Five Year- Results of Iris-Fixated Toric Phakic IOLs in Japanese Keratoconus Eyes

Yutaro Nishi, Kyoko Sogo, Kayo Nishi, Miki Tachimichi, Okihiro Nishi　　　　　　 Contact: y.nishi@nishi-ganka.or.jp Nishi Eye Hospital, Osaka, JapanNone of the authors have financial interest

Purpose

To assess the long term safety, efficacy and complications of the Artisan Toric phakic intraocular lens for the correction of Japanese keratoconus eyes.

Previous reportsKeratoconus Astigmatism

• Budo C et al. J Refract Surg. 2005 May-Jun;21(3):218-22 “SE was significantly reduced in all six keratoconus eyes. “

• Kamburoğlu G et al. Cataract Refract Surg. 2007 Mar;33(3):528-30 “Corrected refractive error of a keratoconus patient.”

• Venter J. J Refract Surg. 2009 Sep;25(9):759-64 “Good functional in keratoconus eyes during 1 year follow-up.”

Dick HB et al. Ophthalmology. 2003 Jan;110(1):150-62

‣“European multicenter study; correction of astigmatism during 6month follow-up.”

Guell JL et al. Am J Ophthalmol. 2003 Sep;136(3):442-7 ‣“Correction of high astigmatism.”

Alio JL et al. J Refract Surg. 2005 Jul-Aug;21(4):324-31 ‣“Correction of astigmatism.”

Material and methods‣18 myopic Japanese eyes with

astigmatism ( 21 to 61 y.)

‣10 eyes diagnosed as keratoconus ( 21 to 58 y.)

‣Implantation of Artisan Toric phakic IOLs

‣Implantation period ranged from 3 mo. to 5 y.

‣Examination: UCVA, BCVA, SE (diopters), IOP (mmHg), Endothelial cell count (cells/mm2), ACD (mm), slit-lamp finding

Material PMMA

Overall Ø 8.5 mmOptic Ø 5.0 mm

Results: Keratoconus eyesPre-Ope

(n=10)3-6Mo (n=9)

1Y (n=7)

3Y(n=4)

5Y(n=3)

BCVA 0.71 ±0.35

0.87 ±0.37

  1.0 ±0.18

 1.1 ±0.15

0.9 ±0.14

UCVA 0.07 ±0.09

0.63 ±0.52

  1.0 ±0.12

 0.68 ±0.17

0.7 ±0.21

SE-7.7

±6.3-0.63 ±0.19

-0.1 ±0.35

-0.22 ±0.59

-0.13 ±0.88

Endothelium 3085 ±398.9

2609 ±785.6

2801 ±331.3

2442 ±159.9

2440 ±796.9

IOP11.8

±0.3515.0 ±4.2

11.0 ±0.55

13.5 ±1.3

14.0 ±0.13

IOL extraction in one case

Case: IOL extraction‣58 years old, male: the oldest in

the keratoconus group

‣Preoperative endothelial cell count = 2531cells/mm2: the lowest in the group Postoperative endothelial cell count = 756 cells/mm2

‣Preoperative ACD= 3.1mm, Postoperative ACD= 3.3mm the smallest values among the

group Distance between endothelium

and IOL (center) was more than 1.5mm by Scheimpflug photography, which met the standard criteria

Conclusion‣ Long-term results shows the implantation of the Artisan Toric

IOL in Japanese eyes is a reasonable and moderately safe method for the correction of keratoconus.

‣ It showed good functional results.

‣ Longer-term follow ups are important.

‣The criteria regarding distance between corneal endothelium and phakic IOL (center) may better be reconsidered.