First Author: E.Ispizua Mendivil SPAIN
Co Author(s): M. Mendivil Soto P. Fernandez Avellaneda O. Guergue Diaz de Cerio P. Rivera Perez de Rada M. Nunez
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To describe the profile of the patients who underwent Artisan iris-claw lens implantation surgery, including the aetiology of aphakia and pre-existent ocular comorbidity. Additionally, to compare surgeons’ choice in intraocular lens (IOL) placement. Finally, to assess visual outcomes, refractive results, specially astigmatism, and complication rate after implantation of an iris-claw aphakic IOL.
Ophthalmology Department of Hospital de Basurto, Bilbao, Spain.
Retrospective case series analysis of 54 eyes of 53 patients which underwent Artisan lens implantation for correction of aphakia during February 2014 to January 2017. Mean follow-up time was 9 months, although it ranged from 2 to 22 months. The surgeries were performed by 13 different surgeons, either anterior or posterior pole specialists. The 53 patients (46.3 % male, 53.7 % female), had a mean age of 77,53 years (range 24 to 92). The causes of aphakia were spontaneous IOL luxation into the vitreous (32.75%), complications during phacoemulsification (27.3%), lens luxation into the vitreous during cataract surgery (18.2%). Up to 20% of the cases accounted for other causes such as trauma or IOL opacification.
The main comorbidity was pseudoexfoliation syndrome, present in 30.18%. The rate of high myopia was 9.43%; 7.54% had ocular hypertension and 15% diabetes mellitus. The most commonly associated procedure was pars plana vitrectomy (VPP) with luxated IOL extraction (34.6%), followed by VPP with extraction of cataract fragments (19.2%). Only in 28.8% of the cases Artisan implantation was performed as a single procedure. Secondary implantation of the IOL was deferred in 89.5% of the cases, being performed mostly by vitreo-retinal surgeons (75.5%). The preferred location for IOL implantation was retropupillary (61.8%). Mean preoperative logarithm of the minimum angle of resolution (LogMAR) best-corrected visual acuity (BCVA) was 0.634 units, improving to 0,419 at final follow-up. At this point, 66.6% achieved BCVA better than that measured preoperatively and 8.3% matched their preoperative BCVA, while in 25% of the cases this was worse. The corneal cylinder postoperatively was 1.79D in prepupillary positioning, while it reached an average of 2.96 in retropupillary placement. The most common complication was cystic macular edema (CME) and haptic luxation (9.25% each), being this re-fixed in some cases. The most devastating complication was choroidal haemorrhage (5.5 %). Ocular hypertension and endothelial decompensation occurred in 3.7 % of cases respectively.
With this study we get a picture of the situation in our region. The patients who are undergoing this type of surgery are the elderly patients, mainly due to spontaneous IOL luxation into the vitreous or to complications during cataract surgery. The most commonly related comorbidity is pseudoexfoliation syndrome, which associates both complications during phacoemulsification and late IOL luxations. Most of the times we have to perform complementary procedures, such as VPP, and vitreo-retinal surgeons will rather place the lens in a retropupillar location. Regarding refraction, the remaining corneal cylinder was higher in patients who had undergone a retropupilary implant. This may be related to the higher complexity of the cases, which have most commonly needed an additional VPP. Most of the patients improved their BCVA, however 3 devastating choroidal haemorrhages happened. CME and haptic luxation were common complications. Patients who had previously mention ocular comorbidities had greater rate of complications (44%) than those who did not (38%). Artisan iris-claw lens implantation is a good option for aphakia, and it has good results. However we must not forget that important complications may occur, specially when treating complex patients such as those who need associated procedures like luxated lens extraction.