scholarly journals Evaluation of the efficacy, safety, and stability of posterior chamber phakic intraocular lenses for correcting intractable myopic anisometropic amblyopia in a pediatric cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fathy Fawzy Morkos ◽  
Nader F. Fawzy ◽  
Mohamed El Bahrawy ◽  
Nada Fathy ◽  
Rania Serag Elkitkat
Keyword(s):  
Visual Acuity ◽  
Conventional Therapy ◽  
Case Series ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Anisometropic Amblyopia ◽  
Occlusion Therapy ◽  
Phakic Intraocular Lenses ◽  
Safety And Stability

Abstract Background Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort. Methods This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed. Results The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients’ visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy. Conclusions The present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia.

A Long Term Follow Up of Posterior Chamber Phakic Intraocular Lenses for Correcting Intractable Pediatric Myopic Anisometropic Amblyopia

2021 ◽  
Author(s):  
Fathy Fawzy Morkos ◽  
Nader F. Fawzy ◽  
Mohamed El Bahrawy ◽  
Nada Fathy ◽  
Rania Serag Elkitkat
Keyword(s):  
Conventional Therapy ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
P Value ◽  
Anisometropic Amblyopia ◽  
Occlusion Therapy ◽  
Phakic Intraocular Lenses ◽  
Safety And Stability

Abstract Background Pediatric myopic anisometropic amblyopia is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropic amblyopia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of amblyopia and loss of binocular vision. The aim of the present study was to evaluate the visual and refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting pediatric myopic anisometropic amblyopia. Methods This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised 42 eyes of 42 children with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow up visits were scheduled, with subjective refraction and Pentacam imaging performed. Results The patients’ age range was 3 to 18 years (mean ± SD = 10.58 years ± 4.23). The mean preoperative SE was − 12.54 D ± 2.93. The results declared a significant improvement in the postoperative CDVA (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow up visits had a mean ± SD of 14.67 months ± 16.56 (range of 1 to 54 months). The results showed a refractive stability, with slight (statistically insignificant) improvements in the subjective refraction between the first postoperative and the follow up visits. No postoperative complications were encountered. Conclusions The present study, with the longest reported follow up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting pediatric myopic anisometropic amblyopia. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases of failed conventional therapy to guard against anisometropic amblyopia.

scholarly journals Explantation of domestic models of posterior chamber phakic intraocular lenses in the development of subcapsular cataract in higly myopic patients: clinical features

2021 ◽  
Vol 14 (1) ◽  
pp. 61-64
Author(s):  
G. V. Sorokoletov ◽  
E. R. Tumanyan ◽  
A. N. Bessarabov ◽  
M. A. Soboleva
Keyword(s):  
Young Patients ◽  
Optical Power ◽  
Functional Results ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Corneal Incision ◽  
Irrigation Solution ◽  
Phakic Intraocular Lenses ◽  
Surgical Tactics

To date, the operation of choice in young patients with high myopia, is the implantation of posterior chamber phakic intraocular lenses (PIOL), provided that there are contraindications to keratorefractive interventions, However, in the late postoperative period, cataracts may occur, which requires the development of surgical tactics for lens explantation with simultaneous phacoemulsification of cataract (FEC) implementation.The purpose is to develop and analyze a method for removing a PIOL through a 2 mm corneal incision in subcapsular cataract cases.Material and methods. Posterior chamber domestic models of PIOL type RSK-1(3) and RSK-3 in 22 patients (37 eyes), implanted in the S.N. FEDOROV “EYE MICROSURGERY” clinic in 1994 – 2001 had to be removed due to the development of secondary cataracts. PIOL stayed in the eye 2 to 26 years (averagely 14.30 ± 1.30 yrs). In all cases, the P IOL was removed followed by FEC with implantation of a posterior chamber IOL. The optical power of the IOL was calculated mainly in such a way that the residual myopic refraction was 2.0–3.0 D.Results. The intraoperative condition of the anterior chamber was stable, the volume of irrigation fluid consumed was within 90–120 ml. No complications were detected in the early and late postoperative periods. The results of dynamic ophthalmological follow up of patients showed that visual acuity without correction and with correction after surgery averaged 0.2 ± 0.1 and 0.60 ± 0.15, respectively.Conclusion. The proposed method of explantation of domestic lenses of S.N. FEDOROV NMRC MNTK “EYE MICROSURGERY” shows that it enables a safe, simple removal of PIOL in the event of secondary subcapsular cataract, which allows achieving high clinical and functional results without overspending the irrigation solution.

scholarly journals Verisyse versus Veriflex Phakic Intraocular Lenses: Refractive Outcomes and Endothelial Cell Density 5 Years after Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Dilek Yaşa ◽  
Alper Ağca
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Density ◽  
Endothelial Cell Density ◽  
Intraocular Lenses ◽  
Distance Visual Acuity ◽  
Medical Optics ◽  
Significant Difference ◽  
Phakic Intraocular Lenses

Purpose. To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years.Methods. We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively.Results. The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (−0.25 ± 0.30 D and −0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group,p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed.Conclusion. Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile.

scholarly journals Management of Dislocated Intraocular Lenses with Iris Suture

2016 ◽  
Vol 27 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Mun Y. Faria ◽  
Nuno P. Ferreira ◽  
Mario Canastro
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Clinical Signs ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Pigment Dispersion ◽  
Corneal Incision ◽  
The Mean

Purpose Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. Methods In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. Results A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Conclusions Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

scholarly journals Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia: Five-year follow-up

2011 ◽  
Vol 37 (5) ◽  
pp. 873-880 ◽  
Author(s):  
José F. Alfonso ◽  
Begoña Baamonde ◽  
Luis Fernández-Vega ◽  
Paulo Fernandes ◽  
Jose M. González-Méijome ◽  
...  
Keyword(s):  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Phakic Intraocular Lenses

Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series

2019 ◽  
Vol 104 (5) ◽  
pp. 712-717 ◽  
Author(s):  
Maria Montserrat Bausili Portabella ◽  
Jeroni Nadal ◽  
Juan Alvarez de Toledo ◽  
María Fideliz de la Paz ◽  
Rafael Ignacio Barraquer
Keyword(s):  
Visual Acuity ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Special Focus ◽  
Slit Lamp ◽  
Long Term Outcome ◽  
Slit Lamp Examination ◽  
Special Cases

PurposePurpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage.SettingBarraquer Institute in Barcelona, Spain.DesignRetrospective study of consecutive cases.MethodsStudy of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis.Results345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79.ConclusionsScleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.

Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up

2019 ◽  
Vol 257 (7) ◽  
pp. 1555-1560 ◽  
Author(s):  
Khosrow Jadidi ◽  
Seyed Aliasghar Mosavi ◽  
Farhad Nejat ◽  
Neda Mohammadi ◽  
Hosein Aghamolaei ◽  
...  
Keyword(s):  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Phakic Intraocular Lenses

Long-term results of Descemet-stripping automated endothelial keratoplasty for endothelial failure caused by phakic intraocular lenses

2020 ◽  
pp. 112067212095093
Author(s):  
Diogo Hipólito-Fernandes ◽  
Maria Elisa-Luís ◽  
Miguel Vieira ◽  
Sara Crisóstomo ◽  
Nuno Alves ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Young Patients ◽  
Case Series ◽  
Intraocular Lenses ◽  
Long Term Results ◽  
Endothelial Keratoplasty ◽  
Visual Rehabilitation ◽  
Phakic Intraocular Lenses

Purpose: To describe the surgical approach and long-term outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) for endothelial failure secondary to phakic intraocular lenses (pIOL). Methods: Retrospective, interventional case series of 18 eyes of 13 patients who developed endothelial failure secondary to pIOL implant. Patients were submitted to pIOL explant and DSAEK for visual rehabilitation, with or without phacoemulsification plus posterior-chamber intraocular lens implant. The minimum follow-up time was 3 years and the main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD) and percentage of endothelial cell loss (ECL), intraoperative and postoperative complications. Results: Patients’ mean age was 47.44 (7.86) years with a mean follow-up time of 55.61 (14.13) months. Sixteen eyes (88.9%) had an angle-supported pIOL. The mean pIOL implant-to explant time was 8.17 (2.73) years. BCVA improved from 1.00 (0.36) logMAR preoperatively to 0.29 (0.36) logMAR at 1 year of follow-up ( p < 0.001), remaining stable over the entire follow-up period ( p > 0.05). At the last visit, all corneas were clear, with a mean ECD of 724.74 (325.57) cells/mm2. During the follow-up, two eyes (11.1%) required a re-DSAEK due to early graft failure (<3 months). Conclusion: Our outcomes reveal that an individualized and careful approach may result in a stable visual rehabilitation in young patients with corneal decompensation following pIOL implant.

scholarly journals Toric and Phakic IOLs for the Treatment of Astigmatism and/or High Myopia: Our Experience at Prince Hashem Hospital Zarqa

2019 ◽  
pp. 1-6
Author(s):  
Nancy Al Raqqad ◽  
Naser Al Fgara ◽  
Mohammad Dros
Keyword(s):  
Visual Acuity ◽  
High Myopia ◽  
Contact Lenses ◽  
Intraocular Lenses ◽  
Implantable Collamer Lens ◽  
Proper Patient Selection ◽  
Toric Iols ◽  
Surface Laser ◽  
Phakic Intraocular Lenses

Aim: to share our experience in treating patients with high myopia and or astigmatism  using toric and phakic intraocular lenses at Prince Hashem Hospital in Jordan. Patients and Methods: This is a retrospective study of fifty eyes of 36 patients who were treated between June 2015 and July 2016 at Prince Hashem Hospital in Jordan. Patients’ age ranged between 22 years and 54 years. All patients had high myopia (≥6 dipoters) and/or astigmatism and were not eligible for surface laser ablation and intolerant to contact lenses. Preoperative best corrected visual acuity BCVA, ophthalmological slit lamp examination, manifest and cycloplegic refraction, corneal topography using Oculus Pentacam and IOL master were obtained in all patients. Results: In all the patients preoperative refraction ranged between -4 to -33 sphere and -3.5 to -8 cylinder. Phacoemulsification and implantation of toric intraocular lenses (IOL) was done in 21 patients, Visian implantable collamer lens (sphere and toric ICL) were implanted in 18 patients and toric iris claw lenses (Ophthec Artisan/ Artiflex) were used for the remaining 11 patients. All surgical procedures were done under local anesthesia. All patients showed improvement in their visual acuity after surgery and spectacle independence. Complications were minimal in the form of lens rotation resulting in decrease in BCVA seen in 3 patients with toric IOLs and two Visian ICLs patients.  High intraocular pressure was seen in one patient. Mean follow-up period was between 6 months to 1 year. Conclusion: Toric and phakic IOLs can be very useful in correcting astigmatism and or myopia. Proper patient selection and counseling is essential to ensure best refractive outcome and avoid complications.

Implantation of Phakic Anterior Chamber Lens for the Treatment of Extreme Myopia

2021 ◽  
Vol 11 (1) ◽  
pp. 63-69
Author(s):  
Hongyun Wu ◽  
Liqun Hu
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Negative Effects ◽  
Implantable Collamer Lens ◽  
Before And After ◽  
Macular Retinal Thickness ◽  
Phakic Intraocular Lenses

The purpose of this study was to examine visual function and eye structure before and after implantation of an intraocular lens in the phakic posterior chamber of the eye, for the correction of extreme myopia. Thirty subjects with 12∼ –27 diopters of extreme myopia were implanted with posterior chamber phakic intraocular lenses, and followed-up for 3–27 months. The follow-up examinations included uncorrected visual acuity (UCVA), best corrected visual acuity (BSCVA), intra ocular pressure (IOP), refractive power, lens transparency, intra ocular lens (IOL) position, endothelial cell density (ECD), anterior chamber depth (ACD), axial length, near point of accommodation, and macular retinal thickness. All indices improved after the surgery. These results demonstrate that the implantable collamer lens (ICL) for extreme myopia can effectively improve vision, and does not have negative effects on eye structure and accommodation.

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