Phakic anterior chamber intraocular lens (Verisyse™) implantation in children for treatment of severe ansiometropia myopia and amblyopia: Six-month pilot clincial trial and review of literature

Abstract

Purpose:The current study aims to evaluate both safety and efficacy of Verisyse™ (AMO, Irvine, CA) phakic anterior chamber intraocular lens (IOL) in the reduction of clinically significant (>−8 D) myopic anisometropia in children who are noncompliant to traditional medical treatment including spectacle correction or contact lenses.Design:Retrospective interventional case series.Methods:Six anisometropic myopic pediatric patients in one practice were identified through chart-review. None of the patients were compliant with specatacle correction or contact lens wear and as a result had dense amblyopia of less than 20/400 by Snellen or Allen visual acuity (mean <20/400). All patients underwent Verisyse™ phakic IOL implantation in the more myopic eye by one surgeon (AP). Pre- and post-operative visual acuity, anterior/posterior segment examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients whenever feasible.Results:The age of patients ranged from 5–11 years. The mean post-operative follow-up time was six months from the time of IOL insertion. Improvement in visual acuity >6 lines was achieved in four patients (mean visual acuity of 20/70 at six months). Improvement in stereoacuity was noted in all six patients (from total mean zero seconds-arc to six-months post-operative mean of 500 seconds-arc by randot stereoacuity testing). Improvement of >2 lines of visual acuity lines was achieved in the other two patients. No patient lost any lines of visual acuity. Enhanced physical activity, coordination, and improved social interaction were noted in patients and were reported by the parents. No intra/post-operative complications were noted.Discussion:Irreversible or intractable amblyopia secondary to severe anisometropic myopia is a serious medical concern in the pediatric population. Failure of compliance with contact lens therapy consistently leads to visual loss. Anterior chamber phakic IOLs may provide a safe alternative in treatment of noncompliant anisometropic myopic patients who do not accept spectacle wear or contact lens therapy.Conclusion:To reduce or eliminate highly significant anisometropic myopia in children who are noncompliant with traditional medical treatment, phakic anterior chamber IOL implantation may be considered as an alternative modality of treatment.

Ambliyopi ve Tedavisi

“…Fakik göz içi lens uygulamasının olası komplikasyonu, kornea endotelinde %3-%7 oranında görülen hücre kaybıdır. 56 …”

Anterior chamber phakic intraocular lens implantation in children to treat severe anisometropic myopia and amblyopia: 3-year clinical results

“…5,6,11,12 To our knowledge, none of the published pediatric refractive surgery trials and review articles has evaluated visual quality in terms of contrast sensitivity after corneal laser ablative procedures. 13,14 Postoperative pupil-centroid shifts and cyclotorsional factors can significantly contribute to the induction of higherorder aberrations (HOAs) after laser correction of high refractive errors. 14 The clinical application of pIOLs to treat severe anisometropia was first described by Lesueur and Arne.…”

“…13,14 Postoperative pupil-centroid shifts and cyclotorsional factors can significantly contribute to the induction of higherorder aberrations (HOAs) after laser correction of high refractive errors. 14 The clinical application of pIOLs to treat severe anisometropia was first described by Lesueur and Arne. 7 Long-term follow-up of these patients showed substantial improvement in visual function.…”

“…5,6 More recently, individual cases of anterior chamber phakic intraocular lens (AC pIOL) implantation and posterior chamber pIOL (PC pIOL) implantation to treat severe anisometropia myopia have been reported. [7][8][9][10][11][12][13][14] In this follow-up report of our original study, 15 we evaluated the long-term postoperative outcomes, efficacy, and side effects of AC pIOL implantation to treat severe anisometropic myopia (OÀ8.0 D) in children in whom spectacle correction and contact lenses had been attempted and had failed.…”

Pediatric refractive surgery: Corneal and intraocular techniques and beyond

“…Intraocular refractive procedures have been reported for up to 7 years in the published literature, albeit in smaller numbers for higher refractive errors, also with good visual and refractive outcomes and few complications. [26][27][28][29][30][31][32] Although refractive surgery has been shown to be effective for improving vision and reducing refractive error in children, it is important to remember that it is appropriate only in special circumstances for a few pediatric subpopulations. This workshop discusses appropriate populations to consider for refractive surgery, eligibility criteria, the "nuts and bolts" of setting up a pediatric refractive surgery center, extraocular and intraocular techniques for normalizing refractive error in children, and newer technology that may prove useful in children in the future.…”