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SHORT TAKES Artisan IOL Offers Safe AlternativeIn terms of efficacy, predictability and short-term safety, the Artisan IOL is a viable alternative to spectacles and contact lenses for the correction of moderate to severe myopia, according to a prospective European multicenter study.The Artisan lens is positioned in the anterior chamber and is held in place by fixations to the midperipheral iris stroma, creating a bridge over the optical axis. The lens was implanted in 518 eyes, with powers ranging from -5.0 to -20.0 D. Inclusion criteria were stable refraction for the previous two years, an anterior chamber depth of 3.0 mm or more and an endothelial cell count of 2,000 cells/mm2 or more. Several variations of the surgical implant technique were used. Preoperatively, patients were prepared as for standard cataract surgery, and surgeons used miotic drops (pilocarpine 1% to 2% or acetylcholine chloride). Ocular anesthesia was general, retro- or peribulbar.  Follow-up exams were performed at six months and one, two and three years. Re-searchers observed an uncorrected visual acuity of 20/40 or better in 76.8 percent of eyes, regardless of the postoperative goal. A best spectacle-corrected visual acuity (BCVA) of 20/40 or better was noted in 93.9 percent of eyes, and BCVA remained stable throughout follow-up. Researchers found the incidence of persistent adverse events at three years was relatively low—1.2 percent—and probably involved naturally occurring macular myopic degeneration. Secondary surgical interventions (22 eyes) included repositioning of the lens due to poor initial placement and lens exchange because of preoperative power calculation errors. Glare and halo effects during night driving were noted and related to large pupils in young patients. Researchers reported no rotation of the IOL, pupil ovalization, uveitis or persistent corneal dystrophy. They call for continued monitoring of patients to establish long-term safety. (J Cataract Refract Surg 2000;26:8:1163-71) Camille Budo, MD, Jean C. Hessloehl, MD, Milan Izak, MD, Gregorius P.M. Luyten, MD, Jose L. Menozo, MD, Bozkurt A. Sener, MD, Marie Jose Tassignon, MD, Herve Termote, MD, Jan G.F. Worst, MD IOL’s Design Gives an Edge The edge design of Phamacia & Upjohn’s foldable, silicone, CeeOn Edge model 911 intraocular lens (IOL) prevents the development of posterior capsule opacification (PCO), according to a 42-eye, 36-patient German study. Researchers examined patients 65 years of age or older with good vision in the fellow eye. The IOL’s optic consists of silicone (polydimethyldiphenyl siloxane copolymer) with a high refractive index of 1.46. Its optical diameter is 6.0 mm, and overall diameter is 12.0 mm. Patients were operated on under local anesthesia using phacoemulsification with a 3.5-mm clear corneal incision. Healon (sodium hyaluronate 1%) was used to ensure anterior chamber maintenance. Investigators reported no significant postoperative complications. Follow-up visits to evaluate best corrected visual acuity (BCVA) and the occurrence of complications were conducted at one day, one week, three and six months, and one, two and three years. One day after surgery, 66 percent of the eyes had an uncorrected visual acuity of 0.3 (20/63) or better. At the three-year visit, 92 percent of eyes achieved a BCVA of 0.5 (20/40) or better, and 39 percent achieved a BCVA of 1.0 (20/20) or better. In patients with three-year results, the spherical equivalent was -0.36 D at one week, -0.16 D after three months, -0.24 D after one year, -0.30 D after two years, and -0.34 D at the three-year mark. Postoperatively, there were no signs of haze or discoloration of the IOL, with no inflammatory cell deposits seen on its surface. No Nd:YAG laser treatments were needed during the three-year follow-up. Citing earlier studies on lens material and PCO rates and lens design and PCO rates, the investigators say the absence of complications with the sharp-edged 911 lens supports the clinical theory that a sharp edge on the IOL prevents the development of PCO. The authors also suggest that its good long-term positioning was probably due to the polyvinylidene fluoride (PDFV) haptics and a continuous curvilinear capsulotomy (CCC) smaller than the lens, providing circular cover around the optic. (J Cataract Refract Surg 2000;26:8:1172-75) Werner H. Schmack, MD, Kristian Gerstmeyer, MD Study: Single Agent as Effective, Less Expensive, as Dual Regimen Surgeons may use Acular as a less expensive and safe single-drug regimen without compromising the effectiveness of a two-drug regimen to prevent intraoperative miosis and postoperative inflammation in cataract surgery. So said a study by the Department of Ophthal-mology of the University of Arizona Health Science Center, sponsored by a grant from Allergan. Researchers randomized the eyes of 26 patients to receive ketorolac tromethamine 0.5% (Acular) preoperatively and postoperatively, or flurbiprofen sodium (Ocufen) preoperatively and prednisolone acetate 1% (Pred Forte) postoperatively. The Pred Forte was administered q.i.d. for the first week after surgery, t.i.d. for the second week, b.i.d. for the third week, and then q.d. until one month after surgery. Two weeks to one month were scheduled between procedures. Of the 45 eyes enrolled in the study, 23 received the single-drug regimen and 22 the two-drug regimen. Pupil dilation was measured preoperatively, intraoperatively and at the end of the surgery. Cell and flare were graded subjectively at the slit lamp by one of two observers on a scale of 1 to 4+. Assessments were made at one day, one week and one month postoperatively. Researchers found no significant difference in pupil dilation pre- or postoperatively, no significant between-group differences in cell measurements and no differences between flare measurements at the same examinations. Besides cost-effectiveness, the authors emphasize surgeon convenience with the one-drug regimen. They also state that the single-drug, steroid-containing regimen may be safer, since steroid use is associated with adverse effects such as glaucoma and opportunistic infection. (J Cataract Refract Surg 2000;26:8:1225-27) Robert W. Snyder, MD, PhD, Rand W. Siekert, OD, Jim Schwiegerling, PhD, Eric Donnenfeld, MD, Pam Thompson, COA Deep Sclerectomy Offers Fewer Complications than Trabeculectomy Non-penetrating deep sclerectomy and trabeculectomy appears to offer comparable intraocular pressure (IOP) reduction, success rate, visual outcome and need for postoperative glaucoma medications in the management of primary open angle glaucoma (POAG). Immediate postoperative complications are fewer after the sclerectomy, though, according to a bilateral, randomized, Saudi Arabian clinical trial. Investigators randomized 39 patients (78 eyes) with bilateral POAG to receive deep sclerectomy in one eye and trabeculectomy in the other. No more than three days elapsed between the two procedures. Postoperative management included the frequent application of topical steroids tapered over several weeks. Data was collected at one day, through intervals to one year. Investigators found a significant IOP reduction after surgery in both groups: 12.3 ± 4.2 mmHg in sclerectomy vs. 14.1 ± 6.4 mmHg in trabeculectomy, and an IOP 21 mmHg was achieved in 36 (92.3 percent) and 37 eyes (94.9 percent), respectively. There was less hyphema and anterior chamber inflammation in the deep sclerectomy group. Researchers said complications included three (7.7 percent) flat/shallow anterior chambers and one (2.6 percent) hypotony with trabeculectomy. Internal iris incarceration was found in two eyes (5.1 percent) with sclerectomy. Complications by overfiltration were encountered in the trabeculectomy group only, despite the surgeons’ technique of tightening the scleral flap and allowing gradual suture lysis. The authors call for further study with long-term follow-up to establish the actual effectiveness and safety of the sclerectomy procedure. (Ophthalmology 2000;107:9:1671-74) Fathi El Sayyad, FRCS, Magdi Helal, FRCS, Hazem El-Kholify, FRCS, Mohamed Khalil, MD, MPH, Akef El-Maghraby, FRCS |