Evaluation of the efficacy, safety, and stability of posterior chamber phakic intraocular lenses for correcting intractable myopic anisometropic amblyopia in a pediatric cohort

Abstract

Background Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort. Methods This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed. Results The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients’ visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy. Conclusions The present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia.

The Influence of 0.5% Tropicamide on Anterior Segment Parameters With CASIA2 in Emmetropic, Myopic, and Hyperopic Eyes

“…( Yan et al, 2010 ) In children, the anterior chamber pIOL and posterior chamber pIOL have been used in the treatment of significant anisometropic myopia and amblyopia. ( Pirouzian et al, 2007 ; Morkos et al, 2021 ) A CLR of more than 500 µm is correlated with pigment dispersion syndrome after the implantation of anterior chamber pIOL. ( Baïkoff, 2006 ; Yan et al, 2010 ) In addition, CLR is significantly correlated with central vault distance after ICL surgery.…”

A review of posterior chamber phakic intraocular lenses

“…The greatest advantages of using pIOLs include their predictability, high optical quality and preservation of the child's accommodative power. Morkos et al [50] presented a prospective case study with 42 eyes of 42 patients. The patients were followed-up for 14.67 AE , 16.56 months (range 1-54 months).…”

A comparative study of two phakic posterior chamber implantable lenses

“…[ 4 ] Phakic IOL implantation is considered when corneal refractive surgery is not an option and does not provide complete correction. [ 5 ] It has become a common procedure for correcting myopia, particularly for patients with high myopia. [ 6 ] The current models of posterior chamber phakic IOLs, particularly with the Visian™ implantable collamer lens (ICL, EVO+ V5, Staar Surgical, Monrovia, CA), have achieved good refractive and safety results.…”