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 t…

Changes in higher-order aberrations after implantation of a foldable iris-claw lens in myopic phakic eyes

Purpose To evaluate the change in higher-order aberrations (HOAs) after implantation of a foldable iris-claw phakic intraocular lens (pIOL) in myopic eyes. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods This prospective nonrandomized comparative self-controlled trial included 41 eyes that had implantation of a foldable iris-claw pIOL between July 2003 and November 2004. All patient data for HOAs (Zernike coefficient) were measured and calculated using the same pupil size preoperatively and postoperatively, and the root-mean-square (RMS) wavefront error was calculated. Examinations were performed preoperatively as well as 1 week and 3, 6, and 12 m…

The "sandwich technique" for iris-fixated phakic intraocular lens implantation.

ABSTRACT PURPOSE: To describe a new technique of implantation of the Artisan/Verisyse phakic intraocular lens (PIOL). METHODS: After PIOL insertion into the anterior chamber, a bolus of a high viscosity ophthalmic viseosurgical device (OVD) is placed over the optic, separating it widely from the endothelium. RESULTS: The technique decreases the chance of endothelial damage during enclavation. CONCLUSIONS: A bolus of a high viscosity OVD placed on the anterior surface of the Artisan/Verisyse PIOL may make enclavation safer. [J Refract Surg. 2006;22:96-98.]

Incisional Keratotomy to Toric Intraocular Lenses: An Overview of the Correction of Astigmatism in Cataract and Refractive Surgery

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

Abstract 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…

Kosteneffektivitätsanalyse der Versorgung von Kataraktpatienten mit monofokalen Intraokularlinsen aus Sicht der Leistungserstatter

BACKGROUND Data on the cost effectiveness of cataract surgery with respect to the German statutory health insurance system are hardly available. Hence the increase in visual acuity as primary efficacy endpoint, order of posterior capsule opacification as primary complication endpoint and direct cost for supplementation with monofocal intraocular lenses have been assessed via meta-analyses to evaluate the procedure's cost effectiveness from the perspective of the German statutory health insurance system. MATERIAL AND METHODS Using the medical internet database MEDLINE two meta-analyses on publications between 1995 and 2002 were carried out, one estimating the gained increase in visual acuity…

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses.

ABSTRACT PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOLoptic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpf lug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01±0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32±0.18 mm at the 12 o'clock p…

Impact of the line of sight on toric phakic intraocular lenses for hyperopia

We present a hyperopic patient with a decentered line of sight in whom the residual refractive error after toric phakic intraocular lens (TP IOL) implantation was improved by displacement and individualized treatment. A 35-year-old woman presented with asthenopic complaints 2 months after bilateral TP IOL implantation and IOL rotation 4 weeks later. Examination revealed the line of sight to be nasally and inferiorly decentered in relation to the center of the pupil. A more nasal reenclavation of the TP IOL decreased the coma, and the uncorrected visual acuity was 20/20. We conclude that line of sight should be measured before TP IOL implantation, especially in hyperopic eyes.

Preoperative simulation of postoperative iris-fixated phakic intraocular lens position and simulation of aging using high-resolution Scheimpflug imaging

To increase postoperative safety after implantation of iris-fixated phakic intraocular lenses (pIOLs), optimal preoperative evaluation and patient selection is mandatory. We present a new software tool in a high-resolution Scheimpflug imaging device that precisely simulates the postoperative position of an iris-fixated pIOL and also simulates the effect of aging on the pIOL's position.

Phacoemulsification and Vitrectomy with the Erbium: or Neodymium:YAG-Laser

Summary There are an increasing number of applications for Erbium:YAG and Neodymium:YAG lasers in opthalmology. Laser phacoemulsification and Erbium-laser vitrectomy are of major interest. We report the underlying technology and more than 1-year-experience using the PHACOLASE (Carl Zeiss Meditec, Jena, Germany, 10–100 Hz frequency, 5–50 mJ single pulse energy) for phacoemulsification and pars plana vitrectomy and the Lyla-Dodick laser photolysis (A.R.C. Laser, Eckental-Forth, Germany, 1–20 Hz, up to 8 mJ single pulse energy). The Erbium:YAG laser and Neodymium:YAG laser enabled us to extract lenses with up to medium hard nuclei. Moreover, the Erbium laser enabled fast vitrectomy with little…

Capsule measuring ring to predict capsular bag diameter and follow its course after foldable intraocular lens implantation

Purpose: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size. Setting: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany. Methods: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics). Results: The me…

Evaluation of cut quality using the Amadeus microkeratome with different settings.

Abstract Purpose: To evaluate the quality of keratectomy specimens created with the Amadeus® microkeratome (AMO) using scanning electron microscopy (SEM). Setting: Johannes Gutenberg-University Hospital, Department of Ophthalmology, Mainz, and the Department of Anatomy, Justus Liebig-University, Giessen, Germany. Methods: Corneal cuts were performed in freshly enucleated pig eyes using the Amadeus microkeratome with 9 combinations of oscillation rate and head-advance speed. For the cutting trials, oscillation rates of 8000, 13000, and 18000 rpm and head-advance speeds of 1.0, 2.5, and 4.0 mm/s were chosen. Fifty-four eyes were included, resulting in 9 groups of 6 eyes for each configuration…

Implantation of a custom intraocular lens with a 30-diopter torus for the correction of high astigmatism after penetrating keratoplasty.

Abstract We present a 62-year-old woman who had implantation of an intraocular lens (IOL) with a torus of 30.0 diopters (D) in an eye after penetrating keratoplasty. The patient presented with cataract and a best corrected visual acuity of 20/400. Penetrating keratoplasty was performed in 1975 because of decompensated keratoconus. With a clear but inferiorly decentered corneal graft, visual acuity was limited because of keratoplasty-related high corneal astigmatism of 22.5@156 that could not be successfully treated with spectacles or contact lenses. A custom toric IOL with –30.0 D of cylindrical power was implanted in the capsular bag via a sclerocorneal tunnel incision. Additionally, a sph…

Surgical management of acute angle-closure glaucoma after toric implantable contact lens implantation

A case of pupillary block after implantation of an implantable contact lens (ICL) is reported, and surgical management and prevention are discussed. In a myopic patient, the best corrected visual acuity in the right eye was 20/50 with -15.50 -3.00 x 175. After uneventful implantation of an ICL, painful acute glaucoma developed with an intraocular pressure beyond measurable values. Apparent anterior vaulting of the ICL suggested a sizing problem. In a situation of a mid-wide dilated pupil, immediate explantation of the ICL was performed. Then, using a preoperative iris photography as guidance, an anterior chamber iris-claw toric phakic intraocular lens was implanted. On postoperative examina…

Endothelial cell loss after toric iris-fixated phakic intraocular lens implantation: three-year follow-up.

ABSTRACT PURPOSE: To study quantitative changes in endothelial cell count after implantation of the toric iris-fixated phakic intraocular lens. METHODS: A prospective, non-randomized, self-controlled clinical trial was conducted of 40 eyes (28 myopic, 12 hyperopic) of 23 patients with high ametropia and astigmatism. Non-contact computer-assisted endothelial microscopy was performed before and I1 2, and 3 years after surgery. RESULTS: In the myopic group, mean preoperative endothelial cell count was 3179±531 cells/mm p 2 (range: 1800 to 3900 cells/mm2). The mean intraindividual endothelial cell loss was -1.83±2.25% (range: -9.09% to 0%) in the first year; -1.83+2.95% (range: -7.74% to 3.80%)…

Refractive lens exchange with an array multifocal intraocular lens.

ABSTRACT PURPOSE: To prospectively evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after refractive lens exchange (clear lens extraction) followed by posterior chamber implantation of a multifocal intraocular lens (IOL). METHODS: Fifty eyes of 25 patients (mean age 51 years, range 44 to 62 years) with preoperative spherical equivalent refraction between -15.50 and +5.75 D and cylinder between 0 and 1.50 D underwent bilateral implantation of a zonal progressive multifocal IOL (Array, AMO). RESULTS: Eyes were divided into group A (n=24; myopia, average preoperative spherical equivalent refraction -7.11 ± 3.25 D (-1.75 to -15.50 D), and group B (n=…

Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses Case series and review

Abstract Purpose: To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). Setting: John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. Methods: We report 6 cases of opacification of MemoryLens ® IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopath…

Comparison of biometric measurements using partial coherence interferometry and applanation ultrasound

Abstract Purpose To compare and contrast axial length (AL) measurements assessed by ultrasound biometry and optical biometry. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods Optical biometry and ultrasound biometry were performed in 360 eyes to measure AL. Results In eyes with a clear-appearing crystalline lens, there was a statistically significant median difference in AL measurements between the 2 methods in eyes with a normal or long length. In eyes with cataract, there was a statistically significant median difference in AL measurements in eyes with a normal or short length. In these cases, optical biometry produced larger readings than ultras…

Short-term Follow-up after Implantation of a Foldable Iris-Fixated Intraocular Lens in Phakic Eyes

Objective To evaluate efficiency, predictability, stability, complications, and patient satisfaction after implantation of a foldable iris-fixated phakic intraocular lens (PIOL) for the correction of myopia. Design Prospective, nonrandomized, comparative (self-controlled) trial. Participants Forty-one eyes of 22 myopic patients aged 18 to 56 years (mean, 36 years) with average sphere of −8.2±2.01 diopters (D; range, −12.25 to −3.75 D) and average preoperative cylinder of −0.90±0.62 D (range, −2.50 to 0.00 D) were enrolled in this prospective study. Methods All eyes underwent implantation of a foldable iris-fixated PIOL with an optical zone of 6.0 mm. The follow-up was 6 months in all cases.…

Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens

Purpose To evaluate the changes in pupil size after implantation of an iris-supported toric phakic intraocular lens (TPIOL) for correction of myopia and hyperopia with astigmatism. Setting Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods Twenty-two myopic eyes and 9 hyperopic eyes were included in the study. The mean age of the 2 groups was 34 years and 40 years, respectively. The scotopic pupil size was measured with a handheld infrared pupillometer (Colvard, Oasis Medical) before and 6 months after implantation of the TPIOL. All examinations were performed under scotopic conditions after 2 minutes of dark adaptation with the fellow eye covered. Intraindi…

Evaluation of the practicality of optical biometry and applanation ultrasound in 253 eyes

Abstract Purpose To evaluate the percentage of eyes that could not be measured using optical biometry and ultrasound applanation and the reasons. Setting Department of Ophthalmology, Johannes Gutenberg-University Hospital, Mainz, Germany. Methods Optical biometry (IOLMaster®, Carl Zeiss Meditec AG) and A-scan ultrasound biometry were performed consecutively in 253 eyes scheduled for cataract surgery the next day. Lens opacities were evaluated with the Opacity Lensmeter (Interzeag), and a slitlamp examination and measurement of visual acuity were performed. The 2 techniques were compared in terms of the rate of and reasons for primary measurement failure. Results Measurement with the IOLMast…

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

Abstract 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 sen…