Pigment dispersion and Artisan phakic intraocular lenses -: Crystalline lens rise as a safety criterion

Purpose: To validate the theory that crystalline lens rise can be used as a safety criterion to prevent pigment dispersion in eyes with an Artisan phakic intraocular lens (IOL) (Ophtec BV). Setting: Monticelli Clinic, Marseilles, France. Method. A comparative analysis of crystalline lens rise in 9 eyes with pigment dispersion and 78 eyes without dispersion was performed. All eyes had previous implantation of an Artisan IOL. Anterior segment imaging was done using an anterior chamber optical coherence tomography (AC OCT) prototype. Crystalline lens rise was defined by the distance between the anterior pole of the crystalline lens and the horizontal plane joining the opposite iridocorneal recesses. Results: The study confirmed that crystalline lens rise can be considered a safety criterion for implantation of Artisan-type phakic IOLs. The higher the crystalline lens rise, the greater the risk for developing pigment dispersion in the area of the pupil. This complication occurred more frequently in hyperopic eyes than in myopic eyes. Results indicate there is little or no risk for pigment dispersion if the rise is less than 600 mu m; 67 % of eyes with a rise of 600 mu m or more developed pupillary pigment dispersion. In some cases in which the IOL was loosely fixated, there was no traction on the iris root and dispersion was prevented or delayed. Conclusions. Crystalline lens rise should be considered a new safety criterion for Artisan phakic IOL implantation and should also be applied to other types of phakic IOLs. The distance remaining between the crystalline lens rise and a 600 mu m theoretical safety level allows one to calculate how long the IOL can safely remain in the eye.