By J. Bradley Randleman, MD
The authors of this study reported encouraging long-term outcomes for patients who underwent implantation with iris-claw Artisan-Verisyse (Ophtec B.V., Groningen, Netherlands, and Advanced Medical Optics, Inc., Santa Ana, Calif.) phakic IOLs for myopia, hyperopia, or astigmatism. The results demonstrated good long-term refractive stability and stable endothelial cell counts after an initial postoperative drop.
The study included 399 eyes consecutively implanted with phakic IOLs. The authors followed up with the patients for a mean of 4.05 years. Model 204, 5-mm optic for myopia, was implanted in 101 eyes with a mean preoperative spherical equivalent (SE) of -19.8D; model 206, 6-mm optic for myopia, in 173 eyes with a mean SE of -11.27D; model 203, 5-mm optic for hyperopia, in 41 eyes with a mean SE +4.92D; and the toric model in 84 eyes with a mean SE -6.82D. Additional keratorefractive procedures were performed in 60 percent of the 5-mm myopic group, 20 percent of the 6-mm myopic group, 41 percent of the hyperopic group, and 6 percent of the toric group.
Visual outcomes remained fairly steady in each group after the three-month follow-up visit. At that time, 71.3 percent of the 5-mm myopic group had best spectacle-corrected visual acuity of at least 20/40 and 14.85 percent uncorrected visual acuity of the same level, with 82.6 percent and 42.8 percent of the 6-mm myopia group achieving these levels, respectively, 75.5 percent and 42.8 percent of the hyperopic group, and 86 percent and 65.4 percent of the toric group. At the end of the study, central endothelial cell counts had decreased significantly by 5.11 percent compared with preoperative levels across all of the groups, although within the individual groups, the change was significant only for the two myopic groups. Three IOLs, all in the 5-mm myopic group, were explanted due to unacceptable endothelial cell loss levels, with eye rubbing possibly linked to all of them.
Other complications that occurred during the study were the dislocation of three lenses, two due to ocular trauma and one probably due to an insufficient amount of iris having been grasped by the IOL, which were subsequently repositioned; refractive errors in three eyes that required the exchange of lenses; and one macular hemorrhage, one retinal detachment, and two cataracts.
Financial Disclosures
Dr. Randleman receives lecture fees from Alcon, Inc., Allergan, Inc., and ISTA Pharmaceuticals.