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 Post subject: Phakic IOLs/ICLs
PostPosted: Fri Jul 27, 2007 1:58 am 
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Outcomes of ZB5M Angle-supported Anterior Chamber Phakic Intraocular Lenses at 12 Years

Journal of Refractive Surgery Vol. 23 No. 2 February 2007

Jaime Javaloy, MD, PhD; Jorge L. Ali?, MD, PhD; Maria T. Iradier, MD; Ayman M. Abdelrahman, MD, MSc; Tomas Javaloy, MD; Fernando Borr?s, MD, PhD

Quote:
For the IOL models analyzed in this study, a constant greater loss of endothelial cell density has been found. Considering a physiological rate of decrease in the endothelial cell density of 0.56% per year, a nonoperated healthy eye would reach age 85 years with >1900 cells/mm2. For these calculations, an amortization equation for accounting
has to be used:

(formula)

where ECDi is the current cell density estimated at any moment, ECD0 is the cell density at the fi rst considered instant, and n the number of years for calculating ECDi.

As we estimate a 10.69% surgically induced decrease in the endothelial cell density in the first year and an average rate of 1.78% every year after that, a hypothetical 25-year-old patient with an endothelial cell density of 2500 cells/mm2 who received a ZB5M angle-supported PIOL would reach the advisable explantation number of 1500 cells/mm2 at age 49 years (24 years after implantation). Later enhancements in the design of these angle-supported PIOLs may reduce long-term endothelial damage. The absence of a definitive physiopathological model of endothelial injury after angle-supported PIOL implantation and the large number of eyes implanted, especially in young patients, should oblige surgeons to perform periodic endothelial cell analysis in these patients.

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PostPosted: Fri Oct 26, 2007 4:28 pm 
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J Cataract Refract Surg. 2007 Aug;33(8):1477-81.
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J Cataract Refract Surg. 2007 Aug;33(8):1347.

Severe endothelial cell loss following uneventful angle-supported phakic intraocular lens implantation for high myopia.

Coullet J, Mahieu L, Malecaze F, Fourni? P, Leparmentier A, Moalic S, Arn? JL.
Department of Ophthalmology, Purpan Hospital, Toulouse, France. coullet.j@chu-toulouse.fr

Endothelial decompensation is a serious complication of phakic intraocular lens (pIOL) implantation and is a major concern during the postoperative period. We report 3 eyes in which the same foldable angle-supported pIOL was implanted to correct high myopia. Rapid and severe postoperative endothelial cell loss occurred in all 3 eyes. An over-sized pIOL that induced excessive vaulting into the anterior chamber was the main risk factor. In 2 eyes, the pIOL was explanted uneventfully; 1 eye required Descemet's stripping automated endothelial keratoplasty because of total endothelial decompensation. These cases illustrate the importance of accurate sizing of foldable angle-supported anterior chamber pIOLs to avoid excessive vaulting. They also highlight the importance of regular follow-up and preventive pIOL explantation as soon as significant endothelial cell loss is detected.

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