Late-Onset Decentration of Iris-Fixated Phakic Intraocular Lenses: A Case Series

PURPOSE: To investigate late-onset downward decentration of iris,fixated phakic intraocular lenses (pIOL) resulting from progressive shifting of the haptics through the iris and its influence on the position of the pIOL and the amount of enclavated iris tissue. DESIGN: Institutional, prospective, observational case series. METHODS: Six patients (9 eyes) from among 368 yes had 1 shifted haptic during long-term follow-up. Anterior segment optical coherence tomography (AS OCT) was used to measure the distance between the edges of the pIOL and the corneal endothelium. Slit,lamp photography imaged the pIOL after implantation and after decentration. The images were analyzed to determine decentration and amount of iris tissue at the enclavation sites. RESULTS: Shifting of the haptics occurred in 2.4% and was discovered at a mean follow-up of 4.8 years (range, 3 to 7 years). Mean downward decentration was 0.28 +/- 0.15 mm. Mean edge,distances on the nasal, temporal, superior, and inferior side were 1.71 +/- 0.30 mm, 1.86 +/- 0.31 mm, 1.86 +/- 0.31 mm, and 1.58 +/- 0.34 mm, respectively. Mean enclavated iris tissue on the nasal and temporal side was smaller after decentration when compared with that directly after surgery (P=.033 and P=.017, respectively). Shifting of the haptics did not result in a decreased uncorrected and best,corrected visual acuity. CONCLUSIONS: Late-onset downward decentration resulting from progressive shifting of the haptics occurred in 2.4% and was associated with a decrease in enclavated iris tissue. AS OCT showed a mean distance between the edge of the pIOL and the endothelium greater than the advised safety distance of 1.5 mm. (Am J Ophthalmol 2009; 147:997-1003. (C) 2009 by Elsevier Inc. All rights reserved.)