x 141(o), with an uncorrected visual acuity of 20/60. CONCLUSION: Implantation of a toric intraocular lens in pseudophakic eyes allows the correction of high astigmatism after penetrating keratoplasty. The advantage of this method compared to the keratorefractive options lies in its minor manipulation on the allograft.     

有晶状体眼虹膜固定型人工晶状体植入术后远期视觉质量

目的 探讨有晶状体眼虹膜固定型人工晶状体(verisyse iris-fixated phakic intraocular lens,Verisyse PIOL)植入术后患者的远期视觉质量.方法 选择行Verisyse PIOL植入术后20例(40眼)高度近视患者,观察术前及术后1个月、4.5a患者裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best spectacle-corrected visual acuity,BSCVA)、等效球镜(spherical equivalent,SE)、散光度等,并行患者满意度调查.结果 术后4.5 a UCVA≥0.5者34眼(87.2％),BSCVA≥0.5者39眼(100.0％);和术前相比,术后4.5 a UCVA、BSCVA差异均有统计学意义(t=15.73、6.52,P=0.00、0.00);术后4.5a与术后1个月相比,UCVA、BSCVA差异均无统计学意义(t=0.70、1.71,P=0.49、0.10);术后1个月UCVA、BSCVA与术前相比,差异均有统计学意义(t=15.94、6.38,P=0.00、0.00).术后4.5a,28眼(70.0％) UCVA等于或高于术前BSCVA,5眼(12.5％)UCVA低于术前BSCVA 2行以上.SE为0～-1.25(-0.34±0.35)D,与术后1个月(-0.31±0.55)D相比差异无统计学意义(t=0.25,P=0.80),38眼SE在预期的0～-1D之间.眼压稳定,为11～19(14.83±1.91) mmHg(1 kPa =7.5 mmHg).散光度术后1个月、术后4.5a分别为(1.57±0.81)D、(1.31±0.67)D,差异有统计学意义(P =0.037).患者满意度问卷调查显示,患者总体满意度较高.结论 Verisyse PIOL矫正高度近视安全有效,预测性好,远期疗效稳定,无严重并发症发生.     

Corneal edema and penetrating keratoplasty after anterior chamber phakic intraocular lens implantation

Phakic intraocular lens (IOL) implantation is an increasingly popular option in surgical correction of refractive error. To date, reports of long-term morbidity are infrequent in the literature. We encountered 3 patients who experienced corneal decompensation and cataract progression following angle-fixated anterior chamber phakic IOL placement.     

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.     

前房型人工晶状体植入治疗高度近视眼

目的探讨前房内植入房角支撑型硬性人工晶状体治疗高度近视眼的预测性、安全性和有效性。方法40例(76只眼)高度近视眼患者,术前屈光度数为-9.50～-26．25 D,平均(-15．89±3.78)D,术前最佳矫正视力0．5～1．0,植入房角支撑型硬性人工晶状体(Phakic 6H型)矫正高度近视眼,平均随访时间为1年。术前术后观察裸眼视力、矫正视力、届光度数、眼压、角膜内皮和眼前节的变化等。结果术后1年,裸眼视力为0．3～1．5,最佳矫正视力0．5～1．5,残余屈光度数为-2.00～+0．50 D,平均(-0．40±0．64)D,屈光度数在≤±1．00 D以内占96．1％。术前和术后1年角膜内皮细胞计数分别为(3174±248)个／mm2和(3067±320)个／mm2,两者比较,差异有统计学意义(P<0．01)。术前和术后1年眼压分别为(16．12±2.32)mm Hg(1mm Hg=0．133 kPa)和(15．29±3．38)mm Hg,两者比较,差异有统计学意义(P<0．05)。4只眼主诉有眩光。2只眼瞳孔呈竖椭圆形,2只眼晶状体下偏约1．0 mm。1例患者双眼在术后8个月时曾出现黄斑区出血。结论有晶状体眼房角支撑型硬性人工晶状体治疗超高度近视眼安全有效,且预测性好,值得进一步临床研究,长期疗效和安全性有待进一步观察。     

玻璃体切割术后原晶状体眼和人工晶状体眼屈光的长期变化

目的探讨玻璃体切割术后原晶状体眼和人工晶状体眼屈光的长期变化及临床意义。方法对34例（其中21只眼为原晶状体,13只眼为晶状体摘除及人工晶状体植入术后）玻璃体切割术后的屈光变化经过术后1年的随访观察。结果经过随访观察,原晶状体眼明显近视化改变,其中6只眼因白内障进行性发展而于玻璃体切割术后一年进行了白内障手术;然而人工晶状体眼却没有明显的屈光变化。结论由于玻璃体切割术后很容易发生白内障及近视,可在玻璃体切割术同时做晶状体摘除及人工晶状体植入术。