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The Vivarte IOL was withdrawn from the market because it was shown to cause endothelial damage. Figure 3. The Kelman Duet, Dr. It had four support points to prevent rotation and to reduce stress on the angle structures. The optic had a diameter of 5. Figure 4. The ICare IOL had angle support and an optic disc surrounded by additional lens material that greatly increased the volume of the lens.
Figure 5. The Cachet was the last anterior chamber lens that was fairly successful, although only for a short period of time. This one-piece lens had a flexible plate and haptics. The optic was shaped like a meniscus and had a diameter between 5. The material of this lens was the same as that used for the AcrySof pseudophakic lens for implantation in the posterior chamber, a material that has shown high biocompatibility.
Overall, there have been problems with the anterior chamber lenses with angle support that were developed, and all of those that entered the market were subsequently withdrawn. In the s, a series of reports highlighted numerous complications associated with the implantation of anterior chamber phakic IOLs with angle support. As a result, researchers sought new types of lenses to reduce the adverse effects related to the presence of an IOL in the anterior chamber and to minimize trauma to the iridocorneal angle.
Consequently, an iris-fixated or iris-claw lens was produced from a Worst design developed in This lens had a biconcave optic plate produced in PMMA by compression molding and lathe cutting. Although initially designed for the correction of aphakia, this lens was later modified for the correction of high myopia in phakic patients. The advantage of enclavation was that one size fit all; the lens was designed so that the sizing would not require modification based on the different characteristics of the eye.
Moreover, iris dilation was not compromised, and neither the structure of the angle nor the iris vasculature was altered. In , the design was modified to a 5. In , the design was modified to incorporate a 0.
The name of the lens was changed to Artisan Ophtec. In Europe, a model was available with a spherocylindrical optic toric model and cylinder powers of up to 7.
The Artiflex lens Ophtec, not available in the United States was subsequently designed and produced. This IOL is based on the Artisan platform but has a 6. The diameter of the lens is 8. The IOL can be inserted through a 3.
Figure 6. The Artiflex, a well-enclaved IOL. Iridectomy was performed. The concept of implanting IOLs in the posterior chamber was a valid alternative for phakic eyes because these lenses are positioned at a safe distance from the endothelium and iridocorneal angle. They were also cosmetically appealing because they were visible only with careful examination.
The first posterior chamber IOL was developed in by Dr. Initially, the lens had a collar button arrangement, with the optic in the anterior chamber and the haptics positioned in the posterior chamber behind the iris.
This silicone-plate haptic IOL had a length of The Chiron lens was associated with an increased incidence of anterior chamber inflammation and cataract formation, and production was stopped as a result. This one-piece hydrophobic silicone IOL was designed to float on the crystalline surface behind the iris, with the haptics resting on the zonules.
It was available in two sizes and had a power range from However, production of the Phakic Refractive Lens was abandoned because the lens induced zonular dehiscence with subluxation in the vitreous chamber Figure 7. Figure 7. A Phakic Refractive Lens dislocated 2 years after surgery. Their low incidence of complications correlated to their high refractive quality indicates that these types of lenses are valid options for the correction of high refractive errors when excimer laser surgery is not indicated, as in patients with thin corneas.
Correction of myopia by implantation of a concave Worst-iris claw lens into phakic eyes. Refract Corneal Surg. Surgical correction of severe myopia with an angle-supported phakic intraocular lens. J Cataract Refract Surg. Comparison of contrast sensitivity after angle-supported, iris-fixated and posterior chamber phakic intraocular lens implantation for high myopia.
The Kelman Duet phakic intraocular lens: 1-year results. J Refract Surg. Outcomes of ZB5M angle-supported anterior chamber phakic intraocular lenses at 12 years. Van Cleynenbreugel H. Late postoperative complications of backward implantation of a Vivarte phakic intraocular lens. Adhesion of lens capsule to intraocular lenses of polymethylmethacrylate, silicone, and acrylic foldable materials: an experimental study. Br J Ophthalmol. Adhesion of soluble fibronectin, laminin, and collagen type IV to intraocular lens materials.
The influence of incision-induced astigmatism and axial lens position on the correction of myopic astigmatism with the Artisan toric phakic intraocular lens. Toric phakic intraocular lens: European multicenter study. Contrast sensitivity after implantation of toric iris-claw lenses in phakic eyes.
Tehrani M, Dick HB. Short-term follow-up after implantation of a foldable iris-fixated intraocular lens in phakic eyes. Safety of posterior chamber phakic intraocular lenses for the correction of high myopia: anterior segment changes after posterior chamber phakic intraocular lens implantation.
Posterior chamber silicone phakic intraocular lens. Donoso R, Castillo P. Correction of high myopia with the PRL phakic intraocular lens. Interestingly, the current debate focuses not so much on safety as it does on patient selection. So where to draw the diopter line? Lane said. I believe that if you develop better designs, and as the safety becomes better known and established, that you will see a gradual acceptance of phakic IOLs for lower powers, not just the —14 or —15 myope.
Indeed, there continues to be a need for phakic IOLs better than the two current lenses, according to Dimitri T. A edition of a book that he co-edited, Refractive Surgery, 1 devotes 12 out of 45 chapters to phakic IOLs and related topics. The dream lens. For Dr. Azar, the ideal phakic IOL is easily inserted, removed and exchanged; does not require a large wound; can be fixated adequately without causing pressure on the tissue on which it is fixated; has a relatively thin profile and does not contact adjacent tissue; is made from biocompatible material that does not incite inflammation; has an optical zone large enough to minimize glare; boasts a design that would include optical characteristics to avoid spherical aberration; is affordable; and involves surgery that can be done with relative ease and without the need for special operating room equipment.
Azar said. Azar expressed optimism that the industry will do better. For example, currently, phakic IOLs cannot correct astigmatism, but I predict that down the line lenses will be able to do that. The technology is there.
Further, as the safety of these lenses gets established and the initial learning curve is overcome, I believe more doctors and more patients will choose phakic IOLs at lower degrees of myopia such as —5 and —6 diopters.
That is when you will see more doctors interested in implanting phakic IOLs. Phakic lenses are designed for patients who are prepresbyopic and maintain the natural accommodating ability of their own lens. Lindstrom pointed out. This is in contrast to the other alternative for presbyopes, which is a refractive lens exchange.
I personally would rather implant a phakic lens, take it out and then do the cataract surgery. Lindstrom added that a growing number of physicians are realizing that refractive surgeons can offer patients a continuum of procedures as their eyes and vision needs change. Lindstrom said. Azar reports no financial interests related to this story. Lane reports interests in Alcon.
About Foundation Museum of the Eye. Richard Mills' Opinions, to Azar et al. Amsterdam: Elsevier, Most Commented.
Phakic intraocular lenses, or phakic lenses, are lenses made of plastic or silicone that are implanted into the eye permanently to reduce a person's need for glasses or contact lenses. . With only two phakic lenses available in the U.S.—the Verisyse (Abbott Medical Optics, Santa Ana, Calif.) and the Visian (STAAR Surgical, Monrovia, Calif.)—options for U.S. physicians will . Alcon Logo. Patients Eye Care Professionals About Alcon Innovation Newsroom. Technical Product Information. ACRYSERT® Delivery System. MODEL SN6CWS Anterior Chamber .