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Purpose: To compare visual acuity and contrast sensitivity between Posterior Chamber Phakic Intraocular Lens (ICL) and Iris-Claw Anterior Chamber Phakic Intraocular Lens (Artiflex) implantation for moderate to high myopia. Setting: Dr. Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Participants: Sixty eyes of 30 myopic patients were included in the study. Thirty eyes of 15 patients underwent implantation of ICL (24)/ toric ICL (6) and 30 eyes of 15 patients underwent implantation of Artiflex. Methods: Preoperative and postoperative 1, 6 and 12 months, logarithm of the minimum angle of resolution (log MAR) uncorrected visual acuity (UCVA), log MAR best spectacle-corrected visual acuity (BSCVA), manifest refraction, intraocular pressure (IOP), endothelial cell density (ECD) and complications were evaluated. Contrast sensitivity (CS) was also evaluated at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree spatial frequencies by CC-100 Topcon LCD preoperative and postoperative 1-year. Main outcome measures: Improvement in visual acuity (VA) and CS, percentage change in ECD and IOP. Results: Preoperatively, there was no significant difference in the mean UCVA, BSCVA and CS between the ICL and Artiflex groups (p=0.798; 0.672; 0.510) and the mean spherical equivalent (SE) was significantly better in the ICL group than the Artiflex group (p=0.003). One year postoperatively, the mean UCVA and BSCVA were significantly better in the ICL group than the Artiflex group (p=0.002; 0.0001). We found no significant difference in the mean SE between the ICL and Artiflex groups (p=0.809). The mean photopic CS increased considerably at all spatial frequencies compared with preoperative levels in the ICL and Artiflex groups (p=0.0001) Conclusion: After 1-year follow-up, the phakic IOLs performed well in correcting moderate to high myopia. Preoperatively and 1-year postoperatively, there was no significant difference in the mean photopic CS between the ICL and Artiflex group at all spatial frequencies. No vision-threatening complications occurred during the observation period.

We discuss a case of bipseudophakia with secondary dislocation of a posterior chamber intraocular lens (IOL) into the anterior chamber that was managed by explantation of the anterior and posterior chamber IOLs and implantation of an iris claw IOL.

Many surgeons consider implantation of iris-claw intraocular lenses a favorable option for pediatric aphakic eyes with poor capsular support. The authors present two children who had spontaneous subluxation of such lenses resulting in complications that required explantation. These cases highlight the potential sight-threatening complications of such intraocular lenses.

To evaluate the indication, visual outcome, and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL) during penetrating keratoplasty.This retrospective study comprised 23 eyes (23 patients) without adequate capsule support undergoing posterior iris-claw aphakic IOL implantation (Verisyse/Artisan) during penetrating keratoplasty between 2005 and 2010. Mean follow-up was 18 months (range from 12 to 37 months).The IOLs were inserted during an IOL exchange in 17 eyes and as a secondary procedure in six aphakic eyes. Pseudophakic bullous keratopathy with corneal scar after anterior chamber intraocular lens (ACIOL) was the main indication for penetrating keratoplasty in 16 eyes (69.6 %). The final corrected distance visual acuity (CDVA) in logMAR (mean 1.0 ± 0.46) improved significantly (p0.05) compared to the preoperative CDVA (mean 1.8 ± 0.73). Twenty eyes (86.9 %) had a final visual acuity in logMAR better than the pre-operative CDVA. The mean postoperative IOP 16.3 mmHg ± 4.0 was not significantly (p0.05) higher compared to the preoperative IOP 15.6 mmHg ± 5.1. Complications included slight temporary pupil ovalization in three eyes (13.0 %) and iris-claw IOL sublocation in three eyes (13.0 %); all IOLs could be easily repositioned. Cystoid macular edema occured in one eye (4.3 %) 8 weeks after primary surgery. All grafts remained clear without any sign of graft rejection.Retropupillar iris-claw IOL during penetrating keratoplasty provides good visual outcomes with a favorable complication rate, and can be used for a wide range of indications in eyes without adequate capsule support.

OBJECTIVE: To study the alterations in the corneal endothelial layer two years after the implantation of iris claw phakic lenses. STUDY DESIGN: Prospective study of postoperative results with a minimum follow-up of 6 months, maximum of two years and a mean of 14 months. SETTING: Department of Ophthalmology, ‘La Fe’ University Hospital, Department of Surgery of Valencia School of Medicine, Valencia, Spain. PATIENTS: Ninety eyes of 70 patients presenting high myopia who underwent anterior chamber phakic lens implantation with iris fixation IOLs in the last two years. MAIN OUTCOME MEASURES: Non-contact specular microscopy with video image system was used to perform examination of the corneal endothelium on the central and the mid-peripheral area. Analysis of the cellular density and morphometry was done in every case. RESULTS: The preoperative average cell density of the corneal endothelium was reported to be 3050 ± 335 cell/m 2 . Postoperatively, at 6 months we found a mean of 2946 + 372 cell/m 2 , at one year 2883 ± 318 and 2817 at two years. The loss of endothelial cells was 3.3% in the 6 month follow-up control, 5.5% at 1 year and 7.63% at 2 years. CONCLUSIONS: The density of the endothelial cells showed a slight decrease and no significant detectable morphometrical changes two years after surgery. However, long-term prospective studies need to be carried out in order to evaluate progressive cell loss.

Purpose To evaluate the efficacy, predictability, stability, and complications after implantation of a foldable iris-fixated toric phakic intraocular lens (pIOL) to correct myopic astigmatism. Setting University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. Design Retrospective nonrandomized observational case series. Methods The study assessed eyes having implantation of an Artiflex toric pIOL with spherical power ranging from −1.0 to −13.5 diopters (D) and additional cylinder from −1.0 to −5.0 D, both in 0.5 D increments. The main parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction stability, slitlamp biomicroscopy, tonometry, and central endothelial cell count (ECC). Results The study enrolled 42 eyes of 24 patients with a mean age of 35 years (range 18 to 52 years), a mean spherical equivalent of −7.52 D ± 2.22 (SD) (range −2.63 to −13.0 D), and a mean preoperative cylinder of −1.82 ± 0.96 D (range −1.0 to −5.0 D). Six months postoperatively, the UDVA (Snellen lines) was 1.0 or better in 38 eyes (90%). The CDVA improved by 1 line in 22 eyes (52%) and by 2 lines in 2 eyes (5%); no eye lost lines. All eyes were within ±0.50 of the target refraction (spherical equivalent); the mean refractive astigmatism was −0.18 ± 0.30 D. Refraction was stable from 1 day postoperatively. A slight ECC loss (−0.72%) occurred at 6 months. There were no serious complications. Conclusion After a short-time follow-up, toric pIOL implantation was effective, predictable, stable, and safe for the correction of myopic astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE:Toreportthelong-termresultsofcombinedcollagencrosslinking(CXL)andtoricphakic intraocular lens (pIOL) implantation to correct myopic astigmatism in patients with progressive mild to moderate keratoconus. SETTING: Instituto de Microcirugia Ocular, Barcelona, Spain. DESIGN: Case series. METHODS:From November 2006to July 2009,CXLwasperformedineyes withprovenprogressive keratoconus. Oncerefraction and topographystabilized, toricArtiflex/ArtisanpIOL implantation was performed to correct residual myopic astigmatism. A complete ophthalmologic examination, including manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, biomicroscopy, tonometry, fundoscopy, keratometry, corneal tomography, and central endothelial cell count (ECC), was performed before each procedure and postoperatively at 3 months and at yearly intervals up to 5 years. Main outcome measures were accuracy and stability of the spherical equivalent (SE) and cylinder, keratometry, UDVA (efficacy), CDVA (safety), central ECC, and complications. RESULTS: The median follow-up in the 9 patients (17 eyes) was 36.9 months G 15.0 (SD). The median interval between CXL and pIOL implantation was 3.9 G 0.7 months. Fourteen eyes (82%) were within G0.50 diopter (D) of the attempted SE correction and 13 eyes (76%) were within G1.00 D of the attempted cylinder correction. The mean difference in simulated keratometry between preoperatively and the last follow-up was 0.17 G 0.45 D (range 0.55 to 1.45 D). The postoperative UDVA was 20/40 or better in 16 eyes (94%). No eye lost lines of CDVA. No significant decrease in central ECC occurred (P>.05). CONCLUSION: Combined CXL and toric iris-claw pIOL implantation effectively and safely corrected myopic astigmatism in progressive mild to moderate keratoconus. Financial Disclosure: Dr. G€ is a consultant to Ophtec. No other author has a financial or proprietary interest in any material or methods mentioned.

OBJECTIVE: Critical report on the technique of operative correction of high myopia by implantation of a concave lens (Worst iris claw lens) into the phakic eye, its efficacy and risks. STUDY DESIGN: Prospective study of postoperative results. SETTING: The operations were performed at the Robert Koch Hospital, Hannover-Gehrden, the postoperative examinations at Dr Fechner's practice in Hannover, Germany. PATIENTS: 127 highly myopic eyes were implanted between November 1986 and November 1991. 123 eyes had a follow-up period of at least 6 months (mean 34.2, range 6 to 62 months). RESULTS: 84 of the 123 eyes (68.3%) were corrected within 1.00 dioptre of the desired refraction and only 10 eyes (8.1%) deviated more than 2 dioptres from the calculated correction. The anatomical results were excellent, being characterized by absence of glaucoma and inflammation and by good fixation of the lens. However, in eight of 118 eyes (6.8%) in which the endothelial density was high after operation the density decreased during the follow-up period. CONCLUSIONS: The concave Worst iris claw lens allows correction of high myopia. However, permanent inspection of the endothelial density at regular intervals throughout the life of the patient is required in order to recognize the need for removal of the lens in the event the endothelial density should decrease. This draw-back may be overcome by implanting a negative lens into the posterior chamber of the phakic eye.

To ascertain the potential that phakic anterior chamber lenses (PACL) used for the surgical correction of high myopia have for the induction of chronic subclinical inflammatory reaction, the authors have studied prospectively in one year of surgery the presence of subclinical inflammation in the anterior chamber in 18 clinically controlled cases. Nine of them were implanted with the Baik off ZB5M Domilens type and nine with the Fechner-Worst iris claw type. Clinical follow-up and objective measurements were taken with the Laser Flare Cell Meter Kowa FC-1000. In one year of an uncomplicated follow-up flare measurements were 722.52 ± 639.21 (range 0 to 1557.6) for the iris claw and 42.38 ± 91.67 (range 0 to 228.7) for the ZB5M lens (p0.01, Mann-Whitney test). Cell measurements were 34.52 ± 22.08 (range 5 to 54.8) for the iris claw and 9.3 ± 11.74 (range 0 to 31.8) for the ZB5M type (p0.05 Mann Whitney test). It is concluded that the PACL model ZB5M type is well tolerated in one year of surgery with the induction of marginal levels of flare and cell levels. The Fechner-Worst iris claw type induces unacceptable levels of chronic intraocular inflammation and does not seem suitable for the surgical correction of high myopia. This is the first study that shows that subclinical intraocular inflammation may be present in some models of PACL.

Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs' heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.

PURPOSE: Retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse, Abbott Medical Optics) was performed for aphakic eyes without sufficient capsular support, and safety and recovery of the procedure were compared with transscleral suturing fixation. METHODS: This interventional case series comprised 11 eyes of 10 aphakic patients without capsular support undergoing retropupillary fixation of the Verisyse, and 21 eyes of 20 patients undergoing transscleral suturing fixation of foldable acrylic IOLs (15 eyes of 14 patients, SuperFlex620H [Rayner Intraocular Lenses Ltd]) and polymethylmethacrylate IOLs (6 eyes of 6 patients, CP60NS [CORNEAL Laboratoire]). Surgical time was measured. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were examined preoperatively and 1 day, 1 and 2 weeks, and 1 and 6 months postoperatively. RESULTS: No complications occurred in the Verisyse group, whereas complications were reported in seven eyes in the transscleral suturing fixation group throughout follow-up. Mean CDVA (logMAR) in the transscleral suturing group 1 day after surgery was significantly worse than preoperative CDVA ( P P =.0126). Mean surgical time of Verisyse implantation (20.0±8.9 min) was significantly shorter than transscleral suturing fixation (49.7±18.9 min) ( P CONCLUSIONS: Retropupillary fixation of an iris-claw IOL provides early visual recovery, has a low risk of postoperative increase in IOP, and is a time-saving method compared with transscleral suturing fixation for aphakic eyes without sufficient capsular support.

To report a case of spontaneous dislocation of a Verisyse phakic intraocular lens (PIOL) with severe corneal endothelial cell loss.A 29-year-old woman with no history of trauma presented with complaint of blurred vision in the right eye of 5 months' duration. History included uneventful implantation of a PIOL bilaterally to correct high myopia in January 2007.Visual acuity was 20/100, central endothelial cell density had decreased to 592/mm(2), central corneal pachymetry was 634 microm. The PIOL dislocated temporally and was removed without any lens implanted again. Three months postoperatively, her best-corrected visual acuity was 20/60.A correct fixation with sufficient folded iris inside the claw and long-term follow-up are important for patients with implanted PIOL, and the long-term effects on endothelial cell density in this patient remain to be seen.

To evaluate the intraocular stability and safety of secondary iris-claw intraocular lenses (IOLs) in aphakic patients.Eighteen eyes of 16 patients received iris-claw IOLs to correct for aphakia. Primary outcome measurements included visual acuity (6 m Snellen charts), central endothelium cell count (ECC) and intraocular position of the IOL assessed with anterior segment optical coherence tomography (OCT).Sixteen patients (mean age 66 (range 16-84) years; axial length 24.44 mm) were re-examined 22 months postoperatively (range 12-38 months). Preoperative decimal best corrected visual acuity (BCVA) was 0.51, intraocular pressure (IOP) 15.3 mmHg and central ECC 1816 per mm(2). Postoperative BCVA was 0.68, IOP 13.1 mmHg and central ECC 1626 per mm(2) (difference over time 176 per mm(2) = 10.5%, p0.05). The anterior chamber depth was 4 mm for the eyes with axial length24 mm, and 4.34 mm for thoseor =24 mm.Secondary anterior iris-claw IOLs appears to be a safe choice to correct aphakia with no significant intermediate postoperative central endothelium cell loss, especially in eyes with axial lengthor =24 mm, as distances from the IOL to the central and peripheral cornea proved to be consistent.

Purpose To present a novel technique for the implantation of phakic iris-claw intraocular lenses (IOL) in highly myopic cases. Methods Twelve cases, under the age of 40, with high myopia were included in this retrospective study. The mean follow-up span was 14.4±5.8 months. Phakic iris-claw IOL implantation was performed, through a 5.5 or 6.5 mm self sealing scleral tunnel with Bursa technique. No suturing and opening a peripheral iridectomy or iridotomy was required in our study. Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best-corrected visual acuity (BCVA), induced astigmatism, and intraocular pressure (IOP) assessments. Results All eyes gained one to nine lines of BCVA of the Snellen chart. The vector analysis revealed an induced astigmatism of 0.63 D. No significant IOP change was detected throughout the follow-up. Conclusions The data suggest that nonfoldable iris fixated phakic IOL implantation, through a self-sealing incision with Bursa technique, is safe and requires no iridectomy or iridotomy in cases with deep anterior chambers.

In a case with retinitis pigmentosa, the intraocular lens that dislocated to the anterior chamber 20 tears after the cataract surgery has been removed via scleral tunnel incision. Then, the iris claw lens was placed behind the iris again by the scleral tunnel. This case was reported as an example for both its existing and rehabilitation method.

Purpose To evaluate variations in the position of the phakic iris claw lens (Artisan®, Verisyse®) and the natural crystalline lens during the accommodation process. Methods We measured changes in position of the iris claw lens and the crystalline lens during the accommodation using optical coherence biometry (AC Master®/Carl Zeiss Meditec, Germany) in 17 patients (28 eyes) with a phakic iris claw lens implanted for high myopia and/or myopic astigmatism. Accommodative effort was obtained using an internal optical target within the measuring device. Results There was a forward shift of the phakic iris claw lens with a mean of 70 μm (8–178 μm) of the optical path length (OPL). At the same time the anterior pole of the natural lens showed a forward mean movement of 85 μm (4- 260 μm). Conclusions An anterior displacement of the iris-claw phakic lens was shown in a series of eyes during the accommodation process. As this displacement goes along with the forward displacement of the anterior pole of the crystalline lens, the preoperative measurement of the latter might provide some additional information about the position of the iris claw lens in the accommodative state after implantation.

Purpose: To investigate the influence of the secondary implantation site of the Verisyse® iris-claw intraocular lens (IOL) on high order aberrations (HOAs) using wavefront analysis in aphakic patients. Methods: Twenty aphakic patients (20 eyes) who had complicated phacoemulsification, leaving no capsular support, but good iris support and clear unwounded cornea implantated with the aphakic Verisyse®(AMO) intraocular lens site either implanted retropupilarely or over the iris. Wavefront aberrations were measured using the IRX3 Hartmann-Shack aberrometer at 4 mm pupil aperture diameter. Results: Nine patients were implanted in the anterior chamber versus 11 who had the IOL clipped behind the iris. Best corrected visual acuity was significantly higher and HOAs were significantly lower in the retropupilarely implanted group. Conclusions: In addition to being atraumatic, the Verisyse® intraocular lens implanted behind the iris may restore vision in the absence of capsular support in a more physiological way than when fixated over the iris.

Purpose The aim of this work was to compare retropupillary fixation of an iris-claw intraocular lens (IOL) (Verisyse) with trans-scleral suturing fixation for aphakic eyes without sufficient capsular support as regards the safety and complications of the procedure. Design This study was an interventional comparative prospective one. Patients and methods A total of 42 aphakic eyes of 40 patients were divided into two equal groups: 21 eyes were offered iris-claw IOL and 21 eyes were implanted with scleral-fixed IOL. Intraoperative data (mainly surgical time and intraoperative bleeding) and postoperative data [mainly corrected distance visual acuity (CDVA), intraocular pressure, and postoperative complications] were compared between the two groups during the follow-up period (first day,1 week, 2 weeks,1 month, and after 3 months). Results The mean surgical time in the iris-claw group was 24.77 ± 4.8 min, whereas the mean surgical time in the scleral fixation group was 67.09 ± 8.1 min, with a statistically significant difference between the two groups. On the first postoperative day, the CDVA ranged from 0.06 to 0.5 in the iris-claw group, with a mean of 0.22 ± 0.116, and it ranged from 0.05 to 0.15 in the scleral fixation group, with a mean of 0.10 ± 0.032; there was a statistically significant difference between the groups (P = 0.00021). However, after the first 3 months postoperatively, the CDVA ranged from 0.25 to 1.0 in the iris-claw group, with a mean of 0.51 ± 0.25, and it ranged from 0.15 to 0.6 in the scleral fixation group, with a mean of 0.42 ± 0.16; there was no statistically significant difference between the two groups (P = 0.152). On the first postoperative day, the mean intraocular pressure in the iris-claw group was 15.62 ± 2.59 mmHg, whereas in the scleral fixation group it was 19.62 ± 3.94 mmHg, with a statistically significant difference between the two groups (P = 0.00038). The iris-claw group showed higher rates of anterior chamber reaction, pupillary distortion, and cystoid macular edema postoperatively. In contrast, the rates of corneal edema, vitreous hemorrhage, and conjunctival erosion were higher in the scleral fixation group. Conclusion From our results, it is evident that iris-claw IOLs have now matured to a stage when they can be used with considerable safety and efficacy. The new designs, as well as the evolution of surgical techniques and instrumentation, have made them the best option for primary or secondary implantation in aphakic eyes. The surgical procedure is easier, shorter, and safer than those used for scleral-sutured IOLs.

Purpose To describe the appearance of choroidal neovascularization (CNV) in two myopic patients after implantation of a phakic refractive lens (PRL) and an iris-claw lens. METHODS A PRL was implanted in the left eye of a 35-year-old myopic man. Five weeks later, he reported decreased best-corrected visual acuity (BCVA). Fluorescein angiography revealed juxtafoveal CNV. Photodynamic therapy with Visudyne (PDT) was successfully performed, achieving closure of the membrane. BCVA was 20/40 3 months afterwards. An iris-claw lens was implanted in the left eye of a 24-year-old myopic man. BCVA after surgery was 20/40 (SE -0.75). Three years later subfoveal CNV was diagnosed. PDT was performed, achieving complete closure of CNV. BCVA was 20/100 3 months after treatment. CONCLUSIONS The appearance of CNV in myopic eyes corrected by phakic intraocular lens implantation is a possible complication that must be considered.

Purpose: To evaluate the change in contrast sensitivity after implantation of the Verisyse toric phakic intraocular lens (IOL) (AMO) for the correction of myopia with astigmatism. Setting: Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany. Methods: Eighteen eyes had implantation of an iris-supported toric phakic IOL to correct myopia with astigmatism. The mean preoperative spherical equivalent was −12.65 diopters ± 3.6 (SD). The contrast sensitivity with best spectacle correction was determined before surgery and 3 months after surgery using the CSV-1000 HGT instrument (Vector Vision Inc.). Results: Three months after IOL implantation, the mean contrast sensitivity had significantly increased from preoperatively at midrange spatial frequencies from 3.2 to 4.4 (6 cycles per degree [cpd]; P = .033) and from 2.4 to 3.7 (12 cpd; P = .032). The differences at spatial frequencies of 3 cpd and 18 cpd were not statistically significant ( P = .59 and P = .086, respectively). Conclusions: Implantation of the Verisyse toric iris-claw lens in phakic eyes to correct high or moderate myopia with astigmatism has the potential to improve contrast vision. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels.

We performed a prospective study of the safety, efficacy, and effect of the newer version on HOAs, which has not been described. LogMAR corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refractive spherical equivalent (MRSE), endothelial cell density (ECD), and HOAs were recorded preoperatively and 6, 12, and 24 months after implantation of the pIOL. Implantation was performed by a single surgeon (M.O.K.) in 66 myopic eyes of 37 patients (mean MRSE 8.9 diopters [D] G 1.9 [SD]). At 24 months, the mean MRSE was 0.3 D; 69.4% of eyes had a UDVA of less than or equal to 0.0 logMAR and 100% had a UDVA of less than or equal to 0.18 logMAR. Laser-assisted subepithelial keratomileusiswasperformedin6%ofeyestocorrectaresidual refractive error. Thirty-two eyes (48.5%) gained 1 or more lines of CDVA, and no eye lost a line of CDVA. A statistically significant 17% decrease in the root mean square (RMS) of vertical trefoil Z(3,1) was noted (P Z .016, Student t test, Table 1), and there was a statistically significant 48% decrease in 4th-order spherical aberration, Z(4,0), (P Z .007

PURPOSE To report a successful case of Descemet stripping automated endothelial keratoplasty (DSAEK) performed on a vitrectomized eye with a potentially unstable posteriorly fixated iris-claw intraocular lens (IOL). METHOD A standard DSAEK procedure was performed on a 42-year-old man referred to our institution because of corneal edema occurring after repeat surgery for rhegmatogenous retinal detachment. Preoperatively, the best-corrected visual acuity was 20/200, and slit-lamp examination revealed bullous keratopathy in the presence of a posteriorly fixated iris-claw IOL. RESULTS Both surgery and the postoperative course were uneventful. On day 1, the graft was well centered and fully attached to the posterior corneal surface. The IOL was unchanged in its position. Subsequent follow-up showed progressive improvement in corneal clarity, with a best-corrected visual acuity (BCVA) of 20/50 at the last follow-up examination (4 months). CONCLUSIONS This case demonstrates that DSAEK is an appropriate intervention for eyes with pseudophakic bullous keratopathy, even in the setting of eyes with posteriorly fixated iris-claw IOLs that are at risk of dislocation into the vitreous cavity.

pupil. Several landmark cursors were added to allow multiple landmarks to be measured. We realized that only 2 marks were necessary to orient the surgical dial used for identifying the axis in the operating room. The paper for the copier was very expensive, and we were having problems with the ink on the printer. Fortunately, a very fast system (Hewlett Packard Color Laser Jet 4700) that uses inexpensive paper yet produces an excellent image was identified.

27 children (38 eyes) with cataracts of different origins were treated using iris fixated one-piece Iris-Claw intraocular lenses. Visual acuities outcome in this group was comparable with the results in other series. The Iris-Claw lens is a very versatile IOL, which can be used in most cataract procedures, it can be removed and exchanged with minimal surgical trauma; therefore it is an effective modality in correction of the developmental changes in the refraction of the very young and growing, aphakic eye.

Keratoconus and other ectatic disorders can be an unexpected finding in patients seeking refractive surgery. In this group of patients, refractive laser corneal procedures are in many cases contraindicated as they may worsen the disease. Implantation of toric phakic iris claw lenses is a safe and effective treatment in patients with stable keratoconus. Good results in terms of visual acuity, post-operative residual refractive error and patient satisfaction can be achieved.

We evaluated the safety and efficacy of pars plana vitrectomy (PPV) with primary posterior iris claw intraocular lens (IOL) implantation in cases of posterior dislocation of nucleus and IOL without capsular support. This was a retrospective interventional case series. Fifteen eyes underwent PPV with primary posterior iris claw IOL implantation performed by a single vitreoretinal surgeon. The main outcome measures were changes in best corrected visual acuity and anterior and posterior segment complications. A total of 15 eyes were included in this study. Eight had nucleus drop, three had IOL drop during cataract surgery and four had traumatic posterior dislocation of lens. The final postoperative best corrected visual acuity was 20/60 or better in 11 patients. This procedure is a viable option in achieving good functional visual acuity in eyes without capsular support.

A description of the author's (J.W.) technique for ICCE using a 'single-handed' freon cryo-extractor is given. Flieringa's ring is used for scleral support. Implantation is performed with an Iris Claw Lens. Stainless steel is used as suturing material.

A 25-year-old man had diplopia caused by abducens nerve paresis on both sides after cranial injury. Because of the patient's reports of persistent diplopia after surgical correction, a specially manufactured, tinted iris claw lens was implanted in the left eye, with the crystalline lens in situ. Fourteen years after surgery, specular microscopy was performed to evaluate the corneal endothelium. The difference in mean endothelial cell density in both eyes was 18.6%. The difference between eyes in polygonality and polymegathism was not significant.

The iris claw lens does not have some of the disadvantages of lenses fixed in the anterior chamber angle. It is clipped to the iris from the front and does not touch the structures of the angle. It is useful as a stand-by lens and for secondary implantations, as well as for certain other indications, such as a traumatized eye with anterior synechiae. It is conceivable that in the future this lens type may gain in importance as a carrier of a concave optic for use in myopic eyes.

The description of a concave intraocular lens for the correction of myopia is given and preliminary results are presented. An iris claw type lens is used as the carrier for the concave optic. This lens is fixed in front of the natural lens in the mid-periphery of the iris. It keeps sufficient distance from both the natural lens and the corneal endothelium. The operative technique is described and the indications and contraindications are discussed. The results are encouraging.