Toric phakic IOLs in keratoconus-evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus.

PURPOSE: To evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus. METHODS: In this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed. RESULTS: The mean postoperative uncorrected distance visual acuity (UDVApost) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVApre), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVApost/CDVApre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia (n = 14) showed significantly (p = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus (n = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (p = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVApost. The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D (p < 0.001). No significant difference was found in endothelial cell count. CONCLUSION: The results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.

Effect of 1-piece and 3-piece AcrySof intraocular lenses on the development of posterior capsule opacification after cataract surgery.

PURPOSE: To evaluate the effect of 1-piece and 3-piece hydrophobic acrylic intraocular lenses (IOLs) on posterior capsule opacification (PCO) after cataract surgery. SETTING: Ophthalmology departments of 3 hospitals in the United Kingdom and Germany and the Department of Physics at a United Kingdom university. METHODS: A series of 131 patients having cataract surgery had implantation of an acrylic 1-piece (SA30AL) or an acrylic 3-piece (MA30BA) IOL (AcrySof, Alcon). Surgery was performed according to standardized protocol by a single surgeon at each hospital. Posterior capsule opacification was assessed using digital retroillumination photography. All images were analyzed at a single center according to a standard protocol. Data were analyzed 6 months and 1 year after surgery. RESULTS: There was no statistically significant difference in the percentage area of PCO between the 1-piece (mean 16.0% +/- 15.7% [SD]) and 3-piece (mean 13.6% +/- 19.8%) cohorts 6 months and 1 year after surgery (P =.0664). CONCLUSION: There was no evidence of a difference in the area of PCO after cataract surgery between 1-piece and 3-piece IOLs, which were otherwise matched for material and lens geometry.

Refractive lensectomy and accommodating lens implantation in a case of hyperopia.

We present a 39-year-old woman with high hyperopia who developed an intolerance to contact lenses due to dry-eye syndrome and Grave's disease. Refractive lensectomy with implantation of a custom-made +31.00 diopter (D) accommodating intraocular lens (IOL) (1CU, HumanOptics) was performed in both eyes. This foldable IOL has modified haptics with transmission elements that allow axial movement of the IOL optic and capsular bag secondary to contraction of the ciliary muscle. The calculated pseudophakic accommodation induced by the anterior shift of a +31.00 D IOL is 2.20 D per millimeter of axial displacement. After 6 months, the accommodative range determined by defocusing was 3.00 D. The subjective near point with best distance correction was 32.00 cm. Refractive lensectomy and implantation of an accommodating IOL based on focus shift may be a refractive solution in eyes with high hyperopia and a short axial length.