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Asymptomatic haptic migration of phakic anterior chamber intraocular lens through the peripheral iridectomy

      Abstract

      Objective

      Case series of haptic migration in patients with angle-supported phakic anterior chamber intraocular lens (PAC-IOL: Phakic6H) through the superior peripheral iridectomy (PI).

      Methods

      Charts of 23 patients (35 eyes) with at least 6 months’ postoperative follow-up were retrospectively reviewed. Evaluation included preoperative and postoperative cycloplegic and manifest refractions, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, fundoscopy, corneal topography, and biometry.

      Results

      Mean UCVA was 1.67 ± 0.30 (1.17–2.00) for all 35 eyes preoperatively and 0.35 ± 0.25 (0.00–1.00) postoperatively (p < 0.001; 95% CI 1.21–1.44). BCVA had a mean of 0.31 ± 0.26 for all 35 eyes preoperatively, and a mean of 0.22 ± 0.25 postoperatively (p < 0.001; 95% CI 0.04–0.14). Haptic migration into the superior PI was noted in 8 eyes (23%). The first migration was noted 2 years postoperatively and the last 8 years after implantation (mean, 5.6 ± 2 years). There was no statistically significant difference in the BCVA and UCVA before and after haptic migration. Follow-up ranged from 8 months to 8.5 years.

      Conclusions

      Angle-supported PAC-IOL implantation resulted in significant improvement in both UCVA and BCVA. However, there is a 23% incidence of haptic migration in our series with no sequelae on BCVA or harmful effect on the intraocular structures. This IOL movement may be explained by changes in aqueous dynamics at the level of the PI leading to migration of the haptic into the area of least resistance.

      Objectif

      Étudier des cas de migration de l’haptique dans le site de l’iridectomie périphérique (IP) supérieure après l’implantation de lentilles intraoculaires phaques (LIOP) à support angulaire dans la chambre antérieure (Phakic 6H®).

      Méthodes

      On a examiné rétrospectivement les dossiers de 23 patients (35 yeux) ayant fait l’objet d’au moins 6 mois de suivi postopératoire. Éléments évalués: réfraction sous cycloplégie et réfraction manifeste préopératoires et postopératoires, acuité visuelle non corrigée (AVNC), meilleure acuité visuelle corrigée (MAVC), examen à la lampe à fente, fondoscopie, topographie cornéenne et biométrie.

      Résultats

      L’AVNC moyenne était de 1,67 ±0,30 (1,17-2,00) avant l’intervention et de 0,35 ±0,25 (0,00-1,00) après l’intervention (P <0,001; IC 95 %, 1,21-1,44). La MAVC moyenne était de 0,31 ± 0,26 avant l’intervention et de 0,22 ± 0,25 après l’intervention (P <0,001; IC 95 %, 0,04-0,14). Il y a eu migration de l’haptique dans le site de l’IP supérieure pour 8 yeux (23 %). La première migration a été notée 2 ans après l’intervention et la dernière, 8 ans après l’implantation (moyenne de 5,6 ± 2 ans). Il n’y avait pas d’écart statistiquement significatif entre les MAVC et les AVNC avant et après la migration de l’haptique. La durée du suivi allait de 8 mois à 8,5 ans.

      Conclusions

      L’implantation de LIOP à support angulaire dans la chambre antérieure a donné lieu à une amélioration significative de l’AVNC et de la MAVC. Cependant, il y a eu parmi les cas étudiés une incidence de 23 % de migration de l’haptique, sans séquelles pour la MAVC ni effet nocif sur les structures intraoculaires. Le déplacement des LIO pourrait découler de variations de la dynamique aqueuse au niveau de l’IP, entraînant une migration de l’haptique vers l’endroit où la résistance est la moindre.
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