Outcome of Iris-Claw Phakic Intraocular Lens Implantation for High Myopia; A Subspecialty Training Setting

Purpose: To evaluate the outcome of iris-claw phakic intraocular lens (PIOL) implantation for high myopia in a subspecialty training setting Methods: Iris-claw phakic Artisan (Ophtec B.V., Groningen, The Netherlands) intraocular lens implanted patients were invited for an evaluation visit: 83 eyes had been operated on by a group of 10 cornea fellows under the supervision of nine anterior segment faculty members during 2005-2006. Postoperative time course ranged from four to 38 months. The outcome was assessed in those who participated in the evaluation visit (50 eyes collectively). Results: Evaluation visit uncorrected visual acuity (UCVA) was equal to or better than preoperative best spectacle corrected visual acuity (BSCVA) in 68% of the eyes; mean BSCVA had improved significantly (equivalent to two Snellen lines; P<0.004). Residual spherical equivalent (SE) was within +/- 1.00 diopter (D) in 68% and +/- 2.00 D in 92%; eyes with longer postoperative time courses (>10 months) were on average 0.94 D more myopic (P=0.007). No eye had lost BSCVA. No major complication like retinal detachment or cataract had happened. Better UCVA was predictable by shorter postoperative time course, milder baseline myopia, and better baseline BSCVA (P<0.004). Conclusion: Iris-claw PIOL implantation for high myopia was found efficacious and safe in subspecialty training. A noticeable myopic drift was observed, and refractive predictability was not as favorable as expected. Induced astigmatism, miscalculation, mislabeling/wrong refraction, and myopic progression could have been responsible for >2.00 D residual SE in four eyes.