PIOLs and cataract surgery

Older myopic patients who undergo implantation of Artisan/Verisyse (Ophtec/AMO) phakic intraocular lenses (IOLs) are at a high risk of developing cataract within 10 or 15 years, according to Gré PM Luyten MD, PhD, Leiden University Medical Centre, The Netherlands. A review of 493 eyes that underwent myopic Artisan implantation at his centre from 1996-2015 showed that within 15 postoperative years, half of the patients who were 55 years or older at the time of their procedure underwent cataract surgery, Dr Luyten told the 21st ESCRS Winter Meeting in Maastricht, The Netherlands. By comparison, none of the patients younger than 40 years of age at implantation developed cataracts within the same period, he noted. Overall, the rate of cataract surgery was 3% after five years, 11.6% after 10 years, and 34% after 15 years. The procedures were necessary in 28 of 222 patients in the 40 to 55 years age group, and 10 of 108 patients in the 55 years and older group, after a mean of 10.9 years. Among 81 patients with Artisan IOLs who have undergone cataract procedures at his centre, the average age at the time of implantation of the phakic IOL was 45.7 years and age at the time of cataract removal was 54.9 years. The primary indication was cataract in 54 eyes, pigment-synechiae in one eye, retinal detachment in seven eyes and endothelial cell loss in 18 eyes, including three eyes that underwent Descemet’s stripping automated endothelial keratoplasty. “We see endothelial cell loss in the Artisan patients but it generally doesn’t cause problems. But it is important to check endothelial cell counts every year. Sometimes patients have an unexplained dramatic cell loss. Eye rubbing and/or inflammation may be predisposing factors,” he added. The incidence of cataract with the Artisan lens was lower than that reported with earlier versions of the Visian ICL (STAAR Surgical) posterior chamber (PC) phakic IOL. In a study involving 2,396 eyes with the PC phakic IOL, the phaco rate was 9% at a follow-up of 19.23 months (Chen et al, JCRS 2008; 34:1181-12000). In a study involving 133 eyes of 78 patients implanted with the ICL, the rate of lens opacity development was 40.9% and 54.8% at five and 10 years, respectively, and the phacoemulsification rate was 4.9% and 18.3% at five and 10 years, respectively (Guber et al, Jama Opthalmol 2016;
134:487-494). Gré P M Luyten: g.p.m.luyten@lumc.nl

Tags: IOLs