José L. Menezo

Multicenter study of the Artisan phakic intraocular lens.

PURPOSE To assess the Artisan intraocular lens to correct myopia in phakic eyes. SETTING European multicenter study sponsored by Ophtec BV, Groningen, The Netherlands. METHODS In this prospective multicenter clinical study, the Artisan lens was implanted in 518 eyes between September 1991 and October 1999. The power of the lenses ranged from -5.0 to -20.0 diopters (D). Follow-up examinations were performed at 6 months and 1, 2, and 3 years. Follow-up ranged from 6 months (n = 454) to 3 years (n = 249). The preoperative uncorrected visual acuity (UCVA) was not recorded but was estimated to be worse than 0.1. The preoperative mean best spectacle-corrected visual acuity (BSCVA) was 0.67 +/- 0.26 (SD). Endothelial cell counts were done at 6 months and 1, 2, and 3 years in a subgroup of 129 eyes. RESULTS A UCVA of 20/40 or better was observed in 76.8% of eyes regardless of the postoperative goal. A BSCVA of 20/40 or better was observed in 93.9% of eyes and remained stable throughout the follow-up. Of the eyes with extremely high myopia (>-15.0 D), 63.3% gained 2 or more lines of BSCVA; of those with moderate myopia (-5.0 to -10.0 D), 23.5% gained 2 or more lines. The mean endothelial cell density change was 4.8% at 6 months, 2.4% at 1 year, 1.7% at 2 years, and 0.7% at 3 years. The incidence of persistent adverse events at 3 years was relatively low. Secondary surgical interventions included repositioning of the lens because of poor initial placement and lens exchange because of preoperative power calculation errors. Glare and halo effects during night driving were noted and were related to large pupils in young patients. CONCLUSION The Artisan lens is a safe, stable, efficacious, and predictable method to correct -5.0 to -20.0 D of myopia. This study suggests that the corneal endothelial cell loss is stabilized to the physiologically normal level after 3 years.

Visual performance with multifocal intraocular lenses: mesopic contrast sensitivity under distance and near conditions.

OBJECTIVE To evaluate distance and near visual performance under bright (photopic) and dim (mesopic) conditions in patients who had undergone uncomplicated cataract extraction with multifocal or monofocal intraocular lens (IOL) implantation. DESIGN Prospective, nonrandomized, masked, comparative, observational case series. PARTICIPANTS Thirty-two eyes of 32 patients after zonal-progressive multifocal IOL implantation (Allergan Medical Optics Array SA-40N) and 32 eyes of 32 age-matched patients after monofocal IOL implantation (Allergan Medical Optics SI-40NB). INTERVENTION All eyes underwent phacoemulsification and IOL implantation. MAIN OUTCOME MEASURES At 18 months after surgery, the monocular contrast sensitivity (CS) function was measured with sinusoidal grating charts at distance and near, at one photopic luminance level and 2 mesopic luminance levels (85, 5, and 2.5 candelas per square meter). RESULTS Under bright conditions, CS at distance in the multifocal group was not statistically different (P>0.01) from that in the monofocal group at any tested grating spatial frequency (1.5, 3, 6, 12, and 18 cycles per degree [cpd]). At low luminances, distance CS for the multifocal group was worse than that for the monofocal group at the highest test spatial frequencies (12 and 18 cpd; P<0.01). At near, photopic CS in the multifocal group was lower than at distance; patients with only a monofocal distance correction, however, could not detect the test gratings, even at the highest available contrast. With optimal near spectacle additions (i.e., using the distance correction of the multifocal IOL), there were no significant differences between the photopic near CS values for the multifocal and monofocal groups. When the luminance was decreased, near CS at all spatial frequencies was reduced in both groups. Contrast sensitivity in the near-corrected, multifocal group was significantly worse than in the near-corrected, monofocal group at high spatial frequencies (12 and 18 cpd). CONCLUSIONS This work supports the findings of earlier authors that the Array multifocal IOL, with its center-distance design, is distance biased. Distance CS is within normal limits under bright photopic conditions but shows deficits at higher spatial frequencies (more than approximately 12 cpd) under dim mesopic conditions. Near CS obtained with the multifocal IOL is below that which can be achieved by an appropriate monofocal near correction, for all spatial frequencies and illumination conditions.

Endothelial study of iris-claw phakic lens : Four year follow-up

Purpose: To study quantitative and morphometric endothelial changes in phakic eyes implanted with the Worst iris‐claw lens to correct high myopia. Setting: Department of Ophthalmology, University Hospital “La Fe”, Valencia, Spain. Material and Methods: This retrospective study involved 111 phakic eyes (73 patients) implanted with the Worst iris‐claw lens. Noncontact specular microscopy and computer‐assisted analysis was performed preoperatively and 6 months and 1, 2, 3, and 4 years postoperatively. Results: The mean cell loss was 3.85% at 6 months, 6.59% at 1 year, 9.22% at 2 years, 11.68% at 3 years, and 13.42% at 4 years. At 2 years, the hexagonality and coefficient variation in cell size were close to the preoperative levels. No major complications were seen; early postoperative corneal touch required intraocular lens (IOL) removal in 1 case (0.9%). Four eyes (3.6%) needed a reoperation because of poor IOL fixation (2 eyes), traumatic subluxation of the IOL (1 eye), and miscalculation of the IOL power (1 eye). Conclusions: Although there was a slight, progressive cell loss after IOL implantation, the morphometric changes recovered and were close to the preoperative levels. This suggests that endothelial damage occurred primarily during the surgical procedure.

Iris claw phakic intraocular lens for high myopia.

BACKGROUND The implantation of a Worst-Fechner iris claw intraocular lens (IOL) is one of the surgical procedures used for the correction of high myopia. This technique reduces myopia with stable refractive results; however, its potential long-term risks have not been evaluated. We report results in 94 eyes with a minimum follow-up of 3 years. METHODS We studied 94 eyes of 62 patients with myopia > or = -7.00 diopters (D) who underwent Worst-Fechner IOL implantation. Lens decentration, permeability of the blood-aqueous barrier by iris angiography, and changes in corneal endothelial density were analyzed. RESULTS Mean follow-up time was 48.9 months (range 36 to 72 mo). Three years after surgery, 58 eyes (61%) had an uncorrected visual acuity > or = 20/40, and 77 eyes (82%) gained two or more lines of spectacle-corrected visual acuity with respect to the preoperative value; 75 eyes (79%) were within +/- 1.00 D of emmetropia and 46 eyes (48%) were within +/- 0.50 D of emmetropia. The mean endothelial cell loss was 17.9% at 5 years after surgery, while the percentage of hexagonality and the coefficient of cell variation tended toward preoperative levels. No vision threatening complications were seen. CONCLUSIONS The implantation of a Worst-Fechner iris claw phakic IOL reduced high myopia with a stable refractive outcome. Endothelial cell damage was within acceptable limits. The absence of major complications makes this procedure an acceptable method for correcting high myopia.

Excimer laser photorefractive keratectomy for high myopia

Abstract One hundred and thirty‐three eyes of 103 patients had photorefractive keratectomy with a slit scan mode excimer laser for myopia ranging from −6.00 to −22.00 diopters (D). The epithelium was removed with 20% ethanol, and the ablation was done with a tapered profile surrounding the optical zone. Patients were divided into two groups based on preoperative myopia: Group A, −6.00 D to −12.00 D (88 eyes); Group B, −12.50 D to −22.00 D (45 eyes). In Group A, mean preoperative refraction was −9.59 ± 1.79 D. Mean postoperative refraction was −0.29 ± 1.47 D at one month, −0.85 ± 1.68 D at three months, −1.17 ± 2.04 D at six months, and −0.56 ± 0.74 D at one year. Anterior stromal haze was greatest at the end of the first month; it diminished thereafter. This haze did not reduce the best corrected visual acuity in any eye in Group A. Mean preoperative refraction in Group B was −14.69 ± 5.27 D. Mean postoperative refraction was −1.34 ± 2.02 D at one month, −0.76 ± 2.08 D at three months, −3.88 ± 2.32 D at six months, and −5.50 ± 5.00 D at one year. Three eyes in Group B lost one or two lines of best corrected visual acuity as a result of severe stromal haze and epithelial scarring. Group A’s results were similar to those obtained in eyes with low myopia. In Group B, although a percentage of eyes obtained fairly good results, the lower degree of predictability and large variation in the results suggest that using this technique is unadvisable in eyes with extremely high myopia except in selected cases.

Effect of a plano-convex posterior chamber lens on capsular opacification from Elschnig pearl formation

ABSTRACT Opacification of the posterior capsule occurs most commonly from Elschnig pearl migration or fibrosis. The physical contact of a posterior chamber lens, particularly one with a reverse optic, has been postulated to decrease the rate of capsular opacification by creating a barrier to Elschnig pearl migration. This randomized prospective clinical study comparing the 3M style 34S convex‐plano optic and style 34R plano‐convex (reverse) optic posterior chamber lens demonstrated a statistically significant reduction in capsular opacification by Elschnig pearls at one year in the reverse optic lenses (18.2% versus 7.6%, P = .03). No statistically significant difference in capsular fibrosis rates was noted (2.5% versus 4.5%, P = .48). The reverse optic implant also demonstrated greater iris to implant optic clearance.

Prospective trial of intraoperative mitomycin C in the treatment of primary pterygium

AIMS--A prospective, randomised, double blind, placebo controlled study of intraoperative mitomycin C as adjunctive treatment of primary pterygium was conducted. METHODS--A total of 66 eyes of 54 patients with primary pterygium were treated with excision, with or without a single intraoperative application of mitomycin C (0.1 mg/ml for 5 minutes) to evaluate the efficacy and toxicity of this adjunctive treatment. The mean follow up was 14.1 months (range 12-23 months). RESULTS--Of the 36 eyes that underwent simple excision, 14 (38.8%) exhibited recurrences whereas only one of 30 eyes (3.33%) treated with excision and intraoperative application of mitomycin C had recurrence (p = 0.0006). Neither serious ocular complications nor systemic toxicity were noted in the mitomycin C treated group. CONCLUSION--Intraoperative mitomycin C appears to be an effective and safe adjunctive treatment of primary pterygium.

High dose intravitreal foscarnet in the treatment of cytomegalovirus retinitis in AIDS.

The efficacy and tolerance of high dose intravitreal foscarnet for cytomegalovirus retinitis in patients with AIDS was studied. Foscarnet in a dose of 2400 micrograms was injected directly into the vitreous of 11 patients (15 eyes). Five patients had active retinitis (eight eyes, 53.3%), and received a 3 week induction therapy of six injections as the first step. Six patients had initial inactive retinitis (seven eyes, 46.7%), and received only maintenance therapy which consisted of a weekly injection. The main indications for intravitreal therapy were: myelosuppression, kidney toxicity, catheter related sepsis, or refusal of intravenous therapy. The patients were followed for a mean period of 16 weeks (range 8-28 weeks) and received a total of 304 injections. Vitreous foscarnet levels were measured by high performance liquid chromatography. After a 3 week course of induction therapy, complete resolution of the active retinitis was seen in 62.5% (5/8 cases), while 37.5% (3/8 cases) had partial resolution. No cases failed to respond or progress. The rate of relapse on maintenance therapy was 33% (five of 15 eyes) by 20 weeks, and two of these eyes did not respond to reinduction and progressed in involvement of the macula or optic nerve. Neither important local complications nor intraocular drug toxicity were observed. Vitreous foscarnet levels in two different patients were 896 mumol/l and 74.9 mumol/l at 22 3/4 hours and 42 1/2 hours after the injection. Intravitreal foscarnet appears to be a safe, effective, and useful alternative in patients with intolerance to intravenous and viral therapy.

Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan

Purpose: To evaluate the feasibility and safety of using phakic intraocular lenses (IOLs) to correct high myopia by comparing 3 IOL models: Adatomed, Staar, and Artisan. Setting: La Fe University Hospital, Department of Ophthalmology, and the Fundación Oftalmológica del Mediterráneo, Valencia, Spain. Methods: In this prospective comparative study, a phakic IOL was implanted in 217 highly myopic eyes (118 patients). Fifty‐nine eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. The mean preoperative spherical equivalent was −15.39 diopters (D) ± 2.83 (SD), −16.00 ± 5.05 D, and −16.17 ± 2.75 D in the Adatomed, Staar, and Artisan groups, respectively. The mean follow‐up was 32.4 months (range 19 to 46 months) in the Adatomed group, 18.3 months (range 11 to 21 months) in the Staar group, and 121.4 months (range 38.4 to 154.3 months) in the Artisan group. At the follow‐up examinations, intraocular pressure (IOP), IOL pigment deposits, cataract formation, and visual acuity were evaluated. Results: The best corrected and uncorrected visual acuities improved in all eyes. No significant differences in visual acuity improvement were observed with the 3 materials, although the improvement was somewhat greater in eyes with the Artisan and Staar IOLs. The difference in mean IOP between preoperatively and the last follow‐up examination was 1.5 mm Hg in the Staar group, 1.3 mm Hg in the Adatomed group, and 1.7 mm Hg in the Artisan group (P = .36, P = .26, and P = .32, respectively). The incidence of pigment deposits was similar in the Adatomed and Staar groups, with deposits in 32 eyes (54.23%) and 8 eyes (38.1%), respectively. Anterior cataract formation was higher in the Adatomed group (44.06%) than in the Staar group (9.52%); nuclear cataract developed in 2 Adatomed eyes (1.46%) only. Conclusions: There was a higher incidence of anterior subcapsular cataract formation in the Adatomed group than in the Staar group. Delayed cataract development and the cataract type in patients with Artisan IOLs indicate that age and axial length may be prognostic factors. Factors such as IOL design, material, and placement probably affect cataract formation in eyes with posterior chamber IOLs for high myopia, particularly the Adatomed IOL.

Oxidative Stress in Keratoconus

PURPOSE The purpose of this study was to establish the alterations of oxidative stress-related markers in keratoconus (KC) corneas. METHODS A total of 6 healthy and 11 ectatic corneas (7 KC and 4 post-LASIK) were studied. Different oxidative stress-related markers were determined to assess their implication in the KC pathophysiology. Total antioxidant capacity and total nitrites present in the samples were assayed. Furthermore, lipid peroxidation products and the glutathione contents were determined, together with 4-hydroxynonenal (4-HNE) immunohistochemistry, to establish the relationship between KC and oxidative stress. RESULTS The antioxidant capacity and glutathione content in KC corneas were decreased significantly when compared with healthy corneas. Moreover, the total nitrites and lipid peroxidation were significantly elevated in the corneas with KC when compared with the controls. There was a statistically significant difference in the amount of HNE-positive cells in KC corneas when compared with healthy corneas by immunohistochemistry. Post-LASIK ectatic corneas and KC corneas showed similar results. CONCLUSIONS The increased levels of oxidative stress markers and the decreased antioxidant capacity and antioxidant defenses in KC corneas, as well as in the post-LASIK ectatic corneas, indicate that oxidative stress might be involved in the development of this disease and may provide new insights for its prevention and treatment in the future.