Surgeon: Iris-fixated IOL preferred design for phakic implantation

Lucio Buratto, MD, gave the Binkhorst Medal Lecture here in Paris during ESCRS.

PARIS — An anterior chamber iris-fixated lens is the best location and the design of choice for phakic IOL implantation, according to Lucio Buratto, MD.

Dr. Buratto delivered this assessment in a review of the development of phakic IOLs in his Binkhorst Medal Lecture here at the European Society of Cataract and Refractive Surgeons meeting.

“My personal view is that because of their location and the fact that they don’t need precise measurements, [iris-fixated] lenses can stay in the eye for a longer term with fewer side effects [than other types of anterior and posterior chamber phakic IOLs],” said Dr. Buratto, a founding medical editor of Ocular Surgery News Europe/Asia-Pacific Edition.

He noted that iris-fixated lenses have primarily one single model made of a familiar material with a long follow-up. The only iris-fixated phakic IOL currently in widespread use is the Artisan/Verisyse IOL from Ophtec/Advanced Medical Optics.

Dr. Buratto said he is skeptical of other anterior chamber and posterior chamber phakic IOLs. He reviewed a number of published studies of other phakic lens designs in his presentation.

“Considering that myopic eyes are prone to cataract and glaucoma, and that any surgery increases these risks, my personal view is — because of its location — a posterior chamber phakic IOL cannot be tolerated long-term without secondary effects, especially in young patients with an active life. My personal view on posterior chamber IOLs is that they can cause cataracts over a long-term due to frequent contact with crystalline lens,” he said.

Currently, Dr. Buratto said, there are two phakic IOLs with the widest clinical experience, the Artisan/Verisyse and the STAAR Surgical Visian ICL, a posterior chamber lens. The Ophtec/AMO lens recently received U.S. Food and Drug Administration approval. The STAAR lens is still awaiting U.S. approval.

“A number of anterior chamber IOLs with different designs have appeared on the market, but none of them have stayed on the market for more than 3 years, and none of them have been submitted for FDA approval,” Dr. Buratto said.

“The studies presented for FDA approval are probably the most complete, and the results for both IOLs are excellent from the refractive and visual point of view and without many complications,” he said.

Dr. Buratto cautioned, however, that “these results are the best a surgeon can hope for because when a company wants to have its lens approved, it will select the best surgical facilities, the best surgeons who select ideal patients, and the best operation.”

Regarding which lens he would recommend to another surgeon, Dr. Buratto said, “I would choose the lens that gives the lowest incidence of complications. According to the published literature, the Artisan has the lowest incidence of complications, followed by the ICL. Today, I would not implant any other lenses.”

Dr. Buratto said that “a proactive responsibility” lies in the hands of the surgeon, who has a responsibility to add to the learning process.

“Doctors must follow every single patient for as long as possible, collecting and reporting as much comprehensive data as they can,” he said. “Surgeons must be actively involved in reducing intraoperative complications.”

Dr. Buratto described the ideal IOLs he would like to see in the future: “More foldable IOLs, low aberration IOLs, customized IOLs, light-adjustable IOLs, and new designs and materials. As surgeon I would like to have better IOLs.”

Dr. Buratto concluded by giving surgeons some tips for improving the quality of phakic-IOL implantation.

“First, carefully choose the patients, and carefully test the eye; second, only use a lens with a long follow-up and FDA approval; third, perform the highest quality surgery you can. We have the opportunity to improve the quality of life of millions of people. We must not waste it,” he urged the audience.