Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM:To compare the efficacy and complications of Artisan iris-claw intraocular lens(IOL)implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted.Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy(PPV)combined lens extraction were divided into two groups.Group A:25 eyes received Artisan iris-claw IOL implantation.Group B:20 eyes received posterior chamber IOL sulcus fixation.The corrected distance visual acuity(CDVA)and intraocular pressure(IOP),corneal endothelial cell loss rate,surgical time and complications were compared between the two groups.Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter(P【0.05).No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point(P】0.05).CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery(P【0.05)and there was no statistically significant difference 1 and 3mo after surgery(P】0.05).Mean IOP showed no significant differences between groups before and after surgery.The postoperative complications of Artisan group were anterior uveitis,iris depigmentation,pupillary distortion and spontaneous lens dislocation.The complications of sulcus fixation group include choroidal detachment,intraocular haemorrhage,tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation canbe performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL.This technique is an effective and safe procedure.It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Managing high risk glaucoma with the Ahmed valve implant:20 years of experience

AIM： To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.METHODS： In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure（IOP） control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS： Follow-up ranged from 18 to 120m o with a mean follow-up of 63.2m o. IOP before the operation decreased from 31.6±10.4 mmHg to 18.3±5.4 mm Hg（no systemic treatment） at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference（P〈0.001）. The success rate was 85.2% during the first semester, 76.8% at 12 mo and 50.3% at the end of follow up period（18 to 120 mo after implantation）. Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were： serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6%（phakic eyes）, shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%.CONCLUSION： Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.