Long-term adverse effects with phakic IOL
An ongoing concern with phakic IOLs involves long-term effects on endothelial cell loss. An international group of researchers assessed adverse device effects and annualised endothelial cell loss rate for up to 10 years after implantation of the Acrysof L-series Cachet phakic intraocular lens. The non-randomised study evaluated 638 patients (1,087 eyes) from previous clinical trials. This showed a persistent endothelial cell density decrease in some eyes that was larger than the annual rate expected with ageing. The mean central endothelial cell density change from baseline was -9.6% and -11.0% at six and seven years, respectively. Endothelial cell loss resulted in explantation in 3.1% of all eyes with the lens. Patients had no permanent vision loss. The most common adverse effects were peripheral iris adhesions in 5.2% of cases, corneal endothelial cell loss in 3.9% and IOL explantation in 3.4%.
T Kohnen et al., JCRS, “Long-term safety follow-up of an anterior chamber angle-supported phakic intraocular lens”, Volume 43, Issue 9, p1163–1170.
How many post-operative visits are appropriate?
Many patients undergoing uncomplicated cataract surgery may not require a planned postoperative visit, a new study suggests. Investigators followed 1,249 patients seen during a one-year period. One group of patients (without comorbidity) had no planned postoperative visit, while a second group had a planned postoperative visit. Nine percent of patients initiated a postoperative contact, of whom 26% also had a scheduled visit. The reasons for the patient-initiated contacts were visual disturbance, redness and/or chafing, pain and anxiety. An evaluation of all medical records two years postoperatively found no reports of missed adverse events. The researchers conclude that it was possible to refrain from planned postoperative visits for patients having uncomplicated cataract surgery.
I Westborg et al. JCRS, “Optimizing number of postoperative visits after cataract surgery: Safety perspective”, Volume 43, Issue 9, p1184–1189.
Keratoconus innovations
The ever-increasing popularity of laser refractive surgery makes the detection of corneal abnormalities extremely relevant. The accurate diagnosis of clinical or subclinical keratoconus is critical. Corneal topography is the primary diagnostic tool for keratoconus detection, and pachymetry data and corneal aberrations are also commonly used. However, corneal topography is not infallible. Therefore, complementary techniques should be used. These include corneal pachymetry to characterise the corneal thinning and aberrometry to characterise degradation of the corneal optics. Scheimpflug systems offer the possibility of obtaining topographic, pachymetric and aberrometric information simultaneously. OCT technology allows an accurate pachymetric characterisation.
A Martínez-Abad et al., JCRS, “New perspectives on the detection and progression of keratoconus”, Volume 43, Issue 9, p1213–1227.
