Elsevier

Ophthalmology

Volume 106, Issue 3, 1 March 1999, Pages 458-466
Ophthalmology

Phakic anterior chamber lenses for the correction of myopia: A 7-year cumulative analysis of complications in 263 cases1

https://doi.org/10.1016/S0161-6420(99)90103-3Get rights and content

Abstract

Objective

To perform a prospective, clinical trial to determine the potential cumulative complications of patients implanted with angle-supported phakic intraocular lenses (PIOLs) for the correction of myopia.

Design

Nonrandomized, prospective, comparative trial.

Participants

Two hundred sixty-three eyes of 160 consecutive patients were included.

Intervention

Angle-supported anterior chamber intraocular lenses were implanted into phakic eyes.

Main outcome measures

Night halos and glare were recorded. Central endothelial cell count, postoperative inflammation, applanation tonometry, cataract development, retinal detachment, and pupil ovalization were recorded by the same physician.

Results

Night halos and glare were reported as significant by 20.2% at 1 year and 10% at year 7 of follow-up. This complication was significantly lower in the larger optical zone PIOL (ZSAL-4) than in the ZB5M/ZB5MF group (P < 0.05). Acute postoperative iritis was observed in 4.56% of cases. High intraocular pressure that required antiglaucoma medications appeared in 7.2% of cases. Central corneal endothelial cell density was significantly decreased at postoperative month 3 (P < 0.0001). The percentages of cell loss were 3.76% at month 3 and 1.83% at year 1, and then the percentages decreased by 1.37% more at year 2, 0.72% at year 3, 0.3% at year 4, 0.6% at year 5, 0.4% at year 6, and 0.56% at year 7. The total cumulative loss of central endothelial cells after 7 years was 8.37%. Pupil ovalization was present in 5.9% of cases, although smaller degrees of this complication were observed in another 10.3%. Retinal detachment appeared in 3% of cases. The PIOL explantation was decided in 11 cases (4.18%) because of cataract development (9 cases) and extreme pupil ovalization associated with severe glare (2 cases). The Kaplan-Meier cumulative survival analysis study showed an expected period free from complication of 86.5% for IOP elevation, 98.75% for endothelial cell count inferior to 1500 cells/mm2, 86.97% for pupil ovalization, 95.43% for retinal detachment, and 89.02% for explantation.

Conclusions

Angle-supported PIOL appeared to be well tolerated by the corneal endothelium with a low rate of other complications. Pupil ovalization seemed to be a specific problem for this type of PIOL.

Section snippets

Patients

Two hundred sixty-three eyes implanted with angle-supported PIOLs since October 1990 were included in this study. All patients were consecutively operated on and followed since their implantation by the same physician in a controlled study. The indications for PIOL implantation were stable axial myopia not treatable by corneal refractive surgery techniques used at our institution; age younger than 50 years and older than 20 years; anterior chamber depth of at least 3.4 mm; central corneal

Results

A total of 263 PIOL consecutively implanted eyes were included in this study; 157 of the ZB5M model, 80 of the ZB5MF model, and 26 of the ZSAL-4 model bilateral implants were used in 103 patients. When bilateral implants were performed, the same PIOL model was selected for both eyes. Table 1 lists the number of patients in each group being followed from a minimum of 1 year to a maximum of 7 years. The mean follow-up time for patients in this study was 4.89 ± 2.7 years with a range from 1.2 to

Discussion

The correction of ocular refractive errors by the implantation of PIOLs offers advantages over other refractive surgical techniques that have allowed this procedure to remain as a viable alternative to refractive surgery despite its previous controversial and conflicting history. Phakic intraocular lenses have a well-defined advantage over corneal refractive surgery, especially in moderate and high myopia. Sophisticated refractive surgery techniques such as laser in situ keratomileusis lead to

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    The authors have no financial interest in any aspect of this article.

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