Laser in situ keratomileusis following the implantation of iris-fixated phakic intraocular lenses.

PURPOSE: This study aims to assess the safety, efficacy, predictability, stability and complications associated with laser in situ keratomileusis (LASIK) for the correction of residual refractive errors following implantation of iris-fixated phakic intraocular lenses (pIOLs). METHODS: In this retrospective interventional case series of 92 eyes, an iris-fixated pIOL (Artisan) was implanted to correct myopia and myopic astigmatism. In 10 eyes, a residual refractive error was treated using LASIK. Visual acuity testing, subjective refraction, slitlamp examination and tonometry were all performed preoperatively, then 3 months following pIOL implantation and 1 year after LASIK treatment. The endothelial cell density was measured both prior to pIOL implantation and following LASIK therapy. RESULTS: Comparison of preoperative and postoperative best-corrected visual acuity revealed that none of the combined operated eyes forfeited > or =2 lines of visual acuity after LASIK. Uncorrected visual acuity for all 10 eyes after LASIK was > or =0.8. LASIK made a 61.5% mean reduction in astigmatism possible. Compared to the initial examination, the mean endothelial cell loss after LASIK treatment was 4.1%. CONCLUSIONS: For correction of residual refractive errors following iris-fixated phakic IOL implantation, LASIK appears to be a safe and effective procedure. Larger numbers of patients are required to verify this conclusion.

Posterior synechias following implantation of a foldable silicone iris-fixated phakic intraocular lens for the correction of myopia.

A 45-year-old white woman with unilateral high myopia had uneventful implantation of a -9.0 diopter, foldable, iris-fixated Artiflex I anterior chamber phakic intraocular lens (pIOL) (Ophtec B.V.) in the right eye. Despite application of topical antibiotic and steroid agents for 4 weeks after surgery, iris pigment dispersion developed on the anterior surface of the crystalline lens. Two weeks later, the iris dispersion increased and posterior synechias developed from the iris to the crystalline lens next to the pIOL haptic at the 3 o'clock position. Consequently, pIOL re-enclavation was performed without surgically removing the posterior synechias. Initial and interim mydriatic and steroid eyedrops were administered 4 times a day. Regular follow-up examinations after re-enclavation (at 2, 3, 6, 12, and 24 months) confirmed a stable pIOL position by Scheimpflug photography. Two years after implantation, posterior synechias persisted at the 3 o'clock position, with iris dispersion on the crystalline lens and the posterior side of the pIOL, but with no signs of anterior chamber inflammation and no visual acuity loss.

Internal anterior chamber diameter using optical coherence tomography compared with white-to-white distances using automated measurements.

PURPOSE: To compare internal horizontal anterior chamber (AC) diameter determined by optical coherence tomography (OCT) and horizontal corneal diameter (white-to-white [WTW]) using automated measurements. SETTING: Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. METHODS: Internal AC diameter and WTW distance was measured in 52 eyes of 26 patients using the Visante OCT (Carl Zeiss Meditec), IOLMaster (Carl Zeiss Meditec), and Orbscan IIz topography system (Bausch & Lomb). Statistical evaluation was performed using the Bland-Altman method and regression analysis for comparison of measurement techniques. The Kruskal-Wallis test was used to measure the repeatability of each device. RESULTS: The mean internal AC diameter was 12.45 mm +/- 0.53 (SD) with OCT; the mean WTW distance was 12.17 +/- 0.45 mm with the IOLMaster and 11.84 +/- 0.41 mm with the Orbscan IIz. A positive regression was determined for AC diameter and both WTW measurements. Measurement values varied little between both WTW measurement systems (R(2) = 0.9384). CONCLUSIONS: Anterior chamber measurement using optical coherence tomography (Visante OCT) was easy to handle and showed good repeatability. The internal horizontal diameter of the AC was larger than the horizontal corneal diameter determined by automated WTW measurements (IOLMaster, Orbscan IIz). Optical coherence tomography with the Visante OCT allows direct measurement of the AC width.

Intermittent myopic shift of 4.0 diopters after implantation of an Artisan iris-supported phakic intraocular lens.

A 45-year-old man with bilateral high myopia and myopic astigmatism had uneventful implantation of a -10.5 diopters (D) Artisan iris-fixated anterior chamber phakic intraocular lens (PIOL) (Ophtec) in both eyes. In the first days after surgery, uncorrected visual acuity (UCVA) was 20/16 in the right eye and 20/16 in the left; the position of the PIOL was stable. Ten days after surgery, the left eye developed a myopic shift of 4.0 D. Further examination showed that the myopia disappeared when the pupil was medically dilated. After the pupil returned to a natural position, the myopic shift reappeared. Because there were no changes in the subsequent 4 months, we decided to exclavate the IOL, rotate it by 10 degrees, and reenclavate it with less tissue. The myopic shift did not return over the following 20 months, and the UCVA was 20/20. In rare cases, iris-fixated anterior chamber IOLs may induce refractive changes related to effects on the surrounding anatomic structures. This may be corrected by phakic IOL rotation or reenclavation of the phakic IOL with less tissue.

Confocal microscopic characteristics of stage 1 to 4 diffuse lamellar keratitis after laser in situ keratomileusis.

PURPOSE: To evaluate 4 stages of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis using confocal microscopy. SETTING: Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. METHODS: This retrospective study comprised 17 eyes (15 patients): 11 cases of stage 1 DLK, 5 cases of stage 2, 1 case of stage 3, and 2 cases of stage 4. All eyes were examined by slitlamp biomicroscopy and confocal microscopy. RESULTS: In all cases of stage 1 and 2 DLK, confocal microscopy showed infiltration of inflammatory cells into the flap stroma and the interface. The density of the infiltrates and the number of cells varied within the stage 1 corneas; all stage 2 corneas had dense infiltrates. In the eye with stage 3 DLK, an aggregation of presumed cell remnants was noticed. In the stage 4 cases, there was no active inflammation but stromal folds and numerous activated keratocytes were detected. CONCLUSIONS: Confocal microscopy showed differences in the appearances of the DLK groups. There were similarities in the features of stages 1 and 2. Only stages 1 and 2 represented active inflammation, whereas stages 3 and 4 showed the result of accumulation and decay of the inflammatory cells.