Bilateral Artisan lens for aphakia and megalocornea: Long-term follow-up

Abstract

We received approval from the U.S. implant Food and Drug Administration and the University's Institutional Review Board to the Artisan lens (Ophtec BV) in both eyes of a patient who was aphakic and had megalocornea. No other intraocular lens would easily solve this patient's need because of the large anterior segment. The patient was having increasing difficulty with aphakic contact lenses because of his work environment. We present almost 5 years of follow-up data of this patient.

Three-year follow-up of secondary anterior iris fixation of an aphakic intraocular lens to correct aphakia

“…These IOLs have been used successfully to correct aphakia and high myopia and their use has been reported in aphakic patients with megalocornea and bullous keratopathy. 19,20 In this study, we evaluated secondary implantation of the Artisan aphakic iris-fixated IOL to correct aphakia in eyes with inadequate capsule support. The postoperative UDVA, CDVA, and SE results show the safety, efficacy, predictability, and stability of secondary implantation of this IOL to correct aphakia.…”

Phacoemulsification with corneal astigmatism correction with the use of a toric intraocular lens in a case of megalocornea

“…8,19 Many surgical solutions in megalocornea demonstrate repair procedures resulting from iatrogenic errors or from the consequences of the application of earlier current surgical techniques. 11,17 Most frequently, the development of cataract is observed between the ages of 40 years and 50 years, although some authors report single cases in children. 8,10,11,13 Posterior subcapsular opacifications and nuclear sclerosis are the most frequent clinical manifestations of cataract in megalocornea, although in some cases cortical masses as in our case had a tendency toward swelling and rapid progression of changes.…”

“…11,17 Most frequently, the development of cataract is observed between the ages of 40 years and 50 years, although some authors report single cases in children. 8,10,11,13 Posterior subcapsular opacifications and nuclear sclerosis are the most frequent clinical manifestations of cataract in megalocornea, although in some cases cortical masses as in our case had a tendency toward swelling and rapid progression of changes. 9,10,18 For this reason, surgery was performed in the right eye shortly after the first procedure.…”

“…6,7,[8][9][10]17,20 The surgical solution of using IOLs of larger size fixated in the anterior capsule or the iris or creating individually adjusted IOLs is associated with covering not only the cost of the procedure, but also the risk for complications resulting from the necessity of larger than standard anterior chamber openings. 6,7,9,11,14,17,22,23 The use of toric IOLs compels the surgeon to provide rotational stability and IOL centralization in the capsular bag because of the final refractive effect. 24,25 After insertion of a CTR, the toric IOL was sutured in the anterior chamber, which seemed to be an optimal solution in this case.…”

“…5 A tendency toward premature cataract has been observed in megalocornea. 7,8,10,11 In the case of coexisting corneal astigmatism, an additional refractive effect due to residual error can be unsatisfactory.…”