Seguridad del implante de lente fáquica ACR-128 tras un año de seguimiento / Safety of an ACR-128 phakic lens implant after one year's follow-up

Objetivo: Determinar la seguridad de los lentes fáquicos ACR-128 en la corrección de la alta miopía tras un año de implantados. Método: Se realizó un estudio transversal en 67 ojos de 36 pacientes con miopía corregida con lente fáquica ACR-128 (31 con ambos ojos y 5 con un solo ojo). Se determinó preoperatorio y posoperatorio: tensión ocular, pérdida celular endotelial según conteo, coeficiente de variación celular y hexagonalidad. Además de complicaciones posoperatorias y posición del lente respecto a endotelio y cristalino. El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,06 ± 6,14 (25 mujeres y 11 hombres). Las complicaciones inmediatas fueron hipotonía OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento). La irregularidad de la pupila se presentó OD: 1 (3,03 por ciento), OI: 1 (2,94 por ciento) mediata y OD: 1 (3,03 por ciento), OI: 2 (5.88 por ciento) tardía. Tensión ocular promedio total preoperatorio 14,09 ± 2,51 y posoperatorio 14,22 ± 2,64 (p = 0,90). El conteo celular preoperatorio 2667,27 ± 228,72 y posoperatorio 2591,96 ± 301,21, con 2,94 por ciento pérdida endotelial total 75,31 ± 237,41 (p = 0,06). No hubo diferencias en el coeficiente de variación (p = 0,60) ni la hexagonalidad (p = 0,57). Posición del lente respecto al endotelio 2,09 mm y al cristalino 1,08 mm. Conclusiones: El implante de lente fáquica ACR-128 en la corrección de la alta miopía es un tratamiento seguro al no existir complicaciones posquirúrgico ni modificaciones en la tensión ocular y en el endotelio corneal tras un año del implante(AU)

Objective: Determine the safety of ACR-128 phakic lenses for high myopia correction one year after implantation. Method: A cross-sectional study was conducted of 67 eyes of 36 patients with myopia corrected with ACR-128 phakic lens implants (31 in both eyes and 5 in one eye). Pre- and postoperative determination was made of ocular tension, endothelial cell loss by count, cell variation coefficient and hexagonality, as well as of postoperative complications and lens position with respect to the endothelium and the crystalline lens. Statistical analysis was based on the paired T-test with a significance level of 95 percent Results: Mean age was 28.06 ± 6.14 (25 women and 11 men). An immediate complication was hypotonia: RE: 1 (3.03 percent), LE: 1 (2.94 percent). Pupil irregularity was mediate: RE: 1 (3.03 percent), LE: 1 (2.94 percent) and late: RE: 1 (3.03 percent), LE: 2 (5.88 percent). Total average ocular tension was 14.09 ± 2.51 preoperative and 14.22 ± 2.64 postoperative (p = 0.90). Cell count was 2667.27 ± 228.72 preoperative and 2591.96 ± 301.21 postoperative, with 2.94 percent total endothelial loss 75.31 ± 237.41 (p = 0.06). Differences were not found in the variation coefficient (p = 0.60) or in hexagonality (p = 0.57). Lens position was 2.09 mm with respect to the endothelium and 1.08 mm with respect to the crystalline lens. Conclusions: ACR-128 phakic lens implantation for high myopia correction is a safe procedure with no postoperative complications or modifications in ocular tension or the corneal endothelium after one year's follow-up(AU)

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

Calidad de vida relativa a la función visual en pacientes con implante de lente intraocular fáquico ACR-128 / Vision-related quality of life in patients undergoing ACR-128 phakic intraocular lens implantation

Introducción: El implante de una lente intraocular fáquico para corregir defectos de la refracción presenta una serie de ventajas respecto a otras técnicas como la cirugía refractiva corneal o la extracción de cristalino transparente. Objetivo: Describir los cambios en la calidad de vida relacionados con la función visual en la corrección de alta miopía con implante de lente fáquico ACR-128. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con análisis estadístico separado por ojos. La muestra total se correspondió con 91 ojos (46 derechos y 45 izquierdos) de 49 pacientes a los que se les implantó lente fáquico ACR-128 para la corrección de miopía. Mediante el test de Pelli-Robson se determinó la sensibilidad al contraste binocular a varias frecuencias espaciales y se les aplicó el cuestionario NEI-VFQ-25 antes de la cirugía (pretest) y a los tres meses de realizada la misma (postest). El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,73 ± 5,85 años. Predominio del sexo femenino (71,43 por ciento). Hubo diferencias significativas en todas las frecuencias espaciales de la sensibilidad al contraste binocular entre el pre- y posoperatorio (p < 0,01). Al comparar el pretest y el postest (valoración retrospectiva de la calidad de vida prequirúrgica) no se encontraron diferencias significativas, lo que indicó que no hubo recalibración y que las diferencias con el postest que fueron significativas corroboren el verdadero cambio en la calidad de vida de estos pacientes tras la cirugía. Conclusiones: El implante de lentes fáquicos ACR-128 para la corrección de la alta miopía mejora la calidad de vida relacionada con la función visual sin cambios en su percepción antes y después de la cirugía(AU)

Introduction: Phakic intraocular lens implantation to correct refraction defects has a number of advantages with respect to techniques such as corneal refractive surgery or clear lens extraction. Objective: Describe the changes in vision-related quality of life resulting from high myopia correction by ACR-128 phakic lens implantation. Methods: A prospective longitudinal descriptive study was conducted with independent statistical analysis for each eye. The total sample was 91 eyes (46 right and 45 left) of 49 patients undergoing ACR-128 phakic lens implantation for myopia correction. The Pelli-Robson test was used to determine binocular contrast sensitivity at various spatial frequencies, and the NEI VFQ-25 questionnaire was applied before surgery (pre-test) and three months after surgery (post-test). Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 28.73 ± 5.85 years. Female sex prevailed (71.43 percent). Significant differences were found in all the spatial frequencies of binocular contrast sensitivity between the pre- and postoperative periods (p < 0.01). Comparison of pre- and post-test results (retrospective assessment of presurgical quality of life) did not find any significant differences, indicating that there was no recalibration. Significant differences with respect to the post-test confirm the actual change in these patients' quality of life after surgery. Conclusions: ACR-128 phakic lens implantation for high myopia correction improves vision-related quality of life without changes in its perception before and after surgery(AU)

Lentes intraoculares fácicas para miopia e astigmatismo: revisão prospectiva / Phakic intraocular lenses for myopia and astigmatism: a prospective review

RESUMO O implante de lentes intraoculares fácicas com finalidade refrativa é uma alternativa cirúrgica eletiva segura e eficiente. Essa opção deve ser considerada de forma eletiva para tratar ametropias, nos casos em que as cirurgias de correção visual refrativa a laser na córnea apresentam maior risco de complicações, seja por características da córnea ou pela magnitude da ametropia. Este artigo traz uma revisão prospectiva das lentes fácicas disponíveis no mercado brasileiro em 2020 e suas características.

ABSTRACT Implantation of phakic intraocular lenses for refractive purpose is a safe and efficient elective surgical alternative. This option should be considered to electively treat ametropia when laser corneal refractive surgery has higher risk of complications, either due to corneal characteristics or the magnitude of ametropia. This article provides a prospective review of the phakic lenses available in the Brazilian market in 2020 and their characteristics.

Cirugía de catarata bilateral en paciente con lente intraocular fáquica / Bilateral cataract surgery in a patient with a phakic intraocular lens

RESUMEN La cirugía refractiva corneal es una buena opción para corregir el defecto refractivo de los pacientes y lograr una buena visión sin el uso de espejuelos o lentes de contacto; pero cuando no es posible, las lentes fáquicas constituyen una elección viable, especialmente en pacientes jóvenes que mantienen la acomodación. Se presenta el caso de una paciente con antecedentes de implante de lente fáquica desde hacía 13 años, quien acudió al Instituto Cubano de Oftalmología "Ramón Pando Ferrer" por disminución de la visión en ambos ojos. Se destaca la importancia en la obtención de las medidas biométricas, especialmente la longitud axil, si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar y la obtención del buen resultado refractivo. La interferometría óptica es el mejor modo de obtener estas medidas y la longitud axil no parece modificarse con la presencia de una lente fáquica(AU)

ABSTRACT Corneal refractive surgery is a good option to correct the refractive defect and achieve good vision without the use of eyeglasses or contact lenses. When it is not possible, phakic lenses are a viable choice, particularly in young patients who maintain accommodation. A case is presented of a female patient with an antecedent of phakic lens implantation 13 years before who presents at Ramón Pando Ferrer Cuban Institute of Ophthalmology with vision reduction in both eyes. Mention should be made of the importance of obtaining biometric measurements, especially of the axial length, if it changes after phakic lens implantation, for accurate calculation of the lens to be implanted and the achievement of a good refractive result. Optical interferometry is the best way to obtain those measurements, and axial length does not seem to change with the presence of a phakic lens(AU)

Efecto de la lente fáquica ACR-128 sobre la tensión ocular y el endotelio corneal en las altas miopías / Effect of the ACR-128 phakic lens on ocular tension and the corneal endothelium in high myopia

RESUMEN Objetivo: Describir los efectos sobre la tensión ocular y el endotelio corneal con el implante de la lente fáquica ACR-128 para la corrección de la alta miopía. Métodos: Se realizó un estudio descriptivo, observacional, longitudinal y prospectivo en 60 ojos de 32 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las complicaciones trans y posoperatorias, la presión intraocular, la densidad de las células endoteliales, el coeficiente de variabilidad y la hexagonalidad, así como la posición de la lente. El análisis estadístico se realizó con la Prueba T para datos pareados, con una significación del 95 por ciento. Resultados: La edad media fue de 27,41 ± 5,91 años y el 68,75 por ciento correspondió al sexo femenino. El equivalente esférico preoperatorio promedio fue de -11,54 ± 3,20 dioptrías. Resultó sin complicaciones transoperatorias el 100 por ciento; las posoperatorias inmediatas fueron de 93,33 por ciento y las mediatas y tardías del 95,00 por ciento. No hubo diferencias significativas entre el pre y el posoperatorio en la tensión ocular (p=0,2570); la densidad endotelial fue p= 0,0928; el coeficiente de variación p= 0,889 y la hexagonalidad (p= 0,0957). Conclusiones: El implante de la lente fáquica ACR-128 para la corrección de las altas miopías es un procedimiento seguro, al ofrecer escasas complicaciones y mínimos efectos en la tensión ocular y en el endotelio corneal(AU)

ABSTRACT Objective: Describe the effects of ACR-128 phakic lens implantation for high myopia correction on ocular tension and the corneal endothelium. Methods: An observational descriptive longitudinal prospective study was conducted of 60 eyes of 32 patients with myopia corrected with the ACR-128 phakic lens. Determination was made of intra- and postoperative complications, intraocular pressure, endothelial cell density, variability and hexagonality quotient, and lens position. Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 27.41 ± 5.91 years and 68.75 percent of the patients were female. Mean preoperative spherical equivalent was -11.54 ± 3.20 diopters. Complications were none in the intraoperative period, 93.33 percent in the immediate postoperative period and 95.00 percent mid- or long-term. No significant differences were found between the pre- and postoperative periods concerning ocular tension (p= 0.2570). Endothelial cell density was p= 0.0928, the variability quotient p= 0.889 and hexagonality p= 0.0957. Conclusions: ACR-128 phakic lens implantation for correction of high myopia is a safe procedure causing few complications and minimal effects on ocular tension and the corneal endothelium(AU)

Resultados visuales en la corrección de la alta miopía con implante de lente fáquica ACR-128 / Visual results of correction of high myopia with ACR-128 phakic lens implantation

RESUMEN Objetivo: Describir los resultados visuales en la corrección de la alta miopía con implante de lente fáquica ACR-128. Métodos: Se realizó un estudio descriptivo, observacional longitudinal y prospectivo en 60 ojos de 32 pacientes con miopía corregida con lente fáquica ACR-128. Se determinó el componente esférico esperado y observado, el cilindro queratométrico, las agudezas visuales sin corrección y mejor corregidas en el pre y en el posoperatorio y el astigmatismo inducido. El análisis estadístico se realizó con la Prueba T para datos pareados, con una significación del 95 por ciento. Resultados: La edad media fue 27,41 ± 5,91 años, el equivalente esférico preoperatorio -11,54 ± 3,20 dioptrías y el 68,75 por ciento eran femeninas. El componente esférico en dioptrías esperado (-0,53 ± 0,37) y observado (-0,42 ± 0,47) sin diferencias (p= 0,0742). Entre ± 1,00 el 91,67 por ciento y entre ± 0,50 el 70 por ciento. Ningún ojo quedó por encima de +0,50 dioptrías. El cilindro queratométrico en dioptrías, pre (1,44 ± 0,76) y posoperatorio (1,49 ± 0,84) sin astigmatismo inducido (p= 0,6377). El 100 por ciento tenía agudeza visual sin corrección preoperatoria ≤ 0,1 y posoperatoria ≥ 0,3. Después de la cirugía el 10 por ciento alcanzaba 1,0 y 71,6 por ciento ≥ 0,5. Solo el 28,33 por ciento tenía la unidad en el preoperatorio, y el 70 por ciento en el posoperatorio (98,33 por ciento ≥ 0,7). Conclusiones: El implante de lente fáquica ACR-128 proporciona corrección refractiva y predictibilidad favorables para el paciente, al reducir el componente esférico al deseado, no inducir astigmatismo y mejorar la agudeza visual, todo lo que se traduce en un adecuado resultado visual(AU)

ABSTRACT Objective: Describe the visual results of correction of high myopia with ACR-128 phakic lens implantation. Methods: An observational descriptive longitudinal prospective study was conducted of 60 eyes of 32 patients with myopia corrected with the ACR-128 phakic lens. Determination was made of the expected and observed spherical component, the keratometric cylinder, uncorrected and best corrected visual acuity in the pre- and postoperative periods, and induced astigmatism. Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 27.41 ± 5.91 years, preoperative spherical equivalent was -11.54 ± 3.20 diopters, and 68.75 percent of the patients were female. Spherical component in diopters expected (-0.53 ± 0.37) and observed (-0.42 ± 0.47) without differences (p= 0.0742). Between ± 1.00 diopters 91.67 percent and between ± 0.50 diopter 70 percent. No eye was above +0.50D. Keratometric cylinder in diopters, preoperative (1.44 ± 0.76) and postoperative (1.49 ± 0.84) without induced astigmatism (p=0.6377). In 100 percent visual acuity without correction ≤ 0.1 preoperative and ≥ 0.3 postoperative. After surgery 10 percent reached 1.0 and 71.6 percent ≥ 0.5. Only 28.33 percent had the unit corrected in the preoperative period and 70 percent in the postoperative period (98.33 percent ≥ 0.7). Conclusions: ACR-128 phakic lens implantation provides patients with favorable refractive correction and predictability. This is achieved by reducing the spherical component to desired values, not inducing astigmatism and improving visual acuity, all of which leads to an adequate visual result(AU)

Two-staged treatment for advanced keratoconus in children / Tratamento em dois estágios para ceratocone avançado em crianças

Abstract We present a case of a 12-year-old patient with advanced keratoconus in both eyes who received a two-staged treatment in the right eye (OD) to decrease keratoconus progression rate and rehabilitate patient's vision. At the initial clinical examination, visual acuity without correction in OD was count fingers; cycloplegic refraction was -22.00 - 7,50 x 100° = 20/400; corneal topography demonstrated a curvature of 64.28 x 105° / 55.38 x 15°; and tomography (WaveLight - Allegro Oculyzer) demonstrated a curvature of 68.1 x 114° / 63.3 x 163° Q = -2.67. Initially, the patient received an intrastromal ring segment (210 mm / 200 µm) slightly off center to avoid the thinnest part of the cornea. Six months later a phakic lens was implanted in the anterior chamber. At the follow-up visit 13 months after phakic lens implantation (19 months after ring implantation), visual acuity in OD was 20/20 without correction; cycloplegic refraction was -0.50 -0.75 x 180o = 20/20; and corneal topography showed keratometry of 63.22 x 44o / 61.10 x 134o. The results demonstrated that the associated procedures were successful in decreasing irregular astigmatism and markedly improving patient's uncorrected visual acuity in OD, postponing the need for corneal transplantation to a more suitable age, if required.

Resumo Apresentamos o caso de um paciente de 12 anos de idade com ceratocone avançado em ambos os olhos, que recebeu um tratamento em dois estágios no olho direito (OD) de modo a diminuir a taxa de progressão do ceratocone e reabilitar a visão do paciente. No exame clínico inicial, a acuidade visual sem correção no OD era contar dedos; refração sob cicloplegia era -22.00 - 7,50 x 100° = 20/400; a topografia demonstrou uma curvatura de 64,28 x 105° / 55,38 x 15°; e a tomografia (WaveLight - Allegro Oculyzer) demonstrou uma curvatura de 68,1 x 114° / 63,3 x 163° Q = -2,67. Inicialmente, o paciente recebeu um segmento de anel intraestromal (210 mm /200 µm) ligeiramente fora de centro de modo a evitar a porção mais fina da córnea. Seis meses mais tarde, uma lente fácica foi implantada na câmara anterior. No acompanhamento de 13 meses após a implantação da lente fácica (19 meses após a implantação do anel), OD apresentava uma acuidade visual de 20/20 sem correção; uma refração sob cicloplegia de -0,50 -0,75 x 180o = 20/20; e a topografia da córnea demonstrou ceratometria de 63,22 x 44° / 61,10 x 134°. Os resultados demonstraram que a associação de procedimentos foi bem sucedida na diminuição do astigmatismo irregular, com uma melhora significativa da acuidade visual sem correção no OD, adiando a necessidade de transplante de córnea para uma idade mais adequada, caso necessário.

Corrección de la alta miopía con implante de lente fáquica ACR-128 / Correction of high myopia with ACR-128 phakic lens implantation

La alta miopía es aquella igual o mayor a -6 dioptrías esféricas, no en función de la curvatura corneal elevada, como es el caso del queratocono, ni por la esclerosis del cristalino que ocurre en etapas preseniles, sino en dependencia de la longitud axial mayor de 25,5 o 26,0 mm. La corrección óptica de estos defectos altos es difícil, ya que es frecuente que los pacientes se sientan incómodos con el uso de gafas, pues no obtienen una buena calidad de visión, y con el fin de mejorarla se han desarrollado distintos procedimientos quirúrgicos. Se presenta una paciente de 26 años de edad con miopía elevada, quien no se adapta a los lentes de contacto y no desea continuar con los espejuelos; no es candidata a la cirugía refractiva corneal. Se le implantaron lentes fáquicas ACR IOL-128 (Soleko, Italia) sin complicaciones. El equivalente esférico preoperatorio -11,5 y -6 dioptrías disminuyó a -1,00 y -0,5 respectivamente, y la agudeza visual sin cristales de cuenta dedos y 0,1 a 0,8 y 0,9 respectivamente. Con este caso se evidencia que las lentes fáquicas son una opción con buenos resultados en la corrección de la alta miopía(AU)

The high myopia, by definition, is that equal or bigger to -6 spherical dioptrías; not in function of the bend high corneal, like it is the case of the queratocono, neither for the sclerosis of the crystalline lens that happens in stages preseniles, but in dependence of the axial longitude bigger than 25,5 or 26,0 mm. The optic correction of these high defects is difficult, since it is frequent that the patients feel uncomfortable with the glasses use, because they don't obtain a good quality of vision and with the purpose of improving it, different surgical procedures have been developed. Young patient 26 years old is presented with high myopia that doesn't adapt to the contact eyeglasseses and she doesn't want to continue with the espejuelos, she is not candidate to surgery refractive corneal and she is implanted eyeglasseses fáquica ACR IOL-128 (Soleko, Italy) without complications. The equivalent spherical preoperatorio -11,5 and -6 dioptrías diminish at -1,00 and - 0,5 respectively and the visual sharpness without glasses of bill fingers and 0,1 at 0,8 and 0,9 respectively. With this case it is evidenced that the lenses fáquicas are an option with good results in the correction of the high myopia(AU)

Antecedentes y actualidad de las lentes fáquicas para la corrección de las ametropías / Antecedents and current status of the use of phakic lenses for ametropia correction

La cirugía refractiva es una subespecialidad que comprende todos los procedimientos quirúrgicos dirigidos a modificar la refracción ocular en sus distintas ametropías. Su finalidad es mejorar la agudeza visual no corregida y simultáneamente disminuir la dependencia de los anteojos o lentes de contacto. Existen diferentes opciones como son: los procedimientos queratorrefractivos y los implantes de lentes intraoculares, con extracción del cristalino (pseudofaquia) o en un ojo fáquico, entre la córnea y el cristalino. En ocasiones es necesaria la combinación de más de un procedimiento. Las lentes intraoculares fáquicas pueden dividirse en dos grupos: lentes de cámara anterior, que incluye las de soporte angular y las de fijación iridiana, y lentes de cámara posterior, que son las implantadas en surco. A diferencia de la cirugía láser sobre la córnea o de la cirugía del cristalino, la corrección de ametropías moderadas-severas mediante estas lentes permite mantener la acomodación, además de obtener una mejor calidad óptica, cierta reversibilidad del procedimiento y la posibilidad de mejorar defectos refractivos residuales mediante la cirugía corneal mínima. De ahí la motivación para realizar una búsqueda de diversos artículos publicados, con el objetivo de describir todos los tipos de lentes intraoculares en ojos fáquicos y sus ventajas. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con todos sus buscadores(AU)

Refractive surgery is a subspecialty comprising all the surgical procedures aimed at modifying ocular refraction in its various ametropias. Its aim is to improve uncorrected visual acuity, reducing dependence on eyeglasses or contact lenses. There are different options, such as keratorefractive procedures and intraocular lens implantation, with removal of the crystalline lens (pseudophakia) or in phakic eyes, between the cornea and the crystalline lens. A combination of more than one procedure is sometimes required. Phakic intraocular lenses are divided into two groups: anterior chamber lenses, including the angle-supported and iris fixation types, and posterior chamber lenses, performed by sulcus implantation. Unlike laser corneal or crystalline lens surgery, correction of moderate-to-severe ametropia using these lenses makes it possible to retain accommodation, and provides better optical quality, a certain reversibility of the procedure, and the possibility of correcting residual refractive defects by minimum corneal surgery. Hence the motivation to conduct an updated search in various published papers with the purpose of describing all the types of phakic intraocular lenses and their advantages. Use was made of the Infomed platform, particularly the Virtual Health Library with all its search engines(AU)

Investigation of the Changes in Refractive Surgery Trends in Korea

PURPOSE: To evaluate changes in clinical practice in the field of refractive surgery in Korea over the past 10 years. METHODS: A survey consisting of 59 multiple-choice questions regarding the preferred types of refractive surgery, excimer laser machine, and presbyopia surgery was mailed to 742 members of the Korean Society of Cataract and Refractive Surgery in January 2016, and 50 members responded to the survey. These data were compared with the 2005 or 2007 survey results.

Is partial coherence interferometry more accurate than a scan ultrasonography in the estimation of anterior chamber depth?

Purpose: To assess the degree of agreement of anterior chamber depth [ACD] measurements by optical device [NIDEK AL-scan biometer] and contact ultrasound A-scan [Mentor [[R]] - Advent [[TM]] A/B system US biometry]

Setting: Department of Ophthalmology at ALAZHAR University, Cairo, Egypt

Methods: This prospective observational cross sectional comparative study of 50 normal healthy eyes were included in this study, ACD estimation was done by 2 methods partial coherence interferometry[PCI], and contact ultrasound A-scan. The measurements was performed by the same observer. The difference in measurements between the two methods was assessed using the t-test

Results: The mean ACD [ +/- SD] by the two methods were [2.8 mm] and [3.5 mm], respectively. There was a statistically significant difference between measurements recorded by the 2 methods [P<0.01]

Conclusion: there was a statistically different between the two methods the PCI values were significantly higher [by 0.7 mm] than the U/S values with no correlation between the two sets of values. So PCI is more accurate but we still need U/S measurements in some situations [e.g., tear film abnormalities, corneal pathologies]

Lentes intraoculares fácicas de câmara posterior / Phakic posterior chamber intraocular lenses

Resumo O objetivo deste artigo foi reunir estudos que reportam resultados disponíveis na literatura científica, considerando a previsibilidade, segurança, eficácia, e estabilidade das lentes intraoculares fácicas de câmara posterior. E relatar as complicações documentadas para estas lentes. A revisão criteriosa dos estudos publicados na literatura ate o momento revelam resultado satisfatórios quanto à eficácia, elevada previsibilidade, estabilidade e segurança do implante de lente intraocular de câmara posterior, para correção das miopia, hipermetropia e astigmatismo.

Abstract The objective of this article was to gather studies that report results available in the scientific literature, considering the predictability, safety, efficacy, and stability of posterior chamber phakic intraocular lenses. And report the documented complications for these lenses.

Lentes plegables suturadas a iris / Iris-sutured foldable lenses

Para la corrección quirúrgica de la afaquia existen en la actualidad varias técnicas quirúrgicas que permiten fijar los lentes intraoculares plegables o rígidos en cámara posterior suturados al iris o al sulcus ciliar. En estas circunstancias el cirujano determinará cuándo, dónde y el tipo de lente mejor a implantar. Se presenta un paciente con una afaquia traumática del ojo izquierdo, con agudeza visual sin corrección de movimiento de mano a 1 m. Se le realizó implante secundario de lente intraocular plegable de cámara posterior suturada al iris. En el examen biomicroscópico en lámpara de hendidura del ojo izquierdo se observó midriasis media paralítica, refracción dinámica de +11,00 (0,6) y tensión ocular normal. Se le realizó examen por bimicroscopía indirecta sin alteración. Al mes de operado la agudeza visual mejor corregida alcanzó la unidad de visión. Las complicaciones presentadas fueron ovalización de la pupila y depósitos de pigmentos de iris en el lente intraocular(AU)

There are several surgical techniques for the surgical correction of aphakia, which allow fixing foldable or rigid intraocular lenses in the posterior chamber by suturing them to iris or to ciliary sulcus. Under these circumstances, the surgeon will determine the time, the place and the type of lenses that is better to be implanted. This is a patient with traumatic aphakia in his left eye, with visual acuity without correction equals to hand movement at 1 m distance. He was performed a secondary implantation of a iris-sutured posterior chamber foldable intraocular lens. In the biomicroscopic exam of the left eye using the slit lamp, there was observed mean paralytic midriasis, dynamic refraction of +11,00 (0.6) and normal ocular pressure. He also underwent an indirect biomicroscopy with no alteration. After a month of his surgery, the best corrected visual acuity reached the vision unit. The complications found were ovalization of pupil and iris pigment depots in the intraocular lens(AU)

Long Term Corneal Endothelial Cell Density Loss after Iris-fixed Phakic Intraocular Lens Implantation

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.

Visual Outcomes, Patient Satisfaction and Spectacle Independence with a Trifocal Diffractive Intraocular Lens

PURPOSE: To evaluate visual outcomes following implantation of a trifocal diffractive intraocular lens (IOL) and to analyze their correlation with patient satisfaction and ease of performing daily tasks. METHODS: This was a prospective study enrolling 100 eyes of 50 patients undergoing cataract surgery with implantation of trifocal IOL AT LISA tri 839MP. Visual and refractive outcomes were evaluated during a 3-month follow-up. Postoperatively, a questionnaire was used to evaluate patient satisfaction with regard to surgical outcome, spectacle independence, perception of photic phenomena, and ease of performing some vision-related activities. RESULTS: A total of 91%, 87%, and 79% of eyes achieved a monocular uncorrected distance, near, and intermediate visual acuity of 0.1 logarithm of the minimum angle of resolution or better, respectively. After the surgery, 96% of the patients could perform their daily activities without problems. The mean spectacle independence scores for reading, doing computer work, and for distance were 10.33 ± 12.47, 5.71 ± 11.90, and 3.92 ± 9.77, respectively (scale: 0 = no spectacles needed; 40 = spectacles always needed). No correlation was found between spectacle independence and visual outcome (-0.101 ≤ r ≤ 0.244, p ≥ 0.087). Mean scores (0 = no symptoms; 40 = strong symptoms) for glare at night, ghost images, and halos were 15.15 ± 12.02, 4.49 ± 7.92, and 13.34 ± 10.82, respectively. No correlation was found between photic phenomena and visual outcome (-0.199 ≤ r ≤ 0.209, p ≥ 0.150). A total of 80% of patients reported satisfaction with the surgery outcome, and 86% would recommend the surgery to friends and family. CONCLUSIONS: Implantation of the AT LISA tri 839MP IOL after cataract surgery provides effective visual restoration associated with a minimal level of photic phenomena, a positive impact on the performance of vision-related daily activities, and a high level of postoperative patient satisfaction.

Traumatic Dislocation of Posterior Chamber Phakic Intraocular Lens into the Berger's Space

No abstract available.

Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism

PURPOSE: To compare the effectiveness of toric foldable iris-fixated phakic intraocular lens (pIOL) implantation and non-toric foldable iris-fixated pIOL implantation with limbal relaxing incisions (LRIs) for correcting moderate-to-high astigmatism in myopic eyes. MATERIALS AND METHODS: The medical records of 146 patients (195 eyes) with myopic astigmatism who underwent toric foldable iris-fixated pIOL implantation (toric group; 94 eyes) or non-toric foldable iris-fixated pIOL implantation with concurrent LRIs (LRI group; 101 eyes) were retrospectively reviewed. For subgroup analysis, the two groups were subdivided according to preoperative astigmatic severity [moderate, 2.00 to <3.00 diopters (D); high, 3.00–4.00 D]. Visual and astigmatic outcomes were compared 6 months postoperatively. RESULTS: The uncorrected distance visual acuity was at least 20/25 in 100% and 98% of the toric and LRI group eyes, respectively. The toric group had lower mean residual cylindrical error (-0.67±0.39 D vs. -1.14±0.56 D; p<0.001) and greater mean cylindrical error change (2.17±0.56 D vs. 1.63±0.72 D; p<0.001) than the LRI group, regardless of the preoperative astigmatic severity. The mean correction index (1.10±0.16 vs. 0.72±0.24; p<0.001) and success index (0.24±0.14 vs. 0.42±0.21; p<0.001) also differed significantly between the groups. CONCLUSION: Both surgical techniques considerably reduced astigmatism and had comparable visual outcomes. However, toric foldable iris-fixated pIOL implantation was more reliable for correcting moderate-to-high astigmatism in myopic eyes.

Comparison of Toric Foldable Iris-Fixated Phakic Intraocular Lens Implantation and Limbal Relaxing Incisions for Moderate-to-High Myopic Astigmatism

PURPOSE: To compare the effectiveness of toric foldable iris-fixated phakic intraocular lens (pIOL) implantation and non-toric foldable iris-fixated pIOL implantation with limbal relaxing incisions (LRIs) for correcting moderate-to-high astigmatism in myopic eyes. MATERIALS AND METHODS: The medical records of 146 patients (195 eyes) with myopic astigmatism who underwent toric foldable iris-fixated pIOL implantation (toric group; 94 eyes) or non-toric foldable iris-fixated pIOL implantation with concurrent LRIs (LRI group; 101 eyes) were retrospectively reviewed. For subgroup analysis, the two groups were subdivided according to preoperative astigmatic severity [moderate, 2.00 to <3.00 diopters (D); high, 3.00–4.00 D]. Visual and astigmatic outcomes were compared 6 months postoperatively. RESULTS: The uncorrected distance visual acuity was at least 20/25 in 100% and 98% of the toric and LRI group eyes, respectively. The toric group had lower mean residual cylindrical error (-0.67±0.39 D vs. -1.14±0.56 D; p<0.001) and greater mean cylindrical error change (2.17±0.56 D vs. 1.63±0.72 D; p<0.001) than the LRI group, regardless of the preoperative astigmatic severity. The mean correction index (1.10±0.16 vs. 0.72±0.24; p<0.001) and success index (0.24±0.14 vs. 0.42±0.21; p<0.001) also differed significantly between the groups. CONCLUSION: Both surgical techniques considerably reduced astigmatism and had comparable visual outcomes. However, toric foldable iris-fixated pIOL implantation was more reliable for correcting moderate-to-high astigmatism in myopic eyes.

Clinical Outcomes of Foldable Iris-Fixed Phakic Intraocular Lens and Change in Corneal Endothelial Cell Density

PURPOSE: To evaluate the efficacy, safety, stability and complications of the foldable iris-fixated phakic intraocular lens (Artiflex(R), Ophtec BV, Groningen, Netherlands) implantation for the correction of myopia with astigmatism. METHODS: The present study included 40 eyes of 20 patients who underwent Artiflex lens implantation, and 20 eyes of 10 patients who underwent Toric Artiflex lens implantation and were followed up for 1 year. We retrospectively examined visual acuity, refraction, any changes in astigmatism, efficacy, safety and corneal endothelial cell density. A correlation coefficient analysis of the factors that affected the changes was performed. RESULTS: The mean preoperative refractive spherical equivalent was -9.18 +/- 2.27 D and reached -0.45 +/- 0.45 D at 1 year after surgery. Postoperatively, 99.9% of the eyes showed improved visual acuity of more than 0.8. In patients with Toric Artiflex lens implantation, the preoperative mean astigmatism was -2.67 +/- 0.87 D, and at 1 year postoperatively -0.76 +/- 0.40 D, showing a statistically significant decrease (p < 0.001). The preoperative mean endothelial cell density was 2,850 +/- 230 cells/mm2 and decreased 1.3% on the final follow-up (2,812 +/- 261 cells/mm2) but without statistical significance (p = 0.456). Statistically significant correlation was not observed between endothelial cell loss and anterior chamber depth (r2 = -0.146, p = 0.267). CONCLUSIONS: Implantation of the iris-fixed intraocular lenses, Artiflex and Toric Artiflex, was safe and effective for correcting high myopia and astigmatism.