One-year follow-up of a new posterior chamber toric phakic intraocular lens implantation for moderate-to-high myopic astigmatism.

PURPOSE: To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. METHODS: The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from - 4.50 to - 18.50 diopters (D) and cylindrical refraction from - 0.50 to - 5.50 D. RESULTS: This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from - 10.45 ± 2.74 D preoperatively to - 0.34 ± 0.51 D and - 0.40 ± 0.56 D at 6 and 12 months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00 D and ± 0.50 D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. CONCLUSIONS: The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

Explantation of phakic intraocular lenses: causes and outcomes.

PURPOSE: To describe reasons for explantation of anterior and posterior chamber phakic intraocular lenses (pIOLs), as well as outcomes of the surgery. METHODS: The medical files of patients who underwent pIOL explantation due to complications were reviewed. All patients were divided into three groups based on the type of explanted pIOL: anterior chamber angle-supported (AS pIOL), anterior chamber iris-fixated (IF pIOL), and posterior chamber (PC pIOL). RESULTS: Sixty-two eyes of 41 patients were evaluated. There were 26 (41.9%), 16 (25.8%), and 20 (32.2%) eyes in the AS pIOL, IF pIOL, and PC pIOL groups, respectively. The mean interval between the implantation and removal of the pIOL (i.e., survival time) was 13.6 ± 8.1 years (range 0.01-21.22 years). The mean follow-up after the explantation was 22.5 ± 4.0 months (range 11.3-28.7 months). The main causes of explantation were cataract in the PC pIOL group (60%) and chronic endothelial cell loss in the AS pIOL group (53.8%) and IF pIOL group (56.2%). Overall, the procedure most often combined with pIOL explantation was phacoemulsification and implantation of a posterior chamber IOL (40.3%), followed by keratoplasty (9.6%). Intraoperative complications were significantly more common in the AS pIOL group than the other groups (p < 0.001). CONCLUSIONS: Explantation of anterior chamber pIOLs due to severe endothelial cell loss and the proportion of keratoplasty was more common in patients with a relatively long survival time. Therefore, patients with pIOL implantation should be monitored regularly after surgery.

The effects of complicated cataract surgery on iris structure and anterior chamber angle.

PURPOSE: To evaluate iris structure in aphakic eyes scheduled for placement of a secondary intraocular lens. METHODS: Twenty-eight aphakic eyes of 28 patients who were scheduled for secondary intraocular lens implantation between January 2012 and January 2017 at Beyoglu Eye Training and Research Hospital after a complicated cataract surgery were recruited in this study. The phakic fellow eyes of the patients were defined as a control group. Iris thickness was assessed using anterior segment optical coherence tomography at 750µm (IT750) and 2000µm (IT2000) from the scleral spur. Moreover, maximum iris thickness (ITM) and anterior chamber angle parameters such as trabecular iris surface area at 500 and 750µm (TISA500, TISA750), angle opening distances at 500 and 750µm (AOD500, AOD750) and anterior chamber depth (ACD) were also evaluated. RESULTS: Mean IT750, IT2000 and ITM readings and were significantly lower in the aphakic eyes compared to the healthy eyes (P=0.04, P=0.01, P=0.01 respectively). Anterior chamber parameters (TISA500, TISA750, AOD500 and AOD750) and ACD were significantly increased in aphakic eyes following complicated cataract surgery compared to healthy fellow eyes (all P<0.001). CONCLUSIONS: Complicated cataract surgery leading to aphakia results in decreased iris thickness and increased anterior chamber depth. These findings might be helpful in the selection of the type of surgery for placement of a secondary IOL.

Long-term assessment of visual and refractive outcomes of laser in situ keratomileusis for hyperopia using the AMARIS® 750S Excimer laser.

PURPOSE: To evaluate the long-term efficacy and safety of hyperopic laser in situ keratomileusis (LASIK) using the AMARIS® 750S (Schwind, Eye-tech-solutions, GmbH) excimer laser. METHODS: The medical records of one hundred eleven eyes of 62 patients who underwent LASIK for hyperopia using the AMARIS® 750S excimer laser were reviewed retrospectively. Patients were divided into three groups based on preoperative spherical equivalent (SE) refraction: low hyperopia (less than +2.50 diopters [D]), moderate hyperopia (+2.75D to +4.00D), and high hyperopia (over +4.00D). Uncorrected and best corrected visual acuity (BCVA), long-term stability of refraction, and complications were evaluated. RESULTS: Of the entire sample, the mean preoperative SE was +3.64D±1.22D. The mean age was 37.4±11.2 years (20-59). The mean follow-up for all eyes was 51 months. At the last visit, the mean SE was +0.85D±0.34D (SD) in the low hyperopia group, +1.09D±0.43D in the moderate hyperopia group, and +1.63D±0.47D in the high hyperopia group. (+1.15D±0.49D overall). Preoperative uncorrected visual acuity (UCVA) was 0.52±0.34 logMAR and increased to 0.18±0.15 logMAR at 4 years follow-up (P<0.01). There was no statistically significant difference between preoperative and postoperative BCVA. The UCVA was 0.30 logMAR or better in 100% of eyes in the low hyperopia group, 93.7% in the moderate hyperopia group, and 69.9% in the high hyperopia group (%89.2 overall). CONCLUSIONS: LASIK is safe and effective for correcting hyperopia in the short term; however, the efficacy of the procedure is limited in the patients with high hyperopia and longer follow-up.