Phakic Intraocular Lens (IOL) for Myopia Correction Workup: Other Tests

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Phakic Intraocular Lens (IOL) for Myopia Correction

Sections Phakic Intraocular Lens (IOL) for Myopia Correction
Overview
Workup
Treatment
Media Gallery
References

Workup

Other Tests

Determination of the lens formula is as follows:

Van der Heijde's nomogram for iris claw lens power calculation
Feingold's formula (proprietary) for a precrystalline lens implant
Matrix formula for phakic anterior chamber intraocular lens (AC IOL) power calculation
Binkhorst 2 formula for posterior chamber intraocular lens (PC IOL) power calculation

Treatment & Management

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Barsam A, Allan BD. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev. 2012 Jan 18. 1:CD007679. [Medline].
Klaproth OK, Rehrmann J, Kohnen T. Dynamic positional change and defocus curve of a phakic foldable anterior-chamber angle-supported intraocular lens during accommodation. Ophthalmology. 2013 Jul. 120(7):1373-9. [Medline].
Alio JL, Abbouda A, Peña-Garcia P. Anterior segment optical coherence tomography of long-term phakic angle-supported intraocular lenses. Am J Ophthalmol. 2013 Nov. 156(5):894-901.e2. [Medline].
Na KS, Jeon S, Joo CK. Effect of intraoperative manipulation during iris-claw phakic IOL implantation on endothelium. Can J Ophthalmol. 2013 Aug. 48(4):259-64. [Medline].
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Stonecipher KG, et al. EW Roundtable:The Unhappy Postoperative Refractive Patient. Eye World. May 2002.
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Trindade F, Pereira F, Cronemberger S. Ultrasound biomicroscopic imaging of posterior chamber phakic intraocular lens. J Refract Surg. 1998 Sep-Oct. 14(5):497-503. [Medline].
Zaldivar R, Davidorf JM, Oscherow S, Ricur G, Piezzi V. Combined posterior chamber phakic intraocular lens and laser in situ keratomileusis: bioptics for extreme myopia. J Refract Surg. 1999 May-Jun. 15(3):299-308. [Medline].
Kohnen T. Searching for the perfect phakic intraocular lens. J Cataract Refract Surg. 2000 Sep. 26(9):1261-2. [Medline].
Pérez-Santonja JJ, Alió JL, Jiménez-Alfaro I, Zato MA. Surgical correction of severe myopia with an angle-supported phakic intraocular lens. J Cataract Refract Surg. 2000 Sep. 26(9):1288-302. [Medline].
Allemann N, Chamon W, Tanaka HM, Mori ES, Campos M, Schor P, et al. Myopic angle-supported intraocular lenses: two-year follow-up. Ophthalmology. 2000 Aug. 107(8):1549-54. [Medline].
Alio JL, de la Hoz F, Perez-Santonja JJ, Ruiz-Moreno JM, Quesada JA. Phakic anterior chamber lenses for the correction of myopia: a 7-year cumulative analysis of complications in 263 cases. Ophthalmology. 1999 Mar. 106(3):458-66. [Medline].
Aguilar-Valenzuela L, Lleo-Perez A, Alonso-Munoz L, Casanova-Izquierdo J, Perez-Molto FJ, Rahhal MS. Intraocular pressure in myopic patients after Worst-Fechner anterior chamber phakic intraocular lens implantation. J Refract Surg. 2003 Mar-Apr. 19(2):131-6. [Medline].
Alio JL, de la Hoz F, Ismail MM. Subclinical inflammatory reaction induced by phakic anterior chamber lenses for the correction of high myopia. Ocular lenses for the correction of high myopia. Ocular Immunology and Inflammation. Swets & Zeitlinger: 1993. Vol 1: 219-223.
Ardjomand N, Kölli H, Vidic B, El-Shabrawi Y, Faulborn J. Pupillary block after phakic anterior chamber intraocular lens implantation. J Cataract Refract Surg. 2002 Jun. 28(6):1080-1. [Medline].
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Asano-Kato N, Toda I, Hori-Komai Y, Sakai C, Fukumoto T, Arai H, et al. Experience with the Artisan phakic intraocular lens in Asian eyes. J Cataract Refract Surg. 2005 May. 31(5):910-5. [Medline].
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Assil KK. The ARTISAN myopia lens: interim results of the US FDA clinical study. Available at http://www.ophthalmic hyperguide.com. Accessed: Dec 2005.
Baikoff G, Arne JL, Bokobza Y, Colin J, George JL, Lagoutte F, et al. Angle-fixated anterior chamber phakic intraocular lens for myopia of -7 to -19 diopters. J Refract Surg. 1998 May-Jun. 14(3):282-93. [Medline].
Baikoff G, Colin J. Intraocular lenses in phakic eyes. Ophthalmol Clin North Am. 1992. 5:789-795.
Barraquer J. Anterior chamber plastic lenses. Results of and conclusions from five years' experience. Trans Ophthalmol Soc U K. 1959. 79:393-424. [Medline].
Benedetti S, Casamenti V, Marcaccio L, Brogioni C, Assetto V. Correction of myopia of 7 to 24 diopters with the Artisan phakic intraocular lens: two-year follow-up. J Refract Surg. 2005 Mar-Apr. 21(2):116-26. [Medline].
Budo C, Hessloehl JC, Izak M, Luyten GP, Menezo JL, Sener BA, et al. Multicenter study of the Artisan phakic intraocular lens. J Cataract Refract Surg. 2000 Aug. 26(8):1163-71. [Medline].
Colin J. Bilensectomy: the implications of removing phakic intraocular lenses at the time of cataract extraction. J Cataract Refract Surg. 2000 Jan. 26(1):2-3. [Medline].
Colin J, Robinet A, Cochener B. Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology. 1999 Dec. 106(12):2281-4; discussion 2285. [Medline].
Dejaco-Ruhswurm I, Scholz U, Pieh S, Hanselmayer G, Lackner B, Italon C, et al. Long-term endothelial changes in phakic eyes with posterior chamber intraocular lenses. J Cataract Refract Surg. 2002 Sep. 28(9):1589-93. [Medline].
Dick HB, Kohnen T, Jacobi FK, Jacobi KW. Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision. J Cataract Refract Surg. 1996 Jan-Feb. 22(1):63-71. [Medline].
Fechner PU. Cataract formation with a phakic IOL. J Cataract Refract Surg. 1999 Apr. 25(4):461-2. [Medline].
Fechner PU. Intraocular lenses for the correction of myopia in phakic eyes: short-term success and long-term caution. Refract Corneal Surg. 1990 Jul-Aug. 6(4):242-4. [Medline].
Fechner PU, Haigis W, Wichmann W. Posterior chamber myopia lenses in phakic eyes. J Cataract Refract Surg. 1996 Mar. 22(2):178-82. [Medline].
Fechner PU, Strobel J, Wichmann W. Correction of myopia by implantation of a concave Worst-iris claw lens into phakic eyes. Refract Corneal Surg. 1991 Jul-Aug. 7(4):286-98. [Medline].
Fechner PU, van der Heijde GL, Worst JG. The correction of myopia by lens implantation into phakic eyes. Am J Ophthalmol. 1989 Jun 15. 107(6):659-63. [Medline].
Fechner PU, Wichmann W. Correction of myopia by implantation of minus optic (Worst iris claw) lenses into the anterior chamber of phakic eyes. Eur J Implant Surg. 1993. 5:55-59.
Fyodorov SN, Zuew VK, Tumanyan NR, Suheil AJ. Clinical and functional follow-up of minus IOL implantation in high grade myopia. Oftalmochirurgia. 1993. 2:12-17.
Gonvers M, Othenin-Girard P, Bornet C, Sickenberg M. Implantable contact lens for moderate to high myopia: short-term follow-up of 2 models. J Cataract Refract Surg. 2001 Mar. 27(3):380-8. [Medline].
Jimenez-Alfaro I, Benitez del Castillo JM, Garcia-Feijoo J, Gil de Bernabe JG, Serrano de La Iglesia JM. Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation. Ophthalmology. 2001 Jan. 108(1):90-9. [Medline].
Kashani AA. Phakic posterior chamber intraocular lenses for the correction of high myopia. J Refract Surg. 1996 May-Jun. 12(4):454-6. [Medline].
Koch DD. Enter with caution (editorial). J Cataract Refract Surg. 1996. 22:153-154.
Krumeich JH, Daniel J, Gast R. Closed-system technique for implantation of iris-supported negative-power intraocular lens. J Refract Surg. 1996 Mar-Apr. 12(3):334-40. [Medline].
Landesz M, van Rij G, Luyten G. Iris-claw phakic intraocular lens for high myopia. J Refract Surg. 2001 Nov-Dec. 17(6):634-40. [Medline].
Landesz M, Worst JG, Siertsema JV, van Rij G. Correction of high myopia with the Worst myopia claw intraocular lens. J Refract Surg. 1995 Jan-Feb. 11(1):16-25. [Medline].
Landesz M, Worst JG, Van Rij G, Houtman WA. Opaque iris claw lens in a phakic eye to correct acquired diplopia. J Cataract Refract Surg. 1997 Jan-Feb. 23(1):137-8. [Medline].
Malecaze FJ, Hulin H, Bierer P, Fournie P, Grandjean H, Thalamas C, et al. A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and artisan phakic lens. Ophthalmology. 2002 Sep. 109(9):1622-30. [Medline].
Maloney RK, Nguyen LH, John ME. Artisan phakic intraocular lens for myopia:short-term results of a prospective, multicenter study. Ophthalmology. 2002 Sep. 109(9):1631-41. [Medline].
Menezo JL, Aviño JA, Cisneros A, Rodriguez-Salvador V, Martinez-Costa R. Iris claw phakic intraocular lens for high myopia. J Refract Surg. 1997 Sep-Oct. 13(6):545-55. [Medline].
Menezo JL, Cisneros A, Hueso JR, Harto M. Long-term results of surgical treatment of high myopia with Worst-Fechner intraocular lenses. J Cataract Refract Surg. 1995 Jan. 21(1):93-8. [Medline].
Menezo JL, Cisneros AL, Rodriguez-Salvador V. Endothelial study of iris-claw phakic lens: four year follow-up. J Cataract Refract Surg. 1998 Aug. 24(8):1039-49. [Medline].
Menezo JL, Martinez MC, Cisneros AL. Iris-fixated Worst claw versus sulcus-fixated posterior chamber lenses in the absence of capsular support. J Cataract Refract Surg. 1996 Dec. 22(10):1476-84. [Medline].
Menezo JL, Peris-Martinez C, Cisneros AL, Martinez-Costa R. Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan. J Cataract Refract Surg. 2004 Jan. 30(1):33-44. [Medline].
Nuzzi G, Cantù C. Vitreous hemorrhage following phakic anterior chamber intraocular lens implantation in severe myopia. Eur J Ophthalmol. 2002 Jan-Feb. 12(1):69-72. [Medline].
Perez-Santonja JJ, Hernandez JL, Benítez del Castillo JM, Rodriguez-Bermejo C, Zato MA. Fluorophotometry in myopic phakic eyes with anterior chamber intraocular lenses to correct severe myopia. Am J Ophthalmol. 1994 Sep 15. 118(3):316-21. [Medline].
Pérez-Santonja JJ, Bueno JL, Meza J, García-Sandoval B, Serrano JM, Zato MA. Ischemic optic neuropathy after intraocular lens implantation to correct high myopia in a phakic patient. J Cataract Refract Surg. 1993 Sep. 19(5):651-4. [Medline].
Pérez-Santonja JJ, Bueno JL, Zato MA. Surgical correction of high myopia in phakic eyes with Worst-Fechner myopia intraocular lenses. J Refract Surg. 1997 May-Jun. 13(3):268-81; discussion 281-4. [Medline].
Pérez-Santonja JJ, Iradier MT, Benítez del Castillo JM, Serrano JM, Zato MA. Chronic subclinical inflammation in phakic eyes with intraocular lenses to correct myopia. J Cataract Refract Surg. 1996 Mar. 22(2):183-7. [Medline].
Pérez-Santonja JJ, Iradier MT, Sanz-Iglesias L, Serrano JM, Zato MA. Endothelial changes in phakic eyes with anterior chamber intraocular lenses to correct high myopia. J Cataract Refract Surg. 1996 Oct. 22(8):1017-22. [Medline].
Pérez-Torregrosa VT, Menezo JL, Harto MA, Maldonado MJ, Cisneros A. Digital system measurement of decentration of Worst-Fechner iris claw myopia intraocular lens. J Refract Surg. 1995 Jan-Feb. 11(1):26-30. [Medline].
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Media Gallery

Phakic myopia lens of -20.0 diopters, 7 years postoperatively, in a 30-year-old man. There is slight upward decentration. The lens appears well tolerated.
The drawing shows the relation of the phakic iris claw lens to the surrounding structures. Courtesy of Professor Jan J. F. Worst, MD.
Slit lamp photograph of optical section of the anterior segment showing a gap between the anterior surface of the crystalline lens and the posterior surface of the implanted myopia iris claw lens. Courtesy of Professor Jan J. F. Worst, MD.
Phakic minus iris claw lens, 12 years postoperatively, in a 36-year-old patient shown in 3D. The lens is seen to sit on top of the iris cone. This picture helps to understand why the much larger angle-supported lenses have to be vaulted by 20° to keep clear of the iris.
Phakic myopia iris claw lens, 11 years postoperatively. The claws of the lens are shifted upwards. This configuration makes iris fixation in the claws easier at the time of surgery. It reduces the chances of pressure by the lens haptics and the optic on the natural lens and the iris, in case a bigger knuckle of iris is drawn inside the claw.
Anterior segment fluorescein angiography in a case of iris claw lens (Artisan lens) in a phakic myope. There is no dye leakage. Courtesy of Professor Jan J. F. Worst, MD.
5-mm optic Artisan lens. Courtesy of Professor Jan J. F. Worst, MD.
6-mm diameter optic, Artisan lens. Courtesy of Professor Jan J. F. Worst, MD.
This 64-year-old patient had an iris claw lens implanted in his aphakic eye on the posterior surface of the iris, 10 years ago. The white line represents the pupil in its normal state. Note fine pigment on the surface of the intraocular lens in this area. Bigger pigment granules are seen in the periphery. It seems that the pigment dispersed as a result of friction between the anterior surface of the intraocular lens and the posterior surface of the iris, over a very long time. This happened in spite of the fact that the posterior chamber was very roomy due to aphakia. Courtesy of Kiranjit Singh, MD.
Gonioscopy in the same patient as in Image 9 with iris claw lens fixed to the back of the iris. The angle shows severe pigmentation of the angle of the anterior chamber. Only the very finely pulverized pigment is deposited in the angle. Courtesy of Kiranjit Singh, MD.
Gonioscopy in 3D of the other eye of the same patient as in Image 9 that received anteriorly fixed iris claw lens in the aphakic eye, 11 years ago. There is total absence of pigmentation in the angle of the anterior chamber. Courtesy of Kiranjit Singh, MD.
Postmortem appearances in an eye with an iris claw lens showing the ciliary body and the posterior surface of the iris. There is a total lack of inflammatory or degenerative changes. Courtesy of Professor Jan J. F. Worst, MD.
Besides producing optical problems, a decentered phakic intraocular lens, by taking the haptics closer to the limbus, makes the eye vulnerable to intermittent endothelial touch whenever the eye is forcibly rubbed. It can be prevented by a careful fixation during surgery. The decentered lens can be managed by opening the claws and refixation at the right place. Courtesy of Professor Jan J. F. Worst, MD.
Eleven years after phakic minus iris claw lens implantation in a 35-year-old patient, the pupil has been dilated for fundus examination. Iris claw lens does not affect the movements of the iris and the pupil, except at the point where the iris passes through the claw. The crystalline lens is not affected since the implanted lens remains far away from it.
This phakic intraocular lens is fixated to the midperiphery of the iris.

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Author

Arun Verma, MD Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India

Disclosure: Nothing to disclose.

Coauthor(s)

Daljit Singh, MBBS, MS, DSc † Professor Emeritus, Department of Ophthalmology, Guru Nanak Dev University; Director, Daljit Singh Eye Hospital, India

Daljit Singh, MBBS, MS, DSc is a member of the following medical societies: All India Ophthalmological Society, American Society of Cataract and Refractive Surgery, Indian Medical Association, International Intra-Ocular Implant Club, Intraocular Implant and Refractive Society, India

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Louis E Probst, MD, MD Medical Director, TLC Laser Eye Centers

Louis E Probst, MD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel S Durrie, MD Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center

Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology

Disclosure: Received grant/research funds from Alcon Labs for independent contractor; Received grant/research funds from Abbott Medical Optics for independent contractor; Received ownership interest from Acufocus for consulting; Received ownership interest from WaveTec for consulting; Received grant/research funds from Topcon for independent contractor; Received grant/research funds from Avedro for independent contractor; Received grant/research funds from ReVitalVision for independent contractor.

Sections Phakic Intraocular Lens (IOL) for Myopia Correction
Overview
Workup
Treatment
Media Gallery
References

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