Myopic angle-supported intraocular lenses - Two-year follow-up

Objective: To evaluate clinical and refractive results of myopic angle-supp orted intraocular lenses (IOLs). Design: Prospective, noncomparative case series. Participants: Twenty-one eyes of 12 patients (7 female) with a mean age of 29.5 years and a follow-up of 24 months. The prospective study included hig hly myopic eyes (more than -11.00 diopters [D]) with spectacle-corrected vi sual acuity better than 20/200. Methods: Twenty-one eyes underwent implantation of a single-piece IOL with Z-shaped haptics for angle support (each haptic with two footplates) and an optical zone of 4.5 mm (NuVita, Bausch & Lomb Surgical, Irvine, CA). The d ioptric power of the IOL was calculated considering refraction, keratometry , and anterior chamber depth (specific nomogram), and its diameter was dete rmined by adding 0.5 mm to the corneal diameter. Main Outcome Measures: We evaluated the following clinical and refractive d ata: visual acuity without and with correction (VAsc and VAcc), spherical e quivalent (SE) obtained under cycloplegia, slit-lamp biomicroscopy, keratom etry, applanation tonometry, endothelial cell count, ultrasound pachymetry, gonioscopy, indirect ophthalmoscopy, subjective complaints, and descriptio ns of complications. Results: Mean postoperative VAsc was 20/74. Mean preoperative VAcc (20/50) increased to 20/30; 65% gained at least two lines of VAcc, and no eye had a decrease in VAcc. Preoperative SE (-18.95 D) evolved to -2.06 D, stabilizi ng after one month. Iris retraction (pupil ovalization) more than 0.5 mm wa s noted in eight eyes (40%). Mean keratometry, corneal astigmatism, and ult rasound pachymetry were stable during the study (P > 0.01). Significant end othelial cell loss was demonstrated in the second year. Gonioscopy showed 7 0 (87.5%) footplates ideally positioned with no iris depression. Reports of glare and haloes in dark environment were considered light in 80% and not referred in 20%, and spectacles were used for residual refraction in 75%. I ntraocular lens exchange was needed in one eye because of undersizing, and the IOL was removed in one eye because of chronic inflammatory reaction ass ociated with ocular hypertension (this patient was excluded from the statis tical analysis). Conclusions: This report demonstrates good efficacy for correction of high myopia by the phakic IOL used during the two years of follow-up. Long-term complications (safety) such as iris retraction and endothelial cell loss re main a concern. Ophthalmology 2000; 107:1549-1554 (C) 2000 by the American Academy of Ophthalmology.