Phakic IOL useful for high myopia, hyperopia, astigmatism

An iris-fixed phakic IOL (Verisyse/Artisan, Advanced Medical Optics) is effective in correcting high myopia, hyperopia, and astigmatism, according to 5-year follow-up data from a prospective study conducted in France.


Nantes, France-Five-year follow-up data on eyes in which an iris-fixed phakic IOL (Verisyse/Artisan, Advanced Medical Optics) had been implanted, show that the lens is effective in correcting high myopia, hyperopia, and astigmatism. The most frequent long-term complications found in the study were endothelial cell density loss and IOL decentration, said Joanna Brejtfus, MD, Clinique Sourdille, Nantes, France.

The 5-year outcomes also indicate that lens dislocation can occur at any time after surgery and that cell loss in eyes with iris-claw IOLs is greater than it is in normal eyes without surgery, said Dr. Brejtfus.

"Careful follow-up, searching for subclinical subluxation and endothelial cell loss, is necessary," she said. "Endothelial cell counts should be performed every year as long as the lens remains in the eye."

Early postoperative complications included temporary elevation of IOP, undercorrection requiring IOL exchange or a laser procedure, inflammatory reaction in the anterior chamber, small pupil ovalization, and pupil block.

Significant late complications included endothelial cell loss and subluxation of the implant.

"We observed important endothelial loss in 40% of the eyes during follow-up," Dr. Brejtfus said. "The most significant finding of up to 70% loss of endothelial cell density occurred in seven eyes."

Although several cases of retinal detachment occurred among the patients in this study, Dr. Brejtfus said she did not believe that any correlation existed between the detachments and refractive surgery.

In the study population, nine eyes had both severe endothelial cell loss and implant subluxation treated by IOL fixation.

Dr. Brejtfus also noted that significant endothelial cell loss was observed beginning in the third year after surgery. Because no patients experienced severe endothelial cell density loss before then, it appears that the length of time that the phakic IOL remains in the eye could be a risk factor.

Analysis of the outcomes also showed that acute implant decentration was associated with loss of vision, ocular pain, and photophobia.