Long-term endothelial changes in phakic eyes with posterior chamber intraocular lenses. J Cataract Refract Surg

University of Vienna, Wien, Vienna, Austria
Journal of Cataract and Refractive Surgery (Impact Factor: 2.72). 10/2002; 28(9):1589-93. DOI: 10.1016/S0886-3350(02)01210-5
Source: PubMed


To evaluate the long-term endothelial cell changes in phakic eyes after implantation of a posterior chamber phakic intraocular lens to correct high ametropia.
Department of Ophthalmology, University Hospital of Vienna, Vienna, Austria.
Thirty-four eyes of 21 patients having implantation of an implantable contact lens (ICL, Staar Surgical) for high myopia or hyperopia were prospectively examined. The minimum follow-up was 2 to 4 years. Preoperative and serial postoperative specular microscopy (Noncon Robo SP 8000, Konan) was performed to evaluate the long-term endothelial cell changes.
The mean preoperative endothelial cell density was 2854 cells/mm(2). The mean endothelial cell loss from preoperatively was 1.8% at 3 months, 4.2% at 6 months, 5.5% at 12 months, 7.9% at 2 years (n = 34), 12.9% at 3 years (n = 13), and 12.3% at 4 years (n = 11). All other endothelial cell characteristics remained stable during the 4-year follow-up.
Continuous endothelial cell loss was observed after ICL implantation during a 4-year follow-up. There was rapid cell loss until 1 year postoperatively, after which the rate of loss was no longer statistically significant. The percentage of hexagonal cells (polymorphism) and the coefficient of variation (polymegethism) remained stable during the 4-year follow-up.

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    • "Currently, pIOLs are offering a promising alternative for the management of moderate to high myopia.[67] Several lens designs have been developed for this purpose, including angle-supported pIOLs, posterior chamber pIOLs, and iris-fixated pIOLs.[289] In 1986, Worst et al. first designed a negatively biconcave iris-fixated pIOL to correct high myopia. "
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    ABSTRACT: To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia. Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of -11.70 ± 3.77 diopters (D; range -5.50 to -17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry. After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in 17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA. The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.
    Indian Journal of Ophthalmology 03/2012; 60(1):23-8. DOI:10.4103/0301-4738.91340 · 0.90 Impact Factor
    • "ICL can cause rapid endothelial cell loss initially. However, the hexagonal cell percentage and CV are stable during 5 years after surgery.[17] "
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    ABSTRACT: To compare two phakic intraocular lenses, Artiflex and STAAR(®) implantable contact lens (ICL), in high myopia. Isfahan Ophthalmology Clinic, Iran. In a randomized, prospective clinical trial study, 40 eyes of 20 patients who came to Isfahan ophthalmology clinic to correct their refractive error were examined. Artiflex was inserted in 20 eyes and ICL in the other 20 eyes. After 1 year, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), and specular microscopy of corneal endothelium were assessed in both the groups. In this study, there was no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, and specular microscopy, 1 year after surgery. 40% of eyes in the Artiflex group developed anterior chamber cell and flare reaction 1 year postoperatively, but no patient in the ICL group developed the same. So, there is obvious difference in the rate of anterior chamber cell and flare reaction between these two groups. These two lenses have similar outcomes except in the incidence rate of anterior chamber cell and flare reaction that is greater in the Artiflex group. So, these two lenses are safe with predictable outcome in treating high myopia.
    Oman Journal of Ophthalmology 09/2011; 4(3):116-9. DOI:10.4103/0974-620X.91266
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    ABSTRACT: Detailed and exact preoperative examinations are required to secure postoperative results that are highly satisfactory for the patients. The most important measurements are refraction, corneal topography, biometry of the anterior and posterior chamber, as well as endothelial cell density. Each of the various pIOL types has special advantages, but may also entail risks. Anterior chamber pIOLs may influence endothelial cells and may cause pupil ovalization. Posterior pIOLs can provoke cataract formation and pigment dispersion. Since the implantation of a pIOL is elective surgery indications have to be fulfilled and possible contraindications have to be validated carefully. Finally, it has to be mentioned that only a few of the pIOLs described above have been tested in other studies and that only a few long-term examinations were available. Because of this, careful postoperative examinations of the mostly young patients have to be performed over a period of several years in order to minimize long-term complications.
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