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IMPLANTATION of the Artisan™ (Ophtec) anterior chamber lens is a safe, stable and predictable refractive procedure for the correction of high myopia, according to Sónia Campos MD, Department of Ophthalmology, University Hospital , and Coimbra , Portugal .
Dr Campos reported the results of a study in which 45 eyes of 31 patients with preoperative myopia ranging from –12.0 D to –34.0 D (mean:-19.8 D), underwent implantation of an Artisan IOL. She presented the study at the XXI Congress of the ESCRS. After a mean follow-up of 13 months, the patients' mean postoperative UCVA was 4.5/10 and their mean BCVA improved from a preoperative value of 4.3/10 to 6.2/10. Furthermore, 60% of eyes were within ± 0.5 D of emmetropia, 70% were within ±1.0 D, and 94% were within ±2.0 D, Postoperative refraction remained stable during the entire follow-up period, she noted, adding: "Postoperatively, spectacle-corrected visual acuity improved, most likely because of the elimination of minification caused by spectacles. Patients' subjective vision is very good, they feel that their quality of vision is better, because spectacles are very thick bringing not only poor cosmetic appearance, but also aberrations, minification of images and limitations of the visual field." Postoperative refraction remained stable during the entire follow-up period. Complications included one mild decentration and one case of anterior uveitis. There was no change in contrast sensitivity and no significant endothelial cell loss, Dr Campos reported. Preoperatively, all patients were dissatisfied with spectacle correction and had unsuccessfully attempted to wear contact lenses. They also did not meet the refractive criteria for LASIK. All were at least 20 years of age and had an anterior chamber depth of more than 2.60 mm, an endothelial cell count of more than 2200 cells/mm2, clear corneas, and no signs or history of intraocular inflammation or ocular hypertension. "We believe our good results are related to our inclusion criteria and extensive preoperative study," Dr Campos remarked.
"This surgery is technically difficult. Patients also should know preoperatively that eyes with phakic IOL's must be examined regularly for the rest of the patient's life." The Artisan lens is an iris-fixated PMMA lens. Its design is based on Worst and Fechner's iris claw lens. Ophtec changed the IOL design from a bi-concave to a convex-concave model, which is thinner in the periphery, keeping more distance from the cornea, making it safer for the corneal endothelium. Implantation of the lens reduces the anterior chamber depth by 28-34% while IOL-crystalline distances range from 0.78 mm to 0.93 mm. Dr Campos noted that phakic IOLs such as the Artisan may be the treatment of choice in highly myopic patients who are intolerant of contact lenses. She pointed out that previous studies have shown that such individuals preferred the Artisan phakic IOL to LASIK, for myopia ranging from –9.0 D to –19.0 D because of the better quality of vision the lens provides. "There is no ideal method to correct high myopia. Phakic IOLs seem to be a promising treatment. Although we have still have only a small group of patients, our data show that Artisan lens implantation to correct high myopia is a safe, stable and fairly predictable refractive procedure, when performed by a senior anterior segment surgeon and in selected eyes." The Artisan lens is marketed in Europe by the Ophtec company. The same lens is marketed worldwide under the name Verisyse by the AMO company. |
All surgery was performed under general anaesthesia by one senior surgeon (Joaquim Mira MD). The surgeon constricted the pupil with pilocarpine 2% and injected a viscoelastic (hyaluronic acid 1%). He then inserted the lens vertically through a 12 o'clock corneal incision and rotated the IOL into a horizontal position over pupil. Using a lens fixation forceps, he then grasped the lens haptic and pulled an iris fold through the slit of the haptic at 9 o'clock and then at 3 o'clock . After performing a peripheral iridectomy, he closed the incision with sutures. Postoperatively, all patients received oral and topical corticosteroids, antibiotic drops, antiglaucomatous drops and a mydriatic.