AIM:To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens(pIOLs)implantation for high myopia.METHODS:Thisstudywasdesignedfromaconsecutive series of phakic intraocul...AIM:To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens(pIOLs)implantation for high myopia.METHODS:Thisstudywasdesignedfromaconsecutive series of phakic intraocular lens complication and corrective surgeries.Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study.The mean age of patients was 38.6±6.35y(range 32-50y)and the mean time of history of pIOL implantation for high myopia was 6±2y(range 2-10y).Before corrective surgery,best spectaclecorrective visual acuity(BSCVA)ranged from perception to 20/200 in the eyes in which severe complications occurred.RESULTS:Corneal decompensation occurred in 12eyes of 9 high myopic patients after anterior chamber pIOL implantation.Rhegmatogenous retinal detachment(RRD)occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation.Patients with corneal decompensation,had combined procedures consisting of pIOL removal and penetrating keratoplasty(PKP).Removals of pIOL,phacoemulsification and pars plana vitrectomy(PPV)with silicone oil tamponade were performed in patients with RRD.After corrective surgeries,all patients but one(P+,patient 2,right eye)achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit.CONCLUSION:Phakic IOLs may be effective for thecorrection of high myopia.Although these IOLs may have severe complications and it affects safety and efficacy of this surgery.As seen here,corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs.Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.展开更多
AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implanta...AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implantable Coliamer lens(ICL)placement by a single surgeon(Xiao-Wei Gao)to correct preoperative mean spherical equivalents between-9.00diopter(D)and-23.00D.Main outcome measures included uncorrected visual acuity(UCVA),refraction,best spectacle-corrected visual acuity(BSCVA),endothelial cell density(ECD),intraocular pressure(IOP),lens transparency,postoperative uveitis.Visante anterior segment optical coherence tomography(AS-OCT)was used to measure anterior chamber depth(ACD)and the position of ICL.RESULTS:Mean follow-up was 6.54±3.26 months(range 3-12 months).Predictability of the manifest spherical equivalent(SE)refraction to within±1.OOD was achieved in 88%of eyes and±0.50D in 72.5%of eyes.The mean postoperative manifest SE refraction was-1.85±0.72D,with 96.34%of eyes maintaining or gaining≥1 line(s)of BSCVA.The mean 3-month postoperative ECD decreased but had no statistically difference compared with the preoperative ECD.Of the 7 eyes(8.54%)with a mild transient increase in intraocular pressure(up to 30mmHg),none required a second surgical procedure or prolonged topical medication.There was no loss of lens transparency.Pigmented precipitates were observed in 5 eyes(6.09%).The mean preoperative ACD measured with AS-OCT was 3.28±0.14mm,three months after surgery,the mean ACD was2.45±0.22mm.Anterior chamber depth showed astatistically significant reduction.One eye(1.22%)had ICL spontaneous rotation,81 eyes(98.78%)of the lens remained correctly centered.CONCLUSION:The implantation of ICL is an effective surgical option for the management of high myopia.But its long time effect and safety still need more time to prove.展开更多
AIM: To assess the outcomes of posterior chamber implantable collamer lens(ICL) implantation in Chinese pediatric patients with unilateral high myopic amblyopia.·METHODS: Eleven eyes of 11 amblyopic patients aged...AIM: To assess the outcomes of posterior chamber implantable collamer lens(ICL) implantation in Chinese pediatric patients with unilateral high myopic amblyopia.·METHODS: Eleven eyes of 11 amblyopic patients aged11.02±3.34 y underwent ICL(model V4, Staar Surgical Inc.)implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure(IOP),vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1,3mo and the last follow-up time(mean 8.18 ±2.82mo)after surgery.· RESULTS: The mean myopic anisometropia was-13.70 ±3.25 D preoperatively and +0.69 ±2.63 D at 8mo postoperatively. The log MAR corrected distance visual acuity(CDVA) of the amblyopic eye was 1.51 ±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The log MAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%,64%, respectively. The contrast sensitivity of 0.5, 1 and 2cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at1 mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively.·CONCLUSION: This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.展开更多
AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and ana...AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.展开更多
This study aims to evaluate the clinical results of posterior chamber implantable collamer lens(ICL) implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24 y(range 19.2...This study aims to evaluate the clinical results of posterior chamber implantable collamer lens(ICL) implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24 y(range 19.2 to 42.5) were studied. ICL implantation was performed in 13 amblyopic eyes. The mean myopic anisometropia was significantly dropped from-10.70±3.02 D preoperatively to +0.09±1.67 D at 1 mo postoperatively. The logMAR CDVA at 3 d, 1, 3 and mean 9 mo postoperatively improved by a mean of 1.69, 2.50, 3.01 and 3.00 lines and gained more than 2 lines accounted for 23.08%(3 eyes), 41.67%(5 eyes), 63.63%(7 eyes) and 55.56%(5 eyes), respectively. The contrast sensitivity of amblyopic eyes was significantly increased after surgery. Four patients partially recovered near stereopsis(400" to 100"). There was no severe complications were observed. ICL implantation alone can improve vision, contrast sensitivity, and partial restoration of binocular vision in adult patients with high myopic anisometropia.展开更多
AIM:To assess the safety,efficacy and predictability of the AcrySof phakic angle-supported intraocular lens(IOL)(Alcon Inc.,U.S.A.) for correction of high-to-extremely high myopia in adults.· METHODS:In this pros...AIM:To assess the safety,efficacy and predictability of the AcrySof phakic angle-supported intraocular lens(IOL)(Alcon Inc.,U.S.A.) for correction of high-to-extremely high myopia in adults.· METHODS:In this prospective study performed in Tianjin Medical University Eye Center & College of Optometry,Tianjin,China,25 eyes of 13 patients were implanted with AcrySof phakic angle-supported IOLs and followed for 1 year postoperatively.Preoperative manifest refractive sphere was(-12.08±2.44) diopters(D) and cylinder was(-1.35±0.62)D.Visual acuity,predictability and stability of manifest refraction spherical equivalent(MRSE),adverse events,and endothelial cell density were analyzed during 1-year of follow-up.· RESULTS:After 1 year of follow-up,no eyes lost ≥1 line(best spectacle-corrected visual acuity)BSCVA;an uncorrected visual acuity(UCVA) of 20/20 or better was achieved in 60% of eyes;100% had an UCVA of 20/40 or better;a BSCVA of 20/30 or better was achieved by 100% of eyes;84% had a BSCVA of 20/20 or better.The overall mean percentage change in endothelial cell density 1 year after surgery was(-0.27±3.60)%.Two eyes(8%) had increased intraocular pressure(IOP) on the day of surgery.No pupil ovalization,pupillary block,or retinal detachment events were observed.· CONCLUSION:After 1 year of follow-up,the implantation of AcrySof phakic angle-supported IOL is proved to be safe,effective and predictable with minimal complications in patients with high-to-extremely high myopia.Due to the limitation of visiting time,long-term of clinical investigation is necessary to verify the safety and efficacy of this IOL.展开更多
This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens(p IOL).Endothelial cell density(ECD) at baseline,6 mo and 3 y were 3017±296,2775±265 an...This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens(p IOL).Endothelial cell density(ECD) at baseline,6 mo and 3 y were 3017±296,2775±265 and 2558±299 cells/mm^2 respectively.ECD loss at 6 mo was 7.2% and annual ECD loss was 3% over 36 mo.Corrected distance visual acuity at 36 mo was 0.4 log MAR or better in 32(88.9%) eyes.Intraocular pressure did not change(P=0.9).No eyes developed cataract,retinal detachment or pupillary distortion.Angle supported p IOL gives good visual outcome.Endothelial cell loss should be monitored.展开更多
AIM: To evaluate the effect of incision types for Artisan phakic intraocular lens(PIOL) implantation on ocular higher-order aberrations(HOAs).·METHODS: A retrospective review was conducted of the patients who had...AIM: To evaluate the effect of incision types for Artisan phakic intraocular lens(PIOL) implantation on ocular higher-order aberrations(HOAs).·METHODS: A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type: cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter(D)were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity,special equivalents, astigmatism, predictability(±1 D from target refraction), HOAs(coma, trefoil, spherical aberration), and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively.·RESULTS: At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square(RMS) total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group.·CONCLUSION: Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.展开更多
AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospe...AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.展开更多
AIM:To compare the efficacy of selective laser trabeculoplasty(SLT) in replacing medical therapy in pseudophakic and phakic eyes.METHODS:Subgroup of a prospective randomized clinical trial including patients with prim...AIM:To compare the efficacy of selective laser trabeculoplasty(SLT) in replacing medical therapy in pseudophakic and phakic eyes.METHODS:Subgroup of a prospective randomized clinical trial including patients with primary open angle glaucoma or ocular hypertension controlled with medication.Of 38 pseudophakic eyes were matched with 38 phakic eyes.SLT was offered as a way to decrease medication while maintaining the same low eye pressure.SLT was performed over 360°,at 3ns,spotsize 400 μm,100 spots.Data [intraocular pressure(IOP),number of medications needed] were measured at 1h,1wk,1,3,6 and 12 mo.An independent-samples t-test was performed to compare baseline characteristics of the phakic and the pseudophakic group and differences in evolution of mean IOP and number of used medications.Chi-squared analysis was performed to investigate proportions of fast,slow and non-responders.RESULTS:The mean IOP measurement was 13.00± 2.88 mm Hg in the phakic group(38 eyes) and 13.51±3.06 mm Hg in the pseudophakic group(38 eyes)(P>0.05).This changed little after SLT and IOP lowering effect was comparable between the two groups.Main aim however was to lower the amount of medication needed.In the phakic group medication lowered from 1.29±0.62 at baseline,to 0.15±0.46 after 12mo;a reduction of 88.37%.In the pseudophakic group,used medication changed from 1.71±1.04,to 0.41±0.61;a 76.02% reduction.The differences were not statistically significant at any time point(P>0.05).IOP lowering occurred slightly faster in thepseudophakic group(50% of patients after one week) than in the phakic group(68% of patients after more than 4wk).The difference was not significant(P>0.05).CONCLUSION:IOP lowering effect of SLT is comparable between phakic and pseudophakic eyes.展开更多
BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE S...BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole(MH)in a patient with a history of bilateral pIOL implantation for the correction of myopia of–12.00 diopters in both eyes 7 mo ago.The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases,MH can occur following pIOL.In this present case report,we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.展开更多
We report the case of a high myopic patient who had been implanted with angle-supported phakic intraocular lenses (pIOL) in 1990 and who subsequently and gradually developed complications in both eyes including endoth...We report the case of a high myopic patient who had been implanted with angle-supported phakic intraocular lenses (pIOL) in 1990 and who subsequently and gradually developed complications in both eyes including endothelial cell loss, chronic glaucoma, cataract, pupil ovalization and severe iris atrophy. The patient was impaired by photophobia, glare, halo, loss in visual acuity and concerned about the cosmetically deforming aspect of her eyes. Cataract surgery was performed after explantation of the pIOL followed by combined implantation of a standard IOL in the capsular bag and a Dr Schmidt artificial iris in the sulcus. There were no intraoperative and postoperative complications except slight bilateral corneal oedema which resolved completely within 1 month after surgery. Uncorrected and corrected visual acuity improved progressively to reach 0.3 and 0.6 at the last follow-up visit (±1 year), respectively. The patient was very satisfied with the functional and aesthetical outcomes.展开更多
AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS...AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS:Totally 60 eyes of 60 patients underwent p IOL implantation for surgical correction of myopia.Anterior chamber depth(ACD)was measured with the IOLMaster 700,and nasal and temporal safety distances(SD)were measured pre-and postoperatively using Anterior Segment Visante-OCT.SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium.Eyes were divided into 3 groups:convex,concave,and plane according to preoperatory iris configuration.Statistical analysis was performed using the R program,for the comparison of independent groups and multiple comparisons,the Kruskal-Wallis test and the Dunn test were used respectively.RESULTS:Mean difference between nasal preoperative SSD and postoperative RSD was-0.36±0.38,-0.29±0.48,and-0.18±0.30 mm in the concave,convex,and plane group,respectively.Mean difference between temporal SSD and RSD was-0.36±0.37,-0.14±0.38,and-0.24±0.33 mm in the concave,convex,and plane group,respectively.There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group(P<0.002).CONCLUSION:Preoperative SSD and postoperative RSD for iris-claw p IOL shows significant differences in patients with concave and plane iris.展开更多
Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperat...Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.展开更多
Purpose To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens(ICL,STAAR Surgical)with a central port.Methods This prospective,ob...Purpose To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens(ICL,STAAR Surgical)with a central port.Methods This prospective,observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant.A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography(AS-OCT)device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery.Results Preoperative mean pupil size under photopic conditions was 3.38±0.64 mm;after surgery,this increased to 3.48±0.61 mm.Mean pupil size under scotopic light conditions was 5.72±0.79 mm before surgery and 5.84±0.77 mm postoperatively.The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10±0.44 mm(P=0.078)and 0.12±0.58 mm(P=0.098),respectively.The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes(60%).The mean central vault value was 412±177μm under maximum miosis and 506±190μm under maximum mydriasis.We found a positive correlation between vault and differences in pupil diameter under all light conditions(P<0.05).Conclusion Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane.The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.展开更多
文摘AIM:To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens(pIOLs)implantation for high myopia.METHODS:Thisstudywasdesignedfromaconsecutive series of phakic intraocular lens complication and corrective surgeries.Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study.The mean age of patients was 38.6±6.35y(range 32-50y)and the mean time of history of pIOL implantation for high myopia was 6±2y(range 2-10y).Before corrective surgery,best spectaclecorrective visual acuity(BSCVA)ranged from perception to 20/200 in the eyes in which severe complications occurred.RESULTS:Corneal decompensation occurred in 12eyes of 9 high myopic patients after anterior chamber pIOL implantation.Rhegmatogenous retinal detachment(RRD)occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation.Patients with corneal decompensation,had combined procedures consisting of pIOL removal and penetrating keratoplasty(PKP).Removals of pIOL,phacoemulsification and pars plana vitrectomy(PPV)with silicone oil tamponade were performed in patients with RRD.After corrective surgeries,all patients but one(P+,patient 2,right eye)achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit.CONCLUSION:Phakic IOLs may be effective for thecorrection of high myopia.Although these IOLs may have severe complications and it affects safety and efficacy of this surgery.As seen here,corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs.Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.
文摘AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implantable Coliamer lens(ICL)placement by a single surgeon(Xiao-Wei Gao)to correct preoperative mean spherical equivalents between-9.00diopter(D)and-23.00D.Main outcome measures included uncorrected visual acuity(UCVA),refraction,best spectacle-corrected visual acuity(BSCVA),endothelial cell density(ECD),intraocular pressure(IOP),lens transparency,postoperative uveitis.Visante anterior segment optical coherence tomography(AS-OCT)was used to measure anterior chamber depth(ACD)and the position of ICL.RESULTS:Mean follow-up was 6.54±3.26 months(range 3-12 months).Predictability of the manifest spherical equivalent(SE)refraction to within±1.OOD was achieved in 88%of eyes and±0.50D in 72.5%of eyes.The mean postoperative manifest SE refraction was-1.85±0.72D,with 96.34%of eyes maintaining or gaining≥1 line(s)of BSCVA.The mean 3-month postoperative ECD decreased but had no statistically difference compared with the preoperative ECD.Of the 7 eyes(8.54%)with a mild transient increase in intraocular pressure(up to 30mmHg),none required a second surgical procedure or prolonged topical medication.There was no loss of lens transparency.Pigmented precipitates were observed in 5 eyes(6.09%).The mean preoperative ACD measured with AS-OCT was 3.28±0.14mm,three months after surgery,the mean ACD was2.45±0.22mm.Anterior chamber depth showed astatistically significant reduction.One eye(1.22%)had ICL spontaneous rotation,81 eyes(98.78%)of the lens remained correctly centered.CONCLUSION:The implantation of ICL is an effective surgical option for the management of high myopia.But its long time effect and safety still need more time to prove.
文摘AIM: To assess the outcomes of posterior chamber implantable collamer lens(ICL) implantation in Chinese pediatric patients with unilateral high myopic amblyopia.·METHODS: Eleven eyes of 11 amblyopic patients aged11.02±3.34 y underwent ICL(model V4, Staar Surgical Inc.)implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure(IOP),vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1,3mo and the last follow-up time(mean 8.18 ±2.82mo)after surgery.· RESULTS: The mean myopic anisometropia was-13.70 ±3.25 D preoperatively and +0.69 ±2.63 D at 8mo postoperatively. The log MAR corrected distance visual acuity(CDVA) of the amblyopic eye was 1.51 ±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The log MAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%,64%, respectively. The contrast sensitivity of 0.5, 1 and 2cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at1 mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively.·CONCLUSION: This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.
文摘AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.
基金Supported by Natural Science Foundation of China (No.81670848 No.81470626)
文摘This study aims to evaluate the clinical results of posterior chamber implantable collamer lens(ICL) implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24 y(range 19.2 to 42.5) were studied. ICL implantation was performed in 13 amblyopic eyes. The mean myopic anisometropia was significantly dropped from-10.70±3.02 D preoperatively to +0.09±1.67 D at 1 mo postoperatively. The logMAR CDVA at 3 d, 1, 3 and mean 9 mo postoperatively improved by a mean of 1.69, 2.50, 3.01 and 3.00 lines and gained more than 2 lines accounted for 23.08%(3 eyes), 41.67%(5 eyes), 63.63%(7 eyes) and 55.56%(5 eyes), respectively. The contrast sensitivity of amblyopic eyes was significantly increased after surgery. Four patients partially recovered near stereopsis(400" to 100"). There was no severe complications were observed. ICL implantation alone can improve vision, contrast sensitivity, and partial restoration of binocular vision in adult patients with high myopic anisometropia.
文摘AIM:To assess the safety,efficacy and predictability of the AcrySof phakic angle-supported intraocular lens(IOL)(Alcon Inc.,U.S.A.) for correction of high-to-extremely high myopia in adults.· METHODS:In this prospective study performed in Tianjin Medical University Eye Center & College of Optometry,Tianjin,China,25 eyes of 13 patients were implanted with AcrySof phakic angle-supported IOLs and followed for 1 year postoperatively.Preoperative manifest refractive sphere was(-12.08±2.44) diopters(D) and cylinder was(-1.35±0.62)D.Visual acuity,predictability and stability of manifest refraction spherical equivalent(MRSE),adverse events,and endothelial cell density were analyzed during 1-year of follow-up.· RESULTS:After 1 year of follow-up,no eyes lost ≥1 line(best spectacle-corrected visual acuity)BSCVA;an uncorrected visual acuity(UCVA) of 20/20 or better was achieved in 60% of eyes;100% had an UCVA of 20/40 or better;a BSCVA of 20/30 or better was achieved by 100% of eyes;84% had a BSCVA of 20/20 or better.The overall mean percentage change in endothelial cell density 1 year after surgery was(-0.27±3.60)%.Two eyes(8%) had increased intraocular pressure(IOP) on the day of surgery.No pupil ovalization,pupillary block,or retinal detachment events were observed.· CONCLUSION:After 1 year of follow-up,the implantation of AcrySof phakic angle-supported IOL is proved to be safe,effective and predictable with minimal complications in patients with high-to-extremely high myopia.Due to the limitation of visiting time,long-term of clinical investigation is necessary to verify the safety and efficacy of this IOL.
文摘This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens(p IOL).Endothelial cell density(ECD) at baseline,6 mo and 3 y were 3017±296,2775±265 and 2558±299 cells/mm^2 respectively.ECD loss at 6 mo was 7.2% and annual ECD loss was 3% over 36 mo.Corrected distance visual acuity at 36 mo was 0.4 log MAR or better in 32(88.9%) eyes.Intraocular pressure did not change(P=0.9).No eyes developed cataract,retinal detachment or pupillary distortion.Angle supported p IOL gives good visual outcome.Endothelial cell loss should be monitored.
文摘AIM: To evaluate the effect of incision types for Artisan phakic intraocular lens(PIOL) implantation on ocular higher-order aberrations(HOAs).·METHODS: A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type: cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter(D)were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity,special equivalents, astigmatism, predictability(±1 D from target refraction), HOAs(coma, trefoil, spherical aberration), and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively.·RESULTS: At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square(RMS) total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group.·CONCLUSION: Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.
基金Supported by the National Natural Science Foundation of China(No.81700812)。
文摘AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.
文摘AIM:To compare the efficacy of selective laser trabeculoplasty(SLT) in replacing medical therapy in pseudophakic and phakic eyes.METHODS:Subgroup of a prospective randomized clinical trial including patients with primary open angle glaucoma or ocular hypertension controlled with medication.Of 38 pseudophakic eyes were matched with 38 phakic eyes.SLT was offered as a way to decrease medication while maintaining the same low eye pressure.SLT was performed over 360°,at 3ns,spotsize 400 μm,100 spots.Data [intraocular pressure(IOP),number of medications needed] were measured at 1h,1wk,1,3,6 and 12 mo.An independent-samples t-test was performed to compare baseline characteristics of the phakic and the pseudophakic group and differences in evolution of mean IOP and number of used medications.Chi-squared analysis was performed to investigate proportions of fast,slow and non-responders.RESULTS:The mean IOP measurement was 13.00± 2.88 mm Hg in the phakic group(38 eyes) and 13.51±3.06 mm Hg in the pseudophakic group(38 eyes)(P>0.05).This changed little after SLT and IOP lowering effect was comparable between the two groups.Main aim however was to lower the amount of medication needed.In the phakic group medication lowered from 1.29±0.62 at baseline,to 0.15±0.46 after 12mo;a reduction of 88.37%.In the pseudophakic group,used medication changed from 1.71±1.04,to 0.41±0.61;a 76.02% reduction.The differences were not statistically significant at any time point(P>0.05).IOP lowering occurred slightly faster in thepseudophakic group(50% of patients after one week) than in the phakic group(68% of patients after more than 4wk).The difference was not significant(P>0.05).CONCLUSION:IOP lowering effect of SLT is comparable between phakic and pseudophakic eyes.
文摘BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole(MH)in a patient with a history of bilateral pIOL implantation for the correction of myopia of–12.00 diopters in both eyes 7 mo ago.The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases,MH can occur following pIOL.In this present case report,we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.
文摘We report the case of a high myopic patient who had been implanted with angle-supported phakic intraocular lenses (pIOL) in 1990 and who subsequently and gradually developed complications in both eyes including endothelial cell loss, chronic glaucoma, cataract, pupil ovalization and severe iris atrophy. The patient was impaired by photophobia, glare, halo, loss in visual acuity and concerned about the cosmetically deforming aspect of her eyes. Cataract surgery was performed after explantation of the pIOL followed by combined implantation of a standard IOL in the capsular bag and a Dr Schmidt artificial iris in the sulcus. There were no intraoperative and postoperative complications except slight bilateral corneal oedema which resolved completely within 1 month after surgery. Uncorrected and corrected visual acuity improved progressively to reach 0.3 and 0.6 at the last follow-up visit (±1 year), respectively. The patient was very satisfied with the functional and aesthetical outcomes.
文摘AIM:To compare the simulated safe distance(SSD)preoperatively versus real safe distance(RSD)postoperatively in patients with iris-claw phakic intraocular lens(p IOL)implantation according to iris configuration.METHODS:Totally 60 eyes of 60 patients underwent p IOL implantation for surgical correction of myopia.Anterior chamber depth(ACD)was measured with the IOLMaster 700,and nasal and temporal safety distances(SD)were measured pre-and postoperatively using Anterior Segment Visante-OCT.SD was defined as a line measured between the edge of the optic or its simulated image to the endothelium.Eyes were divided into 3 groups:convex,concave,and plane according to preoperatory iris configuration.Statistical analysis was performed using the R program,for the comparison of independent groups and multiple comparisons,the Kruskal-Wallis test and the Dunn test were used respectively.RESULTS:Mean difference between nasal preoperative SSD and postoperative RSD was-0.36±0.38,-0.29±0.48,and-0.18±0.30 mm in the concave,convex,and plane group,respectively.Mean difference between temporal SSD and RSD was-0.36±0.37,-0.14±0.38,and-0.24±0.33 mm in the concave,convex,and plane group,respectively.There were statistically significant differences between SSD and RSS for both nasal and temporal sides in the concave and plane group(P<0.002).CONCLUSION:Preoperative SSD and postoperative RSD for iris-claw p IOL shows significant differences in patients with concave and plane iris.
文摘Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.
文摘Purpose To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens(ICL,STAAR Surgical)with a central port.Methods This prospective,observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant.A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography(AS-OCT)device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery.Results Preoperative mean pupil size under photopic conditions was 3.38±0.64 mm;after surgery,this increased to 3.48±0.61 mm.Mean pupil size under scotopic light conditions was 5.72±0.79 mm before surgery and 5.84±0.77 mm postoperatively.The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10±0.44 mm(P=0.078)and 0.12±0.58 mm(P=0.098),respectively.The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes(60%).The mean central vault value was 412±177μm under maximum miosis and 506±190μm under maximum mydriasis.We found a positive correlation between vault and differences in pupil diameter under all light conditions(P<0.05).Conclusion Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane.The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.
