title: Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia.
abstract: OBJECTIVE
  To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia.
  
  
  METHODS
  Instituto Oftalmólogico de Alicante, Alicante, Spain.
  
  
  METHODS
  This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months.
  
  
  RESULTS
  At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high.
  
  
  CONCLUSIONS
  The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.
authors.affiliation: Refractive Surgery Department, Instituto Oftalmológico de Alicante, Alicante, Spain. gon.munoz@ono.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
authors.forename: Robert
authors.initials: R
authors.lastname: Montés-Micó
authors.forename: César
authors.initials: C
authors.lastname: Albarrán-Diego
authors.forename: José I
authors.initials: JI
authors.lastname: Belda
mesh_terms: D000328:Adult; D002452:Cell Count; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000601:surgery*; D007498:Iris / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007908:Lens, Crystalline / Q000502:physiology*; D007910:Lenses, Intraocular; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D012029:Refraction, Ocular; D012449:Safety; D014792:Visual Acuity