Potential role of the light-adjustable lens in flanged intrascleral haptic fixation.

PURPOSE: To compare maximum tensile strength between commonly used 3-piece intraocular lens (IOL) for flanged intrascleral haptic fixation (FISHF). SETTING: Willis-Knight Eye Institute, Shreveport, Louisiana. DESIGN: Laboratory investigation. METHODS: Haptic tensile strength was compared with MA60AC, CT Lucia 602, AR40E, and the light-adjustable lens (LAL). Haptic strength with a 24-diopter (D) IOL was compared across all lenses, as well as across a range of 10 to 30 D with the MA60AC. A custom device was created to hold the IOL in correct haptic orientation. The maximum tension (mean ± SD) was recorded in Newtons (N) when the haptic lost tension or broke. RESULTS: CT Lucia was the strongest at 1.53 ± 0.11 N vs 1.00 ± 0.15 (MA60AC), 0.87 ± 0.19 (AR40E), and 0.83 ± 0.14 N (LAL) ( P < .001). The LAL and AR40E were similar to a 9-0 polypropylene suture while being significantly stronger than 10-0 polypropylene suture ( P < .001). No difference in haptic tension for the MA60AC from 10 to 30 D ( P > .05). High magnification revealed the highest haptic fractures for MA60AC at 40% compared with LAL, AR40E, and CT Lucia at 0%. CT Lucia and AR40E had 100% of haptics disinserted from the IOL without any damage compared with 60% LAL and 60% MA60AC. CT Lucia, AR40E, and LAL have a flatter haptic angulation at 5 degrees. CONCLUSIONS: Haptic strength, durability, and angulation of the LAL may support the possibility of FISHF in the hands of experienced surgeons. However, further testing is strongly recommended to verify whether physiologic conditions or light treatments may compromise long-term haptic stability.

The Role of Multifocal Intraocular Lens Implantation in Extreme Axial Myopia: A Case Report and Literature Review.

The prevalence of high myopia is rising globally. In addition to an increased risk of retinal detachment, high myopia is associated with earlier cataract formation. Patients with myopia are also often more motivated to become spectacle-independent after a lens procedure. However, the use of multifocal intraocular lens (MfIOL) remains controversial for patients with extreme myopia, which is classified as patients with an axial length >28 mm. Here, we present the case of a 64-year-old patient with visually significant cataract and extreme axial myopia >31 mm in both eyes who desired to be spectacle-independent. A preoperative workup revealed a normal macula with peripheral lattice degeneration. On optical coherence tomography, the macula had a normal fovea contour without the presence of a staphyloma. A thorough peripheral examination was performed by a retina specialist which required no prophylactic treatment. Pentacam analysis demonstrated a low spherical aberration and minimal ectasia risk. Cataract surgery was uneventful with a 5 mm laser capsulotomy centered over the visual axis with the placement of a trifocal intraocular lens. Two months after the cataract surgery, the remaining refractive error was corrected with a laser-assisted in situ keratomileusis enhancement. The patient achieved an uncorrected distance visual acuity of 20/15- and uncorrected near visual acuity of J1+ in both eyes. Overall, this case report and review aims to highlight important preoperative, intraoperative, and postoperative techniques to improve patient outcomes with MfIOL in patients with extreme myopia.