Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty

Meyer, Jay J.; McGhee, Charles N J

doi:10.1097/ico.0000000000000506

Cited by 29 publications

(23 citation statements)

References 18 publications

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“…Given that New hydrophilic acrylic supplementary IOL N Reiter et al patients' expectation are quite high for spectacle free vision, this type of secondary intervention offers a valuable alternative for optical enhancement after cataract surgery; whether it be to correct a refractive surprise or to add a premium function such as multifocality or toricity to the primary IOL. [12][13][14][15][16] The study lenses included premium characteristics like diffractive optic (A45D) or extra addition for macular diseases (A45SML), whereas toric features are also commercially available on the same IOL platform. However, the optical properties were not relevant in our study.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes

Reiter

Werner

Guan

et al. 2017

Eye

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Purpose Management of refractive errors after cataract surgery includes spectacles or contact lens, secondary laser vision correction, intraocular lens (IOL) exchange, or piggyback lens implantation. We evaluated for the first time a single-piece hydrophilic acrylic IOL designed for supplementary sulcus fixation in postmortem pseudophakic human eyes. Methods Pseudophakic human cadaver eyes were imaged by anterior segment optical coherence tomography (AS-OCT) to assess position of the primary IOL. Eyes were prepared as per the Miyake-Apple technique. The supplementary IOL (Medicontur A4 Addon IOL family) was then inserted into the ciliary sulcus. AS-OCT and photographs from anterior and posterior views were used to assess IOL centration, tilt, and interlenticular distance from the primary IOL. Results Data were obtained from 12 eyes having primary IOLs of varying materials and designs in the bag and representing different sizes of eyes and severity of Soemmering's ring formation. The A4 Addon IOL was successfully inserted into the ciliary sulcus and was well centered in all cases. Four cases of tilt were observed on AS-OCT: three with mild tilt due to pre-existing zonular dehiscence, and one due to a localized area of Soemmering's ring formation. Interlenticular distance ranged from 0.34 to 1.24 mm and was not dependent on severity of Soemmering's ring or type of primary IOL. Conclusions The A4 Addon IOL was designed for sulcus fixation as a supplementary lens, with a large diameter, a square-shaped optic, four smooth loop haptics, and a convex-concave optical surface. It exhibited appropriate centration and interlenticular distance with different primary in-the-bag IOLs.

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Section: Discussionmentioning

confidence: 99%

Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes

Reiter

Werner

Guan

et al. 2017

Eye

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“…Reducing the pupil diameter minimises the higher-order aberrations 2. Secondary sulcus piggyback IOL implantation corrects large refractive errors and has a long safety track record 6 7. Extra focus pinhole IOL addresses both irregular astigmatism as well as pupillary defects.…”

Section: Discussionmentioning

confidence: 99%

Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery

Agarwal¹,

Navon

2019

BMJ Case Rep

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A 69-year-old patient presented to us with traumatic mydriasis with irregular pupil measuring 7 mm, with superior loss of iris tissue and large inferior peripheral iridotomy and pseudophakia. The patient had history of blunt trauma 3 years ago in a fire cracker injury. He was operated elsewhere primarily after the trauma for cataract surgery with intraocular lens implantation and had suboptimal visual outcome with glare and photophobia. He presented to us with irregular pupil and inferior iridectomy with pseudophakia. The uncorrected visual acuity was 20/150 improving to 20/50 with glasses. He had a history of cataract surgery with intraocular lens (IOL) implantation done elsewhere several years back. The patient was not a diabetic or hypertensive. There was a para central corneal scar causing irregular corneal astigmatism. Extra focus pinhole IOL was implanted in sulcus having a pinhole aperture 1.36 mm. Preoperative total corneal higher-order aberrations were 3.3 µ and total corneal coma was 0.97 µ. Postoperatively uncorrected distance visual acuity improved to 20/40 intermediate uncorrected visual acuity improved to 20/30 and uncorrected near visual acuity was J3.

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“…Excellent results can be obtained by secondary sulcus implantation of piggyback toric IOLs in pseudophakic eyes [ 5 , 9 ]. Meyer and McGhee [ 9 ] demonstrated an uncorrected distance visual acuity changing from 1.2 to 0.3 after a year of follow-up. Thomas et al [ 10 ] demonstrated an astigmatism reduction of 70.95%.…”

Section: Discussionmentioning

confidence: 99%

Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation

Nuzzi

Monteu²

2017

Case Rep Ophthalmol

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After penetrating keratoplasty (PK), high astigmatism is often induced, being frequently about 4–6 dpt. According to the entity and typology of astigmatism, different methods of correction can be used. Selective suture removal, relaxing incisions, wedge resections, compression sutures, photorefractive keratectomy, and laser-assisted in situ keratomileusis can reduce corneal astigmatism and ametropia, but meanwhile they can cause a reduction in the corneal integrity and cause an over- or undercorrection. In case of moderate-to-high regular astigmatisms, the authors propose a toric multifocal intraocular lens (IOL) implantation to preserve the corneal integrity (especially in PK after herpetic corneal leukoma keratitis). We evaluated a 45-year-old patient who at the age of 30 was subjected to PK in his left eye due to corneal leukoma herpetic keratitis, which led to high astigmatism (7.50 dpt cyl. 5°). The patient was subjected to phacoemulsification and customized toric multifocal IOL implantation in his left eye. The correction of PK-induced residual astigmatism with a toric IOL implantation is an excellent choice but has to be evaluated in relation to patient age, corneal integrity, longevity graft, and surgical risk. It seems to be a well-tolerated therapeutic choice and with good results.

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Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty

Abstract: Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.

Cited by 29 publications

References 18 publications

Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes

Assessment of a new hydrophilic acrylic supplementary IOL for sulcus fixation in pseudophakic cadaver eyes

Xtra focus pinhole IOL (Morchers GMBH) a novel approach to tackle irregular astigmatism and large pupillary defects with a single step surgery

Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation

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