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This retrospective review of a cohort of 61 eyes from 32 patients offers long-term results for phakic Artisan (Ophtec BV) iris-fixated phakic IOL (IF-pIOL). The mean age at surgery was 41.6 years with a range of 25-59 years. Refractive outcomes were satisfactory and stable throughout the 15-year study period with a post implantation manifest refractive spherical equivalent of 0.22 ±0.57 dioptres. The cumulative postoperative uncorrected distance visual acuity was 20/20 Snellen in 20% and 20/40 in 83% of cases. This also remained stable throughout. At the final review, three eyes (6.3%) had lost more than two Snellen lines due to significant cataract. On average, cataract formation took 11 years from implantation. Two eyes had uncontrollable inflammation that was unresponsive to medical therapy, which required explantation. Posterior synechiae formation without inflammation occurred in nine cases (14.8%). The endothelial cell count reduced over the 15 years from a mean of 2904 ±158 cells/mm2 preoperatively to 1752 ±267 cells/mm2 with a yearly rate of loss of 2.64% or 58 cells/mm2 per year. Four eyes have undergone IF-pIOL explantation due to endothelial cell (EC) loss. No retinal or glaucoma complications developed. This study illustrates the excellent visual and refractive results in hyperopia management using IF-pIOLs but also highlights the importance of careful patient selection to avoid significant inflammation, posterior synechiae and endothelial cell loss especially in patients with shallow anterior chambers or predisposing risk factors. 

Implantation of an iris-fixated phakic intraocular lens for the correction of hyperopia: 15-year follow-up.
van Rijn GA, Gaurisankar ZS, Saxena R, et al.
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Mahmoud Ahmed

Royal Liverpool University Hospital, UK.

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