This article is more than 5 years old. Information may no longer be current.
Children can be safely implanted with Artisan lens, surgeon says
The technique proves to be reliable and problem free, according to a study, but a few variations are necessary.
---Implanting the Artisan lens in children has the advantage of easy removal and replacement as the child grows.
ROME – Implantation of the Artisan lens (Ophtec; Boca Raton, Fla.) in children can be effective and should be recommended in certain special cases, according to Mathias Zirm, MD, of Innsbruck, Austria. Two such cases were discussed by Prof. Zirm here at the Rome ’99 meeting. He noted that several variations from normal adult implantations are necessary in pediatric cases.
“When the child’s problem cannot be corrected with spectacles and there is an intolerance to contact lenses, there is no better remedy than the iris-claw lens,” Prof. Zirm said. “We should trust the safety and the many advantages of the procedure. I would implant it in my own child.”
Effective in adults
---Fixation of the Artisan lens in a child’s eye is very easy and nontraumatic.
Prof. Zirm has been performing iris-claw lens implantation in adult patients for more than 20 years with very satisfying results. “The new shape of the Artisan lens,” he said, “does not touch the lens or the cornea and is, therefore, even safer than it used to be. A very important advantage of this type of lens is that the optical zone is much larger in comparison with any other correction inside the cornea. Unwanted side effects, such as glare and halos affecting high myopic or hyperopic patients after correction with laser in situ keratomileusis [LASIK], never have been reported.”
A second important advantage of the technique is, according to Prof. Zirm, the reversibility of the operation. The Artisan lens can be removed easily, leaving the eye in the same condition it was before implantation.
“Our only problem was the increase of intraocular pressure [IOP], but we learned to avoid it with iridectomy first, then even without iridectomy, administering mannitol or Diamox [acetazolamide; Wyeth] intravenously,” Prof. Zirm said.
Prof. Zirm said experience has taught him that after iris-claw lens implantation, postoperative care should be more intensive than after cataract surgery.
“There is a difference,” he explained, “between a lens that is placed in the capsular bag and a lens that is fixed to the iris, which is sensitive uveal tissue. We treat the patients with anti-inflammatory drugs such as in-domethacin [Indocin; Merck] or Voltaren [diclofenac; CIBA Vision] for as long as 4 weeks after surgery.”
The Artisan lens is produced in two optic sizes, measuring 5 mm and 6 mm. “The smaller size is just as effective as the larger size in preventing glare or similar phenomena,” Dr. Zirm said. “That’s why we generally use this size, which can be easily inserted through a clear corneal incision.” He also advised using cohesive viscoelastics such as Healon (sodium hyaluronate; Pharmacia & Upjohn), which make surgical maneuvers safer and easier and can be washed out through the incision after implantation. “Healon is clearly visible inside the anterior chamber. With more liquid viscoelastic substances, unwanted residues can remain unseen inside the chamber,” he said.
In adult patients, Prof. Zirm performs Artisan lens implantation under topical anesthesia, reinforcing the pain-killing effects with lidocaine in some cases. “If the patient can cooperate, moving the eyes in all directions, the surgeon can place the instruments in the ideal position at all times. The fixation is then very easy and nontraumatic,” he explained.
Variations for children
---Two-year-old boy received a treatment of amblyopia with the occlusion of the better eye and is able to function normally with the operated eye.
Recently, Prof. Zirm has extended iris-claw lens use to implantation in young children. Five infants were successfully operated within the past year, he said.
He presented a case of aphakic correction in a 2-year-old male. The child suffered from congenital cataract and neovascularization of the anterior and posterior chambers.
“The implantation was done successfully, and the young patient had no irritation, no iritis, no IOP variation,” he reported.
The main advantage of the technique in this case is that the Artisan lens can be easily removed and replaced as the eyes grow, he said, whereas removal of an IOL implanted in the capsular bag would be far more invasive and problematic. “In children, IOL implantation easily produces capsular fibrosis, and in some cases a very tight fixation of the lens, which makes it almost impossible to remove it. As the eyes grow, the correction will not be adequate, but the lens might have to stay there forever.”
The second case was a 10-year-old male, –11 D, anisometropic, intolerant of contact lenses. The parents had asked for LASIK, which Prof. Zirm refused, as he believes it is contraindicated in growing eyes. The patient was offered iris-claw lens implantation instead and to date is very satisfied; he can at last lead the life of a normal child of his age.
When dealing with children, the implantation technique remains basically the same, with just a few variations, and the results are, according to Prof. Zirm, just as stable, satisfying and free of complications.
One variation is the use of general anesthesia instead of topical. Also, the wound must be very carefully sutured. “We can’t expect the child to be cooperative, disciplined and self controlled, neither during nor after surgery. For the same reason, it might be advisable to perform a scleral tunnel incision rather than a clear cornea incision, to avoid removing the sutures with the risk of being forced to put the child under general anesthesia a second time,” he said.
In children, the lens must be fixed as far into the periphery as possible. It is very important to measure the white-to-white carefully and to choose the right size of the lens. The Artisan lens is specially produced in a smaller size, called Baby Artisan, to fit children’s eyes.
The postoperative period requires additional care. The anterior chamber should be checked frequently, and anti-inflammatory drugs (such as indomethacin) should be administered for a longer time in these young patients.
For Your Information:
- Mathias Zirm, MD, can be reached at Fallmeryerstrasse 3, A-6020 Innsbruck, Austria; (43) 512-581860; fax: (43) 512-5722501. Dr. Zirm has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Ophtec USA can be reached at 6421 Congress Avenue, Suite 112, Boca Raton, FL; (561) 989-8767; fax: (561) 989-9744; e-mail: ophtecusa@aol.com.
- Ophtec bv can be reached at 9728 NR, Groningen, The Netherlands; (31) 50-525-1944; fax: (31) 50-525-4386.