[Case report: A pseudophakic eye with good function 51 years after implantation]. / Vorderkammerlinse im sehenden Auge 51 Jahre nach Implantation.

We describe an anterior chamber pseudophakic eye with good vision 51 years after implantation of an angle fixated anterior chamber lens of the Dannheim type.

Worst-Fechner biconcave minus power phakic iris-claw lens.

OBJECTIVE: Evaluation of long-term results of correction of high myopia by implantation of a biconcave Worst-Fechner minus power iris-claw lens into phakic eyes. METHODS: One hundred and twenty-seven eyes of 70 patients were implanted with the phakic IOL between November 1986 and November 1991. The mean preoperative spherical equivalent refraction was -14.29 +/- 5.77 D (range -5.00 to -31.75 D). The total population decreased from 127 to 68 eyes (53.5%) at the 8-year examination. By this time, 26 of the 70 patients (37%) had been lost to follow-up for unknown reasons. Corneal endothelial density was estimated by comparing the image gained by non-contact specular microscopy with a graduated reticule (Karickhoff method). RESULTS: At the 6-month examination, mean deviation of achieved from calculated refractive correction was +0.52 +/- 1.46 D (range -2.25 to +6.50 D). Seventy-seven eyes (62.1%) deviated 1.00 D or less, and 15 eyes (12.1%) deviated by more than 2.00 D from the calculated correction. A refractive outcome of +/- 1.00 D was attempted in 68 eyes (54% of the 124 eyes) and was achieved in 51 eyes (75%). Mean spectacle-corrected visual acuity preoperatively was 0.54 +/- 0.27 (range 1.20 to 0.05). At the 6-month examination it was 0.73 +/- 0.3, and by the 8-year examination had decreased to 0.65 +/- 0.26. Statistical analysis of corneal endothelial cell density revealed a significant correlation of endothelial cell loss with age (> or = 45 years), anterior chamber depth (< or = 3.4 mm), and IOL power (> or = -11.00 D). Seventeen eyes (13.4%) had a decrease in endothelial cell density and projection to 8-year follow-up resulted in a decrease in 27% of eyes. Four eyes needed a penetrating keratoplasty. CONCLUSION: Implantation of a biconcave Worst-Fechner lens into a phakic eye effectively corrected high myopia with a stable refractive outcome, but 13.4% of implanted eyes suffered significant progressive reduction of endothelial cell density. This style lens is no longer in clinical use.

Iris-claw lens in phakic eyes to correct hyperopia: preliminary study.

PURPOSE: To evaluate the results of implanting convex, iris-fixated, anterior chamber intraocular lenses (IOLs) in phakic eyes to correct high hyperopia. SETTING: Robert Koch Hospital, Hannover-Gehrden, Germany (Center A), and Dr. Daljit Singh Eye Hospital, Amritsar, India (Center B). METHOD: Two eyes at Center A and 67 at Center B had implantation of an anterior chamber, convex, iris-fixated IOL. Follow-up of the 2 eyes at Center A was 91 months. Mean follow-up at Center B was 78 months +/- 24 (SD) (range 12 to 120 months). RESULTS: At Center B, all eyes except two in one patient had clear corneas and no iritis or glaucoma at the last follow-up. The patient with complications (glaucoma and corneal degeneration in both eyes) did not return for follow-up until more than 4 years postoperatively and thus did not have adequate postoperative care. CONCLUSION: Implantation of a convex iris-claw lens into the anterior chamber of phakic eyes to correct high hyperopia was successful from a refractive aspect. The clinical risks appear tolerable. However, life-long observation by endothelial microscopy is mandatory.

Posterior chamber myopia lenses in phakic eyes.

OBJECTIVE: To determine the best technique for implanting a hypernegative intraocular lens (IOL) in the posterior chamber of phakic eyes to neutralize high myopia and its results. SETTING: Robert Koch Hospital, Hannover-Gehrden, Germany. METHODS: We implanted the Chiron-Adatomed silicone myopia IOL in 69 eyes of 37 patients between June 1992 and August 1994 and followed them prospectively. RESULTS: To avoid marked decentration, the IOL should merely touch the ciliary sulcus. Its best length should equal the horizontal diameter of the cornea (white to white). Iritis from implantation trauma was avoided by intravenous administration of 250 mg prednisone preoperatively. When inserting the Chiron-Adatomed myopia IOL, we avoided putting pressure on the crystalline lens with the spatula. In 53 eyes, the difference between precalculated postoperative refraction and achieved postoperative refraction at 3 months was +0.07 +/- 1.05 diopters (D) (mean +/- SD). No eye deviated more than 2.80 D. Eleven of 69 eyes had a follow-up of fewer than 6 months and 13 had marked preoperative cortical opacities. Eight of the remaining 45 eyes with clear or almost clear cortexes showed a central subcapsular opacity after 1 to 2 years, probably IOL induced. CONCLUSION: Use of the Chiron-Adatomed IOL should be confined to older patients with early cataract until its role as the cause of opacities has been clarified by further observation.

Correction of myopia by implantation of a concave Worst-iris claw lens into phakic eyes.

The Worst-Fechner Biconcave Lens for the correction of myopia in phakic eyes is fixated to the anterior iris. Of the 125 eyes implanted between November 1986 and November 1990, 109 eyes ("core group") had a follow-up period of at least 12 months (mean, 25.0; range, 13 to 51). Sixty-eight of these eyes were reexamined at Giessen University Eye Clinic by an independent investigator using a laser flare cell meter; 23 of the eyes also were examined by iris fluorescence angiography. Seventy-five of the 109 eyes (68.8%) were corrected within 1.00 diopters of the desired refraction, and only 10 eyes (9.2%) deviated more than 2.00 D from the calculated correction. The anatomical results were characterized by good fixation, absence of glaucoma, inflammation, and leak from iris vessels. However, the corneal endothelium was damaged in five eyes by surgical trauma, three resulting in corneal edema. In addition, in five eyes the endothelial density decreased during the follow-up period despite an uncomplicated operation, resulting in corneal edema in one eye. These eyes may have had anterior chambers that were too shallow.

Retarded corneoscleral wound healing associated with high preoperative doses of systemic steroids in glaucoma surgery.

We compared two groups of human eyes with corneoscleral wounds. One group consisted of 100 phakic myopic eyes which received an iris fixated "claw" intraocular lens with a minus power optic. Prior to the operation, 350 mg of prednisone was administered systemically. Ten of these eyes (10%) developed a wound dehiscence requiring resuturing. The other group consisted of 1002 cataract operations where 20 mg of prednisone was administered subconjunctivally after the operation. No wound dehiscences occurred in this group. Pretreatment may be of value where fistual formation is desired, ie, with glaucoma surgery.

Super-reversed intraocular lens.

An intraocular lens (IOL) with an inverse (reversed) optic has the convex surface directed toward the retina, a design which has many advantages. We have developed a "super-reversed" IOL by increasing the angle of the haptic from 10 to 20 degrees and by increasing the convexity of the posterior surface (necessitating a concave anterior surface). The main advantage of this model is the distance of approximately 6.3 mm between the anterior corneal surface and the posterior IOL surface. This configuration mimics the natural situation. We report on the implantation of 473 lenses of this design.

Comparison of hydroxypropyl methylcellulose 2% (Adatocel) and hyaluronic acid 1% (Healon).

Hydroxypropyl methylcellulose solutions (2% HPMC) were examined for impurities. There was no evidence of any particulate matter in two solutions from different sources: one prepared by a hospital pharmacy, the other industrially prepared (Adatocel). In a controlled clinical study, Adatocel was compared with Healon (1% hyaluronic acid solution). The postoperative irritation (cellular response) in the anterior chamber was the same in both groups.