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      Incidence rate and occurrence of visually significant cataract formation and corneal decompensation after implantation of Verisyse/Artisan phakic intraocular lens

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          Abstract

          Purpose

          To evaluate the incidence rate and indications for explantation of Verisyse phakic intraocular lenses (pIOLs) over a 13.6 year period.

          Subjects and methods

          Case series describing six cases of explantation of Verisyse pIOLs, out of 213 eyes with Verisyse pIOLs, implanted over a 13.6 year period by one surgeon at one institution, with mean follow-up of 5.6 years per eye.

          Results

          Four pIOLs were removed to facilitate extraction of a visually significant cataract, one was removed due to both cataract formation and development of corneal decompensation, and another was removed due to development of localized peripheral corneal decompensation. The incidence rate of pIOL removal was five per 1,000 patient-years with pIOL. Mean time from insertion of pIOL to cataract removal was 9.3 years (range 4.0–12.6 years). Mean time from insertion of pIOL to development of corneal decompensation was 10 years (range 6.9–13 years). There was no increase in the rate of cataract extraction in the pIOL population compared to the general population.

          Conclusion

          Cataracts may develop in patients with pIOLs, necessitating removal of the pIOL. Corneal decompensation is a serious complication that appears to be directly related to pIOLs. Corneal decompensation can occur up to 13 years following implantation of pIOLs, and long-term follow-up is important to monitor for this complication.

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          Most cited references18

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          Visual outcome and complications after posterior iris-claw aphakic intraocular lens implantation.

          To evaluate the indications, visual outcomes, and complication rate after implantation of a posterior chamber iris-claw aphakic intraocular lens (IOL). Department of Ophthalmology, University Medicine Charité Berlin, Berlin, Germany. Retrospective case series. Eyes without adequate capsule support had posterior chamber iris-claw aphakic IOL implantation (Verisyse/Artisan) between 2005 and 2010. The study comprised 137 eyes (126 patients). The mean follow-up was 5 months (range 1 to 48 months). The IOLs were inserted during primary lens surgery in 10 eyes (7.3%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 95 eyes (69.4%), and as a secondary procedure in 32 aphakic eyes (23.3%). The final mean corrected distance visual acuity (CDVA) (0.38 ± 0.31 [SD] logMAR) was significantly better than preoperatively (0.65 ± 0.58 logMAR) (P < .05). In 128 eyes (93.4%), postoperative refractive errors were within ±2.00 diopters (D) of emmetropia. Complications included slight temporary pupil ovalization in 34 eyes (24.8%), cystoid macular edema in 12 eyes (8.7%), hyphema in 3 eyes (2.1%), early postoperative hypotony in 7 eyes (5.1%) and elevated intraocular pressure in 6 eyes (4.3%), chronic uveitis in 1 eye (0.7%), toxic anterior segment syndrome in 1 eye (0.7%), and endophthalmitis in 1 eye (0.7%). Iris-claw IOL disenclavation occurred in 12 eyes (8.7%); all IOLs could be easily repositioned. The retropupillary iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used for a wide range of indications in eyes without adequate capsule support. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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            Ten-year incidence of age-related cataract and cataract surgery in an older Australian population. The Blue Mountains Eye Study.

            To estimate the 10-year incidence of cataract and cataract surgery in an older Australian population. Prospective population-based study. Persons at least 49 years old living in 2 postcode areas west of Sydney, Australia. Eye examinations were performed at baseline and at 5- and 10-year follow-up visits. Lens photographs were taken and graded by masked graders using the Wisconsin Cataract Grading System. Incidences of nuclear cataract, cortical cataract, posterior subcapsular cataract (PSC), and cataract surgery. Ten-year person-specific incidences were 36.0% for nuclear cataract, 28.0% for cortical cataract, 9.1% for PSC, and 17.8% for cataract surgery. Corresponding rates were 31.7%, 24.4%, 8.2%, and 14.4%, respectively, in men and 39.3%, 30.8%, 9.8%, and 20.1%, respectively, in women. The incidence for each type of cataract and cataract surgery was positively associated with age (P<0.0001). Women had a significantly higher incidence than men for nuclear cataract (P = 0.04), cortical cataract (P = 0.007), any cataract (P = 0.0006), and cataract surgery (P = 0.03) after adjusting for age. There was no significant gender difference for PSC. The mean age at cataract surgery was 75.8 years, and there was no significant gender difference (P = 0.9). Among persons who developed any cataract, 22% had more than one type and 1.3% had all 3 types present. Nuclear cataract and PSC were significantly associated with visual impairment (visual acuity worse than 20/40). Age- and gender-specific cataract incidences in this study were similar to those reported from the U.S. Beaver Dam Eye Study. In this study, 72% of the participants were affected by cataract or had had cataract surgery over the 10-year follow-up period.
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              Myopia and incident cataract and cataract surgery: the blue mountains eye study.

              To assess whether an association exists between myopia and incident cataract and cataract surgery in an older population-based cohort study. The Blue Mountains Eye Study examined 3654 participants aged 49 years or more during 1992 to 1994 and then 2334 (75.1%) of the survivors after 5 years. A history of using eyeglasses for clear distance vision was obtained. Objective refraction was performed with an autorefractor, followed by subjective refraction with a logarithm of minimum angle of resolution (logMAR) chart. Emmetropia was defined as a spherical equivalent refraction between +1 D and -1 D, hyperopia as more than +1 D, and myopia as less than -1 D. Slit lamp and retroillumination lens photographs were graded for presence of cortical, nuclear, or posterior subcapsular cataract, according to the Wisconsin Cataract Grading System. Generalized estimating equation models analyzed data by eye. There was a statistically significant association between high myopia (-6 D or less) and incident nuclear cataract (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.5-7.4). Incident posterior subcapsular cataract was associated with any myopia (OR 2.1, 95% CI 1.0-4.8), moderate to high myopia (-3.5 D or less, OR 4.4, 95% CI 1.7-11.5), and use of distance glasses before age 20 (OR 3.0, 95% CI 1.0-9.3), after adjustment for multiple potential confounders, including severity of nuclear opacity. Incident cataract surgery was significantly associated with any myopia (OR 2.1, 95% CI 1.1-4.2) as well as moderate (-3.5 to more than -6D; OR 2.9, 1.2-7.3) and high myopia (OR 3.4, 95% CI 1.0-11.3). These epidemiologic data provide some evidence of an association between myopia and incident cataract and cataract surgery, after adjustment for multiple confounders and severity of nuclear opacity. These data support other cross-sectional and longitudinal population-based findings.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                1177-5467
                1177-5483
                2014
                08 April 2014
                : 8
                : 711-716
                Affiliations
                [1 ]Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
                [2 ]University of Arizona College of Medicine, Tucson, AZ, USA
                Author notes
                Correspondence: Majid Moshirfar, Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Old Mill Medical Center, 6360 South 3000 East – Suite 200, Salt Lake City, UT 84121, USA, Tel +1 801 585 3937, Fax +1 801 947 9286, Email majid.moshirfar@ 123456hsc.utah.edu
                Article
                opth-8-711
                10.2147/OPTH.S59878
                3986296
                24748765
                66d549fa-12a6-4d62-82a0-256fbb1adb86
                © 2014 Moshirfar et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Ophthalmology & Optometry
                verisyse lens,artisan lens,phakic iol,corneal decompensation,cataract
                Ophthalmology & Optometry
                verisyse lens, artisan lens, phakic iol, corneal decompensation, cataract

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