Optical Coherence Tomography Position Analysis of Retropupillary Iris-Fixated Intraocular Lens in Iris Tissue

Purpose

The aim of this study was to evaluate a micrometer-accurate analysis of the retropupillary Verisyse® intraocular lens (IOL) (Ophtec, Groningen NL; Santa Ana, USA) enclavation in the iris tissue.

Methods

A retrospective consecutive case series was conducted at the Department of Ophthalmology, University Hospital Mainz. Patients with an optical coherence tomography (Spectralis®, Heidelberg Engineering®; Heidelberg, Germany) examination after retropupillary Verisyse® IOL implantation were included retrospectively. The enclavation geometry was measured using the Eye-Explorer® from Heidelberg Engineering® (Heidelberg, Germany). Seventeen measuring positions were determined nasally and temporally at the corresponding enclavation points.

Results

72 eyes of 67 patients after implantation of a retropupillary Verisyse® IOL were analyzed. The average age was 68 ± 17.2 years (63% female; 38% male). The analysis of the position of the Verisyse® IOL showed highly homogeneous data in all measured points. The depth of the anterior chamber showed a positive correlation with width of the posterior deflection of the iris tissue behind the enclavation (Pearson r: 0.321, p=0.041). The offset of the haptics showed greater deviations, and the lens diopter implanted was higher (r = 0.337, p=0.007).

Conclusion

This is the first study that analysis the exact enclavation of retropupillary implanted Verisyse® IOL. It provides new information about the intrastromal course of the haptics in the iris tissue. It could be shown that the haptics do not run parallel in the iris tissue, but are anchored in the iris tissue with an average offset of 95 µm. This rebuts previous assumptions about the intrastromal course and provides new information.

[Aphakic Artisan/Verisyse IOLs as retropupillary implants : Video article]

The retropupillary implantation of an iris claw intraocular lens (IOL) is an uncomplicated and fast technique for rehabilitation of aphakic eyes without any capsular structures and is presented in a video in the online version of this article. A complete anterior pars plana vitrectomy as shown in our case or an extensive preceding anterior vitrectomy as well as an intact iris are prerequisites. Special instruments for the implantation and fixation of the IOL are available to optimize the operative procedure. In addition to a rapid operating time the advantages of a trained surgeon are low complications rates and fast rehabilitation. For eyes with a defective iris diaphragm, ischemic vitreoretinopathy and uveitis, other implantation techniques should be selected.

Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

Background

The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used.

Methods

A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer's holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles.

Results

We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications.

Conclusion

We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange.

[Retropupillary iris claw intraocular lens implantation technique for aphakia]

BACKGROUND

Overview of the retropupillary implantation of iris claw intraocular lenses (Artisan®,Ophtec, Groningen, Niederlande and Verisyse(TM),AMO, Santa Ana CA).

MATERIAL AND METHODS

A literature search and review of implantation techniques, patient selection, potential complications and management strategies.

RESULTS

This approach has the advantage of a simple implantation technique, an anatomically correct implantation site (as compared to endocapsular implantation) and a relatively low complication rate. An intact iris is, however, a prerequisite for this technique. Ischemic vitreoretinopathies, such as diabetes or vascular occlusive entities, as well as uveitis might be considered as contraindications.

CONCLUSIONS

The retropupillary implantation of iris claw intraocular lenses is an interesting and especially time-effective rehabilitation technique for aphakia.

Posteriorly enclavated iris claw intraocular lens for aphakia: long-term corneal endothelial safety study

PURPOSE

To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support.

METHODS

In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion.

RESULTS

All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between -1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred.

CONCLUSIONS

Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.

Examination of human meibum collection and extraction techniques

PURPOSE

To compare various meibum collection methods and extraction techniques.

METHODS

Sixty subjects, all successful contact lens wearers, were seen on two visits. Meibum was collected from the lower lid of the right eye with a glass microcapillary tube, and with a Dacron swab, cytology microbrush, or spatula from the left eye. Extraction with 2:1 chloroform:methanol was done either immediately or after data collection was complete. Individual samples were divided into four equal aliquots for analysis of total lipids, cholesterol, and inorganic phosphates by assay-based techniques. Effects of collection method, extraction, and dry eye status were examined using repeated measures analysis of variance and logistic regression.

RESULTS

Total lipids showed significance for collection device (p < 0.0001) but not for extraction technique (p = 0.13) or dry eye status (p = 0.97). Dacron swab collection was associated with more total lipid on average than each other collection device (p < 0.0001). The cholesterol assay showed significance of collection device (p < 0.0001) and extraction technique (p = 0.0002) but not dry eye status (p = 0.55). Spatula collection was associated with more cholesterol on average than each other collection device (p < 0.0001). For inorganic phosphates, immediate extraction (p < 0.0001), cytology microbrush collection (p < 0.0001), and non-dry eye status (p = 0.03) were associated with the greater likelihood of detection.

CONCLUSIONS

Dacron swab collection was associated with the highest average amount of total lipid detected, whereas spatula collection and immediate extraction was associated with the highest average amount of cholesterol detected. Cytology microbrush collection with immediate extraction on non-dry eye subjects was associated with the highest probability of detection of inorganic phosphates.