spektrum der augenheilkunde - 150 Jahre Augenklinik Graz

eview articleFig. 2 ICARE (Corneal, France) phakic IOLnegative influence on the endothelial cell count in 8consecutive cases during a follow-up period of up to 40months (personal experience of the author, unpublisheddata). IOL exchange can be carefully recommended inpatients, who do not want to be highly myopic after anIOL removal Fig. 4.Alcon (Ft. Worth, USA) introduced an angle-supportedphakic IOL made of hydrophobic acrylic material fewyears ago. The clinical studies with a follow-up time ofup to 3 years show promising results [ 8 , 13 ]. The ‘Cachet’phakic IOL (Alcon, USA) received CE marking in 2008and entered the FDA-approved phase three clinical trials.Th e lens is available in half-diopter increments from− 6.0 to − 16,5 D. In all, 57.8 % of the patients achievedan UCVA of 20/20 or better, post-operatively. A total of95.7 % of the patients were within a refractive range of± 1.0 D. Endothelial cell loss was around 5 % 1 year afterIOL implantation [8 , 13 ].However, the angle-supported phakic IOL ‘Cachet’ hasto be used carefully, since similar data were also promisingwith other angle supported phakic IOLs and thelenses had to be withdrawn from the market afterwards[ 4 ]. Pechmeja et al. [ 14 ] have recently published a casewith severe endothelial cell loss 10 years after the implantationof a cachet angle-supported phakic IOL. However,Alcon had withdrawn the Cachet IOL from the market fora short time of period and just relaunched the IOL withby far stricter criterial for implantation than before.Fig. 3 Scheimpflug imaging of the eye with an ICARE phakicIOL in Fig. 2 . The distance between the IOL and the cornealendothelium is just 1,000 µm. The IOL has a thickness of1,250 µmFig. 4 Scheimpflug imaging of the eye in Fig. 1 after IOL exchange.An Artisan / Verisyse IOL was implanted after ICAREexplantation. The distance between the IOL and the cornealendothelium is more than 2,000 µmSourdille et al’s recommendation [ 12 ]. From our experience,the IOL should be explanted as soon as a significantendothelial cell loss is documented [ 7 ]. A small caseseries of 12 eyes showed that the explantation of theICARE IOL stopped the progression of the endothelialcell death in these eyes. The implantation of a VerisysePMMA IOL in the same surgical session did not have aIris-claw phakic IOLTh is phakic IOL was designed by Fechner and Worst andintroduced in 1986. In contrast to the angle-supportedphakic IOLs, this lens is fixed to the iris and has thereforeone big advantage: ‘ one size fits all eyes ’ [ 5 ]. The lens has alength of 8.5 mm and the optical zone is 5.0 and 6.0 mm.The lens is internationally distributed as ‘Artisan’ lens(Ophtec, Netherlands) and named Verisyse lens (AMO,USA) in the United States of America. It was the first phakicIOL receiving FDA approval in 2004.The Artisan/Verisyse IOL (PMMA material) is availablefrom − 1.0 to − 23.5 D for myopia and from + 1.0 to + 12.0 Dfor hyperopia (Fig. 5 ). Astigmatic correction is possiblefrom + 1.0 to + 7.5 D. The refractive results are good. Theresults of 3 years of the FDA clinical trial showed an UCVAof 20/25 or better in 52 % of the patients. Almost 98 % ofthe patients were within a spherical equivalent of ± 1.0 D.Endothelial cell loss was mean 5 % after 3 years [ 15 ].Ophtec (Netherland) introduced a foldable model ofiris-claw IOL in 2004. The implantation of this IOL named‘Artiflex/Veriflex’ is possible through a 3.2 mm incision.The lens is made of a silicone optic and PMMA haptic andavailable from − 2.0 to − 14.5 D for myopia. Astigmaticcorrection is possible from 1.5 to 3.5 D. The lens is notavailable for hyperopic corrections.Th e 2 years follow-up results have shown very goodrefractive predictability and stability. Around 70 % ofthe patients had an UCVA of 20/20 or better. Endothelial276 Phakic intraocular lenses: past and present 1 3