Multicenter study of the Artisan phakic intraocular lens.

PURPOSE: To assess the Artisan intraocular lens to correct myopia in phakic eyes. SETTING: European multicenter study sponsored by Ophtec BV, Groningen, The Netherlands. METHODS: In this prospective multicenter clinical study, the Artisan lens was implanted in 518 eyes between September 1991 and October 1999. The power of the lenses ranged from -5.0 to -20.0 diopters (D). Follow-up examinations were performed at 6 months and 1, 2, and 3 years. Follow-up ranged from 6 months (n = 454) to 3 years (n = 249). The preoperative uncorrected visual acuity (UCVA) was not recorded but was estimated to be worse than 0.1. The preoperative mean best spectacle-corrected visual acuity (BSCVA) was 0.67 +/- 0.26 (SD). Endothelial cell counts were done at 6 months and 1, 2, and 3 years in a subgroup of 129 eyes. RESULTS: A UCVA of 20/40 or better was observed in 76.8% of eyes regardless of the postoperative goal. A BSCVA of 20/40 or better was observed in 93.9% of eyes and remained stable throughout the follow-up. Of the eyes with extremely high myopia (>-15.0 D), 63.3% gained 2 or more lines of BSCVA; of those with moderate myopia (-5.0 to -10.0 D), 23.5% gained 2 or more lines. The mean endothelial cell density change was 4.8% at 6 months, 2.4% at 1 year, 1.7% at 2 years, and 0.7% at 3 years. The incidence of persistent adverse events at 3 years was relatively low. Secondary surgical interventions included repositioning of the lens because of poor initial placement and lens exchange because of preoperative power calculation errors. Glare and halo effects during night driving were noted and were related to large pupils in young patients. CONCLUSION: The Artisan lens is a safe, stable, efficacious, and predictable method to correct -5.0 to -20.0 D of myopia. This study suggests that the corneal endothelial cell loss is stabilized to the physiologically normal level after 3 years.

Cytokeratin in lens epithelial cells and its effect on anterior lens capsule opacification.

Postoperative lens capsule opacification is a complication of extracapsular cataract extraction. To avoid this problem, we aspirated the epithelial cells lining the internal surface of the capsular bag. Anterior capsule specimens collected three and six years after the first surgical intervention (extracapsular cataract extraction with intercapsular implantation of a poly[methyl methacrylate] intraocular lens) and in vitro studies of epithelial cell cultures revealed the presence of intracellular and extracellular cytokeratin. After several years, the cytokeratin layers were arranged in a pattern analogous to that of liquid crystalline phases and many nonhuman extraocular tissues.

Small capsulotomy and great implant lens.

The envelope technique provokes in all cases a rupture of the zonules. With capsulorhexis, the advantages of working inside the envelope are lost, but the zonules are better protected. The capsulokleisis--or similar capsulotomies--combines the advantages of both systems. The Miyake technique indicates that the ideal lens for the capsular bag is a circular lens filling completely the capsular bag like the phacodrop.

Early results with the 8 mm and 9 mm HEMA disc intraocular lens.

This study presents our experience with 34 HEMA disc intraocular lenses implanted in the capsular bag. Despite the small number of cases and the relatively short mean postoperative follow-up of nine months, the results show a low incidence of uveitis and capsular fibrosis and excellent biocompatibility. The following complications were observed: four luxations of the 8 mm lens and one of the 9 mm lens in the anterior chamber. A visual acuity of 20/20 to 20/40 was obtained in 32 patients (94%).

Two-year postoperative results of Galand lens implantation.

The Galand lens is a closed J-loop implant for capsular-bag fixation. We present a retrospective study of 214 eyes implanted with this lens. Eyes were examined at three months, six months, one year, and two years after surgery. Results indicate that 82.2% of eyes obtained a visual acuity of 20/40 or better at two years after implantation. If patients with other ocular pathology were excluded, the percentage of those whose visual acuity was 20/40 or better at two years was 93.7%. Although this implant avoids "spring action" within the capsular bag, the rate of dislocation into the posterior chamber was low (0.93% in this series). Early stability, before sealing of the capsular leaflets, was obtained by limiting the anterior capsulectomy to the pupillary area. No late zonular rupture was observed. Secondary posterior capsulotomy has been performed in 9.8% of the eyes.