Sir,
We read with interest Hassaballa and Macky's1 article on phakic intraocular lenses (p-IOL) outcomes and complications. In their series significant complications resulting in elevation of intraocular pressure (IOP) requiring additional surgery occurred in two eyes (3%). As noted there are several possible mechanisms for increased IOP in patients implanted with a p-IOL. If IOP remains uncontrolled removal of a p-IOL may potentiate further pigment dispersion. There are case reports of intractable IOP elevation presumed secondary to pigment dispersion requiring surgery.2, 3 We performed non-penetrating glaucoma surgery for a similar case of bilateral severe IOP elevation post p-IOL implantation in a patient with high myopia.3 The authors report pigment dispersion occurring in 28.6% (Artisan) and 15.38% (Visian) in their series. They did not document whether all patients underwent pre- and post-operative gonioscopy to examine the anterior chamber angle. Stulting et al4 reported an incidence of iris pigment precipitates of 6.9%. A long-term incidence of pigment dispersion of 6.6% has also been described.5 This may be of significance as patients undergoing p-IOLs are generally from a younger demographic.
As the article stands, we agree with the authors on the need for long-term data on the efficacy and complications of p-IOLs. Evaluation of the possible effect on trabecular function from p-IOL-related pigment dispersion is warranted. Pigment dispersion is not always benign.
References
Hasaballa MA, Macky TA . Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL. Eye 2011; 25: 1365–1370.
Sanchex-Galeana CA, Zadok D, Montes M, Cortés MA, Chayet AS . Refractory intraocular pressure increase after phakic posterior chamber intraocular lens implantation. Am J Ophthalmol 2002; 134: 121–123.
Toh T, Nguyen DQ, Ruddle JB, Crowston JG, Coote MA . Bilateral acute severe intraocular pressure elevation requiring filtration surgery after implantation of toric Artisan phakic intraocular lenses. Clin Exp Ophthalmol 2011; e-pub ahead of print 30 June 2011; doi:10.1111/j.1442-9071.2011.02646.x.
Stulting RD, John ME, Maloney RK, Assil KK, Arrowsmith PN, Thompson VM . Three-year results of Artisan/Verisyse phakic intraocular lens implantation; results of the United States Food and Drug Administration Clinical Trial; the U.S. Verisyse Study Group. Ophthalmology 2008; 115: 464–472.
Menezo JL, Menezo JL, Peris-Martínez C, Cisneros AL, Martínez-Costa R . Phakic intraocular lenses to correct high myopia: Adatomed, Staar, and Artisan. J Cataract Refract Surg 2004; 30: 33–44.
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Nguyen, D., Toh, T., Ruddle, J. et al. Comment on ‘Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL’. Eye 26, 618 (2012). https://doi.org/10.1038/eye.2011.355
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DOI: https://doi.org/10.1038/eye.2011.355