Reasons for Rejection of Potential Patients for Verisyse Artisan Phakic IOL Implantation

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Reasons for Rejection of Potential Patients for
Verisyse Artisan Phakic IOL Implantation

• Tushar Agarwal, MD
• Rashim Mannan, MD
• Namrata Sharma, MD
• Rasik B Vajpayee, MS, FRCS
  Ed
• Jeewan S Titiyal, MD
• Dr Rajendra Prasad Centre for
  Ophthalmic Sciences, All India Institute of
  Medical Sciences, New Delhi-110029, India

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INTRODUCTION

• Limitations to LASIK exist, especially in higher
  refractive errors in which patients can
  experience reduced accuracy and an increasing
  rate of complications. Patients with higher
  refractive errors have other options like IOL
  implants. The Verisyse lens (Advanced Medical
  Optics, Santa Ana, Calif) was approved by the
  Food and Drug Administration (FDA) for the
  treatment of patients with myopia from 5 D to 20
  D.

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MATERIALS AND METHODS

• Retrospective analysis of 117 eyes which were
  screened for implantation of phakic IOL, was done
  over a period of two years (May 2004-April 2006)
• The mean refractive error, astigmatism,
  intra-ocular pressure, central corneal thickness,
  anterior chamber depth, axial length and
  endothelial cell density were noted
• The demographic profile, baseline parameters,
  past medical and ophthalmic history and
  ophthalmic findings of all patients were analyzed

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RESULTS

• Out of 117 eyes which were screened for Verisyse
  phakic IOL implantation
• 62 eyes were not considered fit for the procedure
• 55 eyes were taken up for phakic IOL
  implantation.

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RESULTS

• The main reasons for rejecting the cases for
  phakic IOL implantation were
• Corneal ectasia (35.5)
• Shallow anterior chamber depth (19.4)
• Cataract, glaucoma or retinal pathologies (16.1)
  
• Low endothelial cell count (3.2).
• Financial constraints (12.9)
• Voluntary refusal of surgery (9.7).

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RESULTS
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RESULTS

• Cases which did not undergo phakic IOL
  implantation although had a significantly lesser
  myopia had a significantly higher astigmatism

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DISCUSSION

• The major cause of rejection of a case for LASIK
  is suboptimal corneal thickness combined with a
  high amount of refractive error, however these
  can be considered for phakic IOL implantation
• However these patients with lesser pachymetry
  values should be evaluated properly to rule out
  keratoconus, which may also have accompanying
  high myopia and is a progressive disease which
  tends to stabilize only beyond third or fourth
  decades of life

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DISCUSSION

• The aim of any refractive surgery including
  phakic IOL implantation is a good postoperative
  visual acuity and the satisfaction of the
  patient. Each patient has to be evaluated
  personally and individually by a complete
  preoperative examination.
• A strict screening out of potential keratoconic
  eyes among cases presenting for Verisyse phakic
  IOL implantation is mandatory.

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CONCLUSIONS

• Artisan phakic IOL is not suitable for
  implantation in all cases of refractive errors.
• The most common cause for not performing pIOL
  implantation was corneal ectatic disorders

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