Phakic intraocular lens explantation: causes in 240 cases.

PURPOSE: To describe the main causes of explantation of phakic intraocular lenses (PIOLs) according to the anatomical site of implantation (angle supported, iris fixated, or posterior chamber). METHODS: This multicentric, retrospective, and consecutive study sponsored by the Spanish Ministry of Health comprised a total of 240 eyes (226 patients) explanted due to PIOL complications. Clinical data of 144 angle-supported lenses, 24 iris-fixated lenses, and 72 posterior chamber lenses explanted were recorded preoperatively and postoperatively. RESULTS: Mean age of the patients at explantation was 46.30 ± 11.84 years (range: 25 to 80 years). The mean time between implantation and explantation was 381.14 ± 293.55 weeks (range: 0.00 to 1,551.17 weeks). It was 422.33 ± 287.81 weeks for the angle-supported group, 488.03 ± 351.95 weeks for the iris-fixated group, and 234.11 ± 4,221.60 weeks for the posterior chamber group. It was 8.10 ± 5.52 years for the angle-supported group, 9.36 ± 6.75 years for the iris-fixated group, and 4.49 ± 4.25 years for the posterior chamber group. This period of time was significantly shorter in the posterior chamber group (P < .001). Overall, the main causes of explantation were cataract formation (132 eyes, 55%), endothelial cell loss (26 eyes, 10.83%), corneal decompensation (22 eyes, 9.17%), PIOL dislocation/decentration (16 eyes, 6.67%), inadequate PIOL size or power (12 eyes, 5%), and pupil ovalization (10 cases, 4.17%). Cataract development was the cause of explantation in 51.39% of angle-supported cases, 45.83% of iris-fixated cases, and 65.28% of posterior chamber cases. Endothelial cell loss was the cause of explantation in 15.97% of angle-supported PIOLs, 8.33% of iris-fixated PIOLs, and 1.39% of posterior chamber PIOLs. CONCLUSIONS: Cataract is the main cause of PIOL explantation, especially in posterior chamber PIOLs. In the angle-supported group, endothelial cell loss was the second cause of explantation.

Femtosecond-assisted keratopigmentation double tunnel technique in the management of a case of Urrets-Zavalia syndrome.

PURPOSE: To describe the successful use of a double intrastromal tunnel femtosecond-assisted keratopigmentation technique to manage a case of unilateral Urrets-Zavalia syndrome. METHODS: A 33-year-old man was referred with a history of trauma in his right eye due to a labor-related accident. Because of myopic anisometropia, he had been previously implanted with an angle-supported phakic intraocular lens. The patient presented iris atrophy and a fixed dilated pupil. He complained of severe and incapacitating photophobia, glare, and decreased vision. To obtain a complete iris replica, the surgery involved creation of double keratopigmented intrastromal tunnels using femtosecond laser and micronized mineral pigments. The deepest layer was stained black first and then the superficial layer was stained with a contoured greenish blue-gray color, which matched the contralateral eye. RESULTS: In the immediate postoperative period, the patient reported a complete elimination of photophobia associated with the corrected distance visual acuity improvement. A very adequate cosmetic outcome was also achieved. Stability was observed during the 12-month follow-up. CONCLUSION: A femtosecond-assisted keratopigmentation technique using 2 pigmented intrastromal tunnels to achieve an intracorneal pigmented replica of the iris was effective in improving the patient's severe visual function disability and cosmetic appearance. To the best of our knowledge, this is the first report of severe visual function disability caused by atrophic iris and a fixed dilated pupil treated with double intrastromal layers of keratopigmentation by means of femtosecond-created tunnels.

Femtosecond-assisted keratopigmentation for functional and cosmetic restoration in essential iris atrophy.

UNLABELLED: We describe a new surgical technique of femtosecond-assisted keratopigmentation (KTP) in a 23-year-old woman with severe visual dysfunction secondary to unilateral essential iris atrophy due to the presence of iridocorneal endothelial syndrome in her left eye. The patient presented with complaints of photophobia and monocular diplopia in the affected eye. Femtosecond-assisted KTP surgery was performed in this eye. Following the procedure, the patient reported complete elimination of photophobia and diplopia, with an excellent cosmetic result. Follow-up of 12 months was unremarkable. To our knowledge, this is the first report of a severe visual function disability caused by essential iris atrophy that was corrected by a new KTP technique. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Keratopigmentation (corneal tattooing) for the management of visual disabilities of the eye related to iris defects.

AIM: To investigate the functional and cosmetic outcomes of keratopigmentation (KTP) in cases of moderate to severe visual dysfunctions owing to different iris disorders. METHODS: 11 eyes with moderate to severe visual disabilities related to iris defects underwent KTP for functional and cosmetic restoration using micronised mineral pigments and assisted with modern technologies such as femtosecond laser and new automated keratopigmentation instruments for the intrastromal and superficial application of the pigments. RESULTS: Following the KTP surgery, the visual-function-related symptoms improved in all cases, from significant improvement to total elimination. Eight patients were asymptomatic after the surgery. In two patients, minimal non-disabling symptoms remained after surgery. One patient with traumatic aniridia complained of significant residual glare at the 3-month postoperative visit and was reoperated to reduce the simulated pupil to 4 mm. The cosmetic outcomes were analysed and classified as excellent in eight patients and good in three. CONCLUSION: KTP using new micronised mineral pigments and new surgical protocols has proven in this series to be an effective surgical technique for the management of moderate to severe visual dysfunctions related to iris defects.

Cross-linking in progressive keratoconus using an epithelial debridement or intrastromal pocket technique after previous corneal ring segment implantation.

PURPOSE: To evaluate and compare the clinical and confocal microscopic outcomes achieved with two different procedures for cross-linking (CXL) in eyes with keratoconus: CXL with epithelial debridement and CXL with intrastromal pocket. METHODS: This retrospective study included 27 eyes of 21 patients (age range: 18 to 53 years) diagnosed with keratoconus who underwent implantation of intracorneal ring segments and CXL with two different techniques: CXL with previous epithelial debridement (classic group, 16 eyes) and CXL with intrastromal pocket for riboflavin infusion (pocket group, 11 eyes). Visual, refractive, topographic, aberrometric, and pachymetric data were evaluated during 12-month follow-up. RESULTS: No statistically significant differences between the classic and pocket groups were found in postoperative visual acuity (P ≥.71), refraction (P ≥.15), keratometry (P ≥.28), corneal aberrations (P ≥.13), or central pachymetry (P ≥.21). A statistically significant improvement in uncorrected visual acuity found at 3 months postoperatively in both groups (P<.03) was consistent with a change in manifest sphere. Mean keratometric reduction at 12 months was 0.03 diopters (D) in the classic group (P=.55) and 0.40 D in the pocket group (P=.05). No significant changes in corneal higher order aberrations or central corneal thickness were found in either group (P ≥.14). CONCLUSIONS: Cross-linking surgery with creation of an intrastromal pocket seems to provide similar clinical outcomes compared to the classic CXL technique.

Phakic intraocular lens implantation for treatment of anisometropia and amblyopia in children: 5-year follow-up.

PURPOSE: To evaluate the safety and efficacy during 5-year follow-up of phakic intraocular lens (PIOL) implantation to correct high anisometropia in amblyopic children who were non-compliant with traditional medical treatment including spectacles or contact lenses. METHODS: Retrospective study of 10 eyes of 10 children with high anisometropia who underwent PIOL implantation (9 with an iris-supported IOL and 1 with a posterior chamber IOL). Patient age at the time of implantation ranged from 2 to 15 years. Mean preoperative spherical equivalent refraction was -10.14 ± 6.96 diopters (D) (range: +8.00 to -18.00 D). Mean logMAR corrected distance visual acuity (CDVA) was 0.84 ± 0.52. Postoperative data at 6, 24, and 60 months were evaluated. RESULTS: Corrected distance visual acuity improved in all children. At 24 months, logMAR CDVA was 0.39 ± 0.35 and at 5 years was 0.36 ± 0.38 (range for both: 0.1 to 1.0) (P=.01). Improvement of more than three logMAR lines of CDVA was achieved in all children except for one (one line improvement) who was implanted with a posterior chamber PIOL. No loss of CDVA was detected in any patient. Five years after surgery, endothelial cell count was >2000 cells/mm(2) in eight (80%) patients; for the remaining two patients, one reported frequent eye rubbing and the other suffered ocular trauma. CONCLUSIONS: Phakic IOL implantation in children with anisometropic amblyopia showed a positive long-term impact on visual acuity.