Artisan iris-fixated toric phakic and aphakic intraocular lens implantation for the correction of astigmatic refractive error after radial keratotomy.

We report 2 patients who had radial keratotomy (RK) to correct myopia. The first patient developed a postoperative hyperopic shift and cataract. Nine years post RK, she had intracapsular cataract extraction and implantation of an Artisan aphakic intraocular lens (IOL). Twenty years post RK, hyperopia and astigmatism progressed to +7.0 -5.75 x 100 with a best corrected visual acuity (BCVA) of 20/20. Due to contact lens intolerance, the Artisan aphakic IOL was exchanged for an Artisan toric aphakic IOL. Three months later, the BCVA was 20/20 with +1.0 -0.50 x 130. The second patient demonstrated residual myopic astigmatism 6 years after bilateral RK and had become contact-lens intolerant. An Artisan toric phakic IOL was implanted in both eyes. Four months later, the BCVA was 20/25 with a refraction of +0.25 -1.0 x 135 and 20/20 with a refraction of -1.0 x 40. Both patients were satisfied with the visual outcomes.

Clinical and theoretical results of intraocular lens power calculation for cataract surgery after photorefractive keratectomy for myopia.

OBJECTIVES: To describe the refractive results of cataract surgery after photorefractive keratectomy (PRK) for patients with myopia, and to find a more accurate method to predict intraocular lens (IOL) power in these cases. DESIGN: Nonrandomized, retrospective clinical study. PATIENTS AND METHODS: Nine patients (15 eyes) who underwent cataract surgery after prior PRK to correct myopia were identified. The medical records of both the laser and cataract surgery centers were reviewed. MAIN OUTCOME MEASURES: Eight different keratometric values (K values; measured or calculated) were entered into 3 different IOL calculation formulas: SRK/T, Holladay 1, and Hoffer Q. The actual biometry and IOL parameters were used to predict postoperative refraction, which was compared with the actual refractive outcome. Also, the relative underestimation of the refractive change in corneal dioptric power by keratometry after PRK was calculated. RESULTS: In 7 of 15 eyes, IOL exchange or piggybacking was performed because of hyperopia. Retrospectively, the most accurate K value for IOL calculation was found to be the pre-PRK K value corrected by the spectacle plane change in refraction. Use of the Hoffer Q formula would have avoided postoperative hyperopia in more cases than the other formulas. The mean underestimation of the change in corneal power after PRK varied from 42% to 74%, depending on the method of calculation. CONCLUSION: The predictability of IOL calculation for cataract surgery after PRK can be improved by using a corrected, refraction-derived K value instead of the measured, preoperative K value.

The influence of keratoplasty on visual prognosis in aniridia: a historical review of one large family.

PURPOSE: To evaluate the visual prognosis in aniridia and the influence of keratoplasty in one large family. METHODS: The medical charts of 30 affected members of this family were studied retrospectively. Their eyes were divided in keratoplasty and nonkeratoplasty groups. In the keratoplasty group, 42 keratoplasties (26 lamellar and 16 penetrating) were performed (20 eyes), with a median follow-up of 18.5 years. In the nonkeratoplasty group, 18 eyes with sufficient follow-up were included. Best corrected visual acuity ever measured (BCVA-ever), BCVA at the last visit (end-BCVA), and the difference between BCVA-ever and end-BCVA (long-term Delta-BCVA) were compared in those two groups. Best postoperative VA (post-BCVA), the difference between pre- and post-BCVA (short-term Delta-BCVA), and its duration and outcomes of the grafts were evaluated in the keratoplasty group. Possible side effects of other procedures and incidents related to aniridia were compared. RESULTS: The median BCVA-ever was 1/10 in both groups. The median end-BCVA was 2/300 in the keratoplasty group and 1.5/300 in the nonkeratoplasty group; the long-term Delta-BCVA was comparable in the two groups. There was a temporary improvement of BCVA in 36 of 42 eyes after corneal transplantation, with a median of 8 logMAR and duration of 12 months. Most grafts failed because of recurrence of aniridic keratopathy. In the keratoplasty group, there were more corneal infections and more retinal detachments. The occurrence of glaucoma was comparable in both groups. In the nonkeratoplasty group, more eyes (five versus three) lost light perception. CONCLUSION: Corneal transplantation in aniridia provided only a temporary improvement in VA in this family. The long-term visual outcome was not affected by keratoplasty.

Long-term follow-up after bilateral Artisan aphakia intraocular lens implantation in two children with Marfan syndrome.

We present two patients with Marfan syndrome and bilateral crystalline lens dislocation who underwent bilateral lens extraction and Artisan aphakia intraocular lens (IOL) implantation. With a follow-up of more than 12 years, we found a good visual outcome, no serious IOL-related complications, and endothelial cell densities within the expected range for eyes without cataract surgery.

Long-term follow-up of the corneal endothelium after aphakic iris-fixated IOL implantation for bilateral cataract in children.

PURPOSE: To evaluate the long-term corneal endothelial cell density (ECD) and outcomes after iris-fixated aphakic intraocular lens (IOL) implantation in children after bilateral congenital or juvenile cataract extraction and to compare the outcomes with data in the literature. SETTING: Academic Medical Centre, Amsterdam, The Netherlands. DESIGN: Case series. METHODS: This retrospective study evaluated the charts and endothelial photographs of children who had Artisan aphakic IOL implantation. The main outcome measure was the ECD at the last follow-up visit. RESULTS: The mean age of the 10 patients (20 eyes) at IOL implantation was 7.4 years (range 4.3 to 11.1 years) and at the last follow-up, 19.6 years (range 14.3 to 26.6 years). After a mean follow-up of 12.3 years (range 10.0 to 15.6 years), the mean ECD was 2702 cells/mm(2) (range 1382 to 3974 cells/mm(2)). Although this is comparable to the mean normal endothelial cell counts in this age group reported in the literature, a wider range of ECD was found in the current study. CONCLUSIONS: The mean corneal ECD after more then 10 years of follow-up was comparable to the mean normal ECD for this age group reported in the literature. The high standard deviation of the mean ECD in the current study highlights the importance of prospective studies on the ECD after iris-fixated aphakic IOL implantation in young patients.