Bioptics by angle-supported phakic lenses and photorefractive keratectomy.
OBJECTIVE
To assess efficacy and safety of the combination of angle-supported phakic intraocular lenses (IOLs) and photorefractive keratectomy (PRK) for the correction of myopia and astigmatism.


METHODS
Prospective, non-randomized single-surgeon study on 48 patients (76 eyes) undergoing angle-supported phakic IOL implantation with surgical peripheral iridectomy, followed 2 to 3 months later by PRK to correct residual refractive error. Twenty-three patients (33 eyes) achieved good uncorrected visual acuity with IOL implantation alone and did not undergo PRK. Thus, the study was completed by 25 patients (43 eyes) with preoperative mean defocus equivalent (DEQ) of 15.73 D (SD 4.67 D) and mean astigmatism of -2.87 D (SD 1.39 D).


RESULTS
Eight months after PRK, mean spherical equivalent was -0.08. Mean DEQ was 0.47 D (SD 0.37); 42/43 eyes (98%) were within +/-1 D of DEQ, and 33/43 eyes (77%) within +/-0.5 D. Mean uncorrected visual acuity was 0.7 (SD 1.9). Safety index was 1.25; efficacy index 1.11. Best-corrected visual acuity improvement (0.16) was statistically significant (95% CI: 1.1 to 2). Halos were moderate in 6/25 patients (24%); severe in 1/25 patients (4%). Endothelial cell density decreased by -6.6%. Pain after PRK was severe in 3/25 patients (12%) and moderate in 13/25 patients (52%). Complications were recurrent iridocyclitis in one eye, transient ocular hypertension in two eyes, and incomplete iridectomy in one eye.


CONCLUSIONS
Angle-supported phakic IOLs followed by adjustment by PRK offer good efficacy, predictability, and safety to manage large refractive myopic errors.
Leccisotti
A
A
Casa di Cura Rugani, Siena - Italy. leccisotti@libero.it
D000328:Adult; D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003315:Cornea / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D032801:Iridectomy; D054018:Lasers, Excimer; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007908:Lens, Crystalline / Q000502:physiology*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology