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Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation.

Abstract：

OBJECTIVE:To assess the safety of posterior chamber phakic intraocular lens (PCPIOL) implantation in patients with high myopia. DESIGN:Prospective, noncomparative, interventional case series. PARTICIPANTS:Twenty eyes of 10 patients were included. INTERVENTION:Staar Collamer Implantable Contact Lens PCPIOLs were implanted for the correction of high myopia. MAIN OUTCOME MEASURES:Intra- and postoperative complications were recorded. Specular microscopy, lens fluorophotometry, laser flare-meter, and ultrasound biomicroscopy were performed before surgery and at different stages of the follow-up period to evaluate endothelial cell density, crystalline lens transmittance, aqueous flare, and anatomic relations of the implanted lenses with the other structures of the anterior segment. RESULTS:There were no intraoperative complications. One patient experienced pupillary entrapment by the lens in the immediate postoperative period, which was resolved without incident. Pigmentary dispersion or cataracts did not appear during the postoperative period. All the lenses remained correctly centered, and no patient reported night halos or glare. Anterior chamber depth showed a statistically significant reduction, between 9% and 12%. Central endothelial density was significantly decreased after surgery. The percentages of cell loss after 3, 6, 12, 18, and 24 months were 4.41%, 4.83%, 5.17%, 5.46%, and 6.57%, respectively. Aqueous flare increased by 49.19% in the first postoperative month in relation to preoperative values. Afterward, it decreased and then remained above preoperative values for the entire follow-up period (33.76% at month 3, 27.81% at month 6, 27.65% at month 12, 23.39% at month 18, and 27.27% at month 24). Crystalline lens transmittance decreased by 0.72% at month 3, by 1.44% at month 6, by 1.95% at month 12, by 2.25% at month 18, and by 2.24% at month 24. Finally, by ultrasound biomicroscopy it was observed that the PCPIOL and the crystalline lens were in contact on the peripheral level in 12 patients (60%) and in the center in another three patients (15%) during at least one checkup. In all the patients, contact between the PCPIOL and the posterior iris surface could be observed. CONCLUSIONS:Posterior chamber phakic IOL implantation for the surgical correction of high myopia is a safe procedure with regard to immediate visual and refractive results. The short-term clinical benefit and lack of immediate surgical complications are impressive. However, the increase in flare, the endothelial cell loss, the decrease in crystalline lens transmittance, and the iris-PCPIOL and crystalline lens-PCPIOL contact are findings that suggest caution regarding the long-term safety of this lens implant.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Jiménez-Alfaro I,Benítez del Castillo JM,García-Feijoó J,Gil de Bernabé JG,Serrano de La Iglesia JM

doi

10.1016/s0161-6420(00)00403-6

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

90-9

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(00)00403-6

journal_volume

108

pub_type

杂志文章

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Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation.