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Surgeon: Patient, lens selection crucial before insertion of phakic IOL
Suitable endothelial cell count and a deep, stable anterior chamber also play role in complication prevention, surgeon says.
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Complications from phakic IOL insertion are rare, but surgeons should select patients and lenses with discretion, according to one surgeon.
OSN Europe/Asia-Pacific Edition Editorial Board Member Lucio Buratto, MD, discussed patient selection for phakic IOLs.
Dr. Buratto focused on two phakic IOLs: the Verisyse from Advanced Medical Optics, which is marketed in Europe as the Artisan from Ophtec, and the Visian ICL (implantable collamer lens) from STAAR Surgical. Both IOLs are approved for patients older than 21 years with various degrees of myopia.
Four complications are associated with phakic lens implantation: acute glaucoma, cataract, endothelial cell loss and retinal detachment, Dr. Buratto said.
“[Cataract and endothelial cell loss] are the most important, in my opinion,” he said. “If we take a look at the multicenter studies, we can see that the complications are not high, but not low either. We can do something to improve our results because most of these complications have been reported with previous lenses and techniques.”
The ideal candidate for phakic IOL insertion should be highly motivated and have realistic expectations, Dr. Buratto said. The patient should also be intolerant of contact lenses, have stable refraction and no systemic conditions affecting the eyes, he added.
Also, the operative eye should have a suitable endothelial cell count; the anterior chamber should be large enough to accommodate the lens; the angle should be open more than 30°; and the pupillary diameter should not be too high. The white-to-white distance should provide space inside the eye for the lens, Dr. Buratto said.
Imaging with OCT
Dr. Buratto recommended using “sophisticated” imaging technology such as the Visante OCT (optical coherence tomography) from Carl Zeiss Meditec to assess patients’ clinical status. Other imaging technologies and corneal densitometry also play a key role, he said.
“We used to do many exams in the past, and we still do these exams but, in my opinion, there is something that can change our surgery, and this is the use of more sophisticated examination,” he said. “I use the Visante more and more now. We get a lot of important information preoperatively and postoperatively. The eye is a dynamic structure, and the internal spaces and the relationship between the IOL and the surrounding tissues change continuously during daily activity,” he said.
For more information:
- Lucio Buratto, MD, can be reached at Centro Ambrosiano di Microchiurgia Oculare, Piazza Repubblica 21, 20124 Milano, Italy; +39-02-6361191; fax: +39-02-6598875; e-mail: office@buratto.com. He has no financial interest in any of the companies or products mentioned in this article.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.