Iris claw phakic refractive IOL gives safe, satisfying results

Dr. Awdeh, a resident in ophthalmology at Duke University Medical Center, Durham, NC, presented results from a series of 19 eyes operated on by Alan N. Carlson, MD, chief, corneal and refractive surgery service, Duke University. During a mean follow-up of about 7.5 months, only a single significant complication was encountered; all eyes achieved excellent best corrected visual acuity (BCVA) outcomes and the patients were consistently pleased with their vision.

"Further studies are needed to assess the risk factors for the minor complications we encountered, but so far, these recipients of the iris-claw phakic refractive IOL are among some of our happiest refractive surgery patients," Dr. Awdeh said.

The enrolled patients had a mean age of 41 years (range, 24 to 57) and a mean preoperative manifest refraction of –12.2 D (range, –9.25 to –19.25 D). Mean preoperative uncorrected visual acuity (UCVA) was count fingers and mean preoperative BCVA was 20/20-2.

Data were presented on visual acuity, predictability, and complications. The best spectacle-corrected visual acuity (BSCVA) analysis showed that no patient lost more than 1 line of BSCVA while three eyes (16%) experienced a loss of 1 line.

In nine eyes (53%), BSCVA remained unchanged and the remaining eyes (31%) gained between 1 and 3 lines of BSCVA. At last follow-up, BSCVA was 20/25 or better in 95% of eyes.

Refractive outcomes were very reliable, and the only major complication involved lens de-enclavation in a single eye.

"When surgical re-enclavation was attempted, we discovered that one of the arms of the lens was defective in its ability to enclavate iris; lens exchange was performed. Subsequently, that eye developed a small, anterior subcapsular cataract, losing a line of correctable vision," reported Dr. Awdeh.

There were four minor complications, including a temporary superior filtering bleb that resolved within a week after treatment with topical antibiotics and steroids, a case of acute angle closure glaucoma (due to an incomplete iridectomy) that responded to a single pulse with the Nd:YAG laser, a hyphema after suture removal, and a wound that required placement of an extra suture.

In addition, an early nuclear sclerotic cataract may have contributed to residual subjective symptoms that a patient had in one eye.

"The iris-claw phakic refractive lens offers a lot of advantages for the treatment of myopia in patients who are not good candidates for LASIK," Dr. Awdeh said. "It is available in a dioptric range up to –20 D, results in refractive outcomes that are accurate and stable, provides high-quality vision, retains accommodation, is removable, and is not associated with sizing issues.

"However, phakic IOL implantation is an intraocular procedure, expensive, and surgeons need to overcome a learning curve for the implantation technique with this iris-claw IOL," Dr. Awdeh said.