Artisan IOLs in the paediatric population
Iris-claw lens safe for endothelium in the treatment of paediatric aphakia. Roibeard Ó hÉineacháin reports
Marije L Sminia MD PhD
The Artisan (Ophtec) iris-fixated intraocular lens appears to be a safe and effective option for the refractive correction of aphakia in children with insufficient capsular support, reported Marije L Sminia MD PhD, at the ESCRS/WSPOS joint symposium during the 38th Congress of the ESCRS.
Dr Sminia, Noordwest Ziekenhuisgroep/ Amsterdam University Medical Center, noted that a primary concern with the anterior chamber IOL is its potential to induce endothelial cell loss, especially in children because of their long-life expectancy. However, research suggests that endothelial cell loss remains within acceptable limits over time in paediatric patients who undergo implantation of the lens as children, she said.
She and her associates conducted a retrospective study with a follow-up of 8.9-to-12.7 years involving 33 eyes of 25 children who underwent implantation of the Artisan lens. The study showed that in 20 bilateral cases there was a normal mean endothelial cell count at four-to-11 years of follow-up. But there was also a large range in endothelial cell loss and two eyes were outliers, one of which had two traumatic IOL dislocations, the other of which had no predisposing factors.
Dr Sminia noted that over 10-to-15 years of follow-up there was no difference between the endothelial cell loss in four eyes of Marfan syndrome patients and that of 29 control eyes from Marfan syndrome patients without IOLs. However, the eyes with Artisan IOLs had an abnormal morphology of the endothelial cells, higher coefficient of cell size variation and lower number of six-sided cells.
Among patients that underwent unilateral implantation of the Artisan lens, there was no difference in endothelial cell loss between fellow eyes and eyes with the IOL in six non-traumatic cataract cases. However, among three eyes with traumatic cataracts, endothelial cell density decreased by 41%.
A recent prospective cohort study supported the findings of her centre’s study, she said. It showed that over a mean follow-up period of 39.3 months, there was a mean total endothelial cell loss of 18 % and a mean annual endothelial cell loss of 5.04% in 21 eyes of 12 children who underwent implantation of the Artisan lens for ectopia (Catala-Mora et al. 2017 Acta Ophthalmologica).
She added that some studies suggest that retropupillary fixation of the Artisan may have advantages in terms of endothelial cell loss. However, there have been no comparative studies in paediatric patients, and studies in adults have yielded contradictory results.
Marije L Sminia: firstname.lastname@example.org