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Sandwich of two implanted iris-fixated intraocular lenses

Poster Details

First Author: H.Biwer GERMANY

Co Author(s):    J. Riedl   A. Gericke   U. Vossmerbaeumer              

Abstract Details


To report a clinical case of a 79-year-old male with an iris sandwiched between two Verisyse® VRSA54. The patient had undergone intracapsular cataract extraction for congenital cataract and was left aphakic ever since. At the age of 75 implantation of iris-fixated IOL in retropupillary position was performed resulting in significantly reduced ametropia. IOL re-positioning was later necessary because of IOL-subluxation into the vitreous cavity. Subsequently endothelial decompensation required penetrating keratoplasty. High post-keratoplasty astigmatism made spectacle correction not feasible and contact lens intolerance developed at senior age. Therefore, a refractive surgical intervention was required.


Clinical case report of a patient who had undergone several refractive and corneal surgeries. Department of Ophthalmology, Universitätsmedizin Mainz, Germany.


Because of the relative frailness of the iris pigment epithelium and the earlier episode of slippage of the retropupillary iris-fixated IOL requiring re-enclavation, options were evaluated for implantation of an add-on optical implant. Anteropupillar enclavation of such device was favored so as not to endanger the stable position of the primary implant. A second iris-fixated IOL was consecutively conceived (Artisan® aphakic/Verisyse® VRSA54, Ophtec BV, Groningen, The The Netherlands), calculated and implanted. Postoperatively imaging was taken using Pentacam® (Oculus GmbH, Wetzlar, Germany), Optical coherence tomography (Heidelberg Engineering GmbH, Heidelberg, Germany) and slit-lamp-photography.


Preoperative refraction with +7,75D sph/ -8,50D cyl @ 6° could be reduced to a postoperative refraction of -3,25D sph/ -3,25D cyl @ 120°. Visual acuity rose from <0.05 to 0.2 uncorrected visual acuity and 0.63 best corrected visual acuity giving the patient access for the first time to usable visual acuity with the eye following the penetrating keratoplasty. Postoperatively imaging showed both implants in correct, nearly perpendicular enclavation sites.


With limited evidence based on a single case it may be concluded that iris tissue may support even a double IOL fixation. In our case, a second iris-fixated IOL as individually customized toric implant corrected the major bulk of residual refractive error. To the best of our knowledge, this is the first published case with an iris sandwiched between two iris-fixated intraocular lenses.

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