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Eva Villota, Alvaro Fdez-Vega Sanz, José I. Blázquez; Simultaneous Iris Claw Intraocular Lens Implantation And Vitrectomy For Aphakia Correction In Subluxated/luxated Intraocular Lens (iol) Or Lenses And Post-traumatic Eyes. A Safe Technique. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6118.
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To evaluate the efficacy and safety of simultaneous implantation of Artisan-Verysise aphakia iris claw lens and vitrectomy in subluxated/luxated intraocular lens or lenses and post-traumatic eyes.
Retrospective study of 40 eyes of 39 patients between july 2007 and October 2010. Underlying conditions were: aphakia due to trauma (18 eyes), late subluxation or luxation of a posterior chamber IOL (17 eyes), complicated cataract or retinal detachment surgery (4 eyes) or zonulolysis in Marfan syndrome (1 eye). Surgical technique consisted in a complete vitrectomy followed by an exchange serum-perfluorooctane. We emphasize the novelty of using this exchange in order to maintain ocular tone during the fixation of iris claw lens. Best-corrected visual acuity (BCVA), spheric equivalents (SE), occurrence of complications and endothelial cell density (ECD) were evaluated.
Follow-up ranged from 2 to 32 months, mean 11.7 months. The most prevalent cause of surgery was aphakia secondary to anterior or posterior segment trauma (45%). After follow-up period, 28 of 40 eyes (70%) achieved BCVA better than that measured pre-operatively and 9 of 40 eyes (22.5%) matched their pre-operative BCVA. Only 3 eyes (7.5%) attained final BCVA worse than preoperative, due to extension of macular degeneration or optic nerve atrophy. Mean postoperative SE was -0.56+/-1.08D, whereas preoperative SE was 6.64 +/-5,79D (P<0.001). SE was within +/- 2,00D of emmetropia in 37 eyes (92.5%). Mean endothelial cell loss was 24.99% at final follow-up. 21 eyes (52.5%) had no complications during or after surgery. Most frequent complication was postsurgical hypotonia (6 eyes/15%) that improved within the first week. 4 eyes (10%) had transient vitreous haemorrhage. 4 eyes (10%) developed retinal detachment the first day after surgery, and required another vitrectomy to solve the problem; all 4 cases maintained or improved vision. 4 eyes (10%) had macular edema and 2 eyes (5%) had choroidal detachment.
Simultaneous iris claw intraocular lens implantation and vitrectomy is an effective and safe procedure to correct aphakia. Moreover, the use of perfluorooctane to maintain ocular tone during the surgery represents an advantage over conventional techniques. Considering the good visual rehabilitation and the low rate of complications, we recommend the use of this surgical technique in vitrectomized eyes.
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