EyeWorld India June 2013 Issue

36 EWAP CAtArACt/IOL June 2013 Patients in need, but iris-fixated IOLs remain niche by Matt Young EyeWorld Contributing Writer Iris-fixated IOLs fill an important need for complicated cases in the Philippines F or several important groups of people in the Philippines and beyond, certain iris-fixated IOLs are coming to the rescue under much more dire circumstances. There, iris-fixated IOLs (Artisan Aphakia, Ophtec, the Netherlands) are important modalities for children who require secondary IOL implantation—for example, in those without sufficient capsular bags. Further, the lens is helpful in adults who had cataract surgeries performed decades earlier and who now require secondary implantation, as well as in adults who have lost their capsular bags due to extensive zonular dehiscence. These groups may not be getting the iris fixation they deserve often enough. A needed niche “In Asia and particularly the Philippines, adults who had lens surgery in the past and have been left aphakic for a long time are good candidates for the Artisan lens implant,” said Manolette Roque, MD , Roque Eye Clinic, St. Lukes Medical Center, Bonifacio Global City, Philippines. “Those candidates are patients who have had intracapsular cataract extraction and have no capsule left.” The Artiflex phakic lens (Ophtec) is the only IOL that does not rotate. The Artisan Aphakia iris fixation lens is designed for small eyes. Source (all): Ophtec In the U.S., children in need of ophthalmic care would see a pediatric ophthalmologist. Many children in the Philippines are cared for by general ophthalmologists outside of metropolitan areas. Economic considerations may limit the ability of a family to seek the initial care of a subspecialist. In the event that congenital cataract surgery ends with complications in the hands of a non-subspecialist—which does indeed happen —children then are referred to subspecialists for secondary lens implantation. Some children who are referred are post-vitrectomy and have had their posterior capsules removed. Others may have damage to their anterior capsular rim, limiting the sulcus-fixated secondary lens implantation option. “They present differently all the time because of the prior surgery,” Dr. Roque said. “Healing is different in each child.” When these complicated cases present, Dr. Roque often turns to the Artisan Aphakia lens for its iris-fixation ability. These lenses are implanted well away from the endothelium. Retro- pupillary implantation is employed and endothelial impact is avoided, eliminating the possibility of long- term damage, Dr. Roque said. “You would like to go ahead and implant the IOL to prevent amblyopia formation,” Dr. Roque said—one of the major benefits of IOL implantation at such a young age. Of course, transscleral sutured IOLs are alternatives to the Artisan Aphakia lens. “But I would rather go with the Artisan,” Dr. Roque said. For an adult case, a transscleral sutured lens procedure takes at least two hours. This video, by Dr. J.L. Güell, shows several cases with the Artisan Aphakia lens, including a pediatric lens implant. Watch this video on your smartphone or tablet using your QR code reader. (Scanner available for free at your app store.) continued on page 38