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Angle-supported phakic IOL proves stable after pupil dilation at 3 months postop
J Cataract Refract Surg. 2010;36(9):1517-1522.
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An angle-supported phakic IOL remained stable in the anterior segment after pupil dilation, a study found.
The AcrySof Cachet pIOL (Alcon) has proven safe and effective in previous studies, the authors said.
"However, to our knowledge, the stability of this pIOL with changes in pupil diameter has not been evaluated," they said. "This is relevant given the characteristics of any anterior chamber angle-supported pIOL and the position of this pIOL model in the anterior chamber."
The observational, cross-sectional study included 20 eyes of 20 patients ages 24 years to 48 years presenting with moderate to high myopia. All eyes were implanted with the AcrySof Cachet pIOL.
Visante anterior segment optical coherence tomography (AS-OCT, Carl Zeiss Meditec) was used to assess IOL positioning and stability before and after pharmacologic pupil dilation 3 months after surgery.
Anatomic parameters included horizontal pupil size, anterior chamber depth, horizontal angle-to-angle distance, distance between the anterior surface of the IOL and the corneal endothelium at three points, distance between the crystalline lens and the pIOL, and temporal and nasal iridocorneal angles.
Study data showed that anterior chamber depth increased a mean 0.06 mm; pupil size, 2.21 mm; temporal iridocorneal angle, 7.75°; and nasal iridocorneal angle, 5.82°. These changes were statistically significant (P < .01).
Changes in distance between the peripheral edges of the IOL and corneal endothelium, and between the crystalline lens and IOL, were statistically insignificant, the authors reported.
"Although there was a slight tendency for the central pIOL to move backward after pharmacologic dilation, the distance between the pIOL edges and the endothelium remained constant," the authors said. "Therefore, sufficient space was maintained between the pIOL and the anterior segment structures after pupil dilation, preventing the possibility of unwanted pIOL contact with ocular structures."
This study by Dr. Alio and colleagues is invaluable for refractive surgeons. Stability of position of a phakic IOL, particularly one positioned in the anterior chamber, is critical to prevent damage to anterior segment structures. Dr. Alio et al have elegantly demonstrated with AS-OCT that even with pupil dilation, there remains a safe distance between the AcrySof Cachet phakic IOL and the corneal endothelium both centrally and peripherally.
– Elizabeth A. Davis, MD, FACS
OSN
Cataract Surgery Board Member