Implantation Of A Customized Fresnel-Zone Bases Posterior Chamber Phakic Iol With Central Port For Hyperopic Astigmatism

To demonstrate the clinical outcome with a novel customized phakic intraocular lens based on Fresnel-zone technology and a central port to correct hyperopic astigmatism without the requirement of an iridectomy or iridotomy

Medipolis Eye Center, Antwerpen, Belgium

A 23 year old young man presented at the Waring Vision Institute with a refraction of OD +4.74 -4.00 x 14° and OS +4.25 -3.75 x 176° with a desire for permanent vision correction. The patient was then referred to Medipolis Eye Center (Antwerpen, Belgium) for treatment with a novel Fresnel-zone based posterior chamber phakic IOL (AMIPLANT GmbH, Schnaittach, Germany). The preoperative refraction was documented as OD +4,25 -5,00 x 10° and OS +4,00 -4,00 x 175°. Pre-OP sizing was performed by a proprietary protocol using anterior segment optical coherence tomography. Surgery was performed on the same day bilaterally under topical anesthesia and uneventfully using Methylcellulose 2%. At 1 day postoperatively, the phakic IOLs were well placed with 2° clockwise rotation in the right eye and 0° rotation in the left eye. Objective refraction was OD +0.37 -0.53 x 107° and OS -0.11 -1.06 x 57°. UCVA was OD logMAR 0.0 and OS logMAR -0.02.  The anterior segment OCT revealed a vault of 954 µm in the right eye and 1015 µm in the left eye with a flat iris and an distance to the corneal endothelium of 2.3 mm.

At 6 weeks the subjective refraction was OD +0.25 -0.50 x 84 and OS +0.25 -0.75 x 45 with UCVA of logMAR -0.1 OD and logMAR 0.0 OS, respectively. IOP was 16 mmHg OD and 14 mmHg OS. The patient was free of any pain or discomfort and was overall very happy with his vision. Both eyes, however, showed Meibomian gland dysfunction and the patient was counseled for conservative treatment.

This new Fresnel-zone based posterior chamber phakic IOL model with a central port eliminates the requirement for an iridectomy or iridotomy also demonstrating safe and effective correction of hyperopia and hyperopic astigmatism in this first clinical implantation. Early postoperative outcomes showed excellent refractive predictability, rotational stability, and high patient satisfaction without adverse events. This innovative platform may expand the indications of phakic IOL technology for hyperopic patients with astigmatism and warrants further evaluation in larger prospective series with longer follow-up.