Several years ago, I traveled to the Netherlands in order to gain firsthand knowledge of the lens technology known as the Artisan lens (OPHTEC, Groningen, the Netherlands), which is currently available outside the US and will soon be distributed under the name of Verisyse in the US (Advanced Medical Optics, Inc., Santa Ana, CA). The positive impression with which I left the country prompted me to begin implanting the lens in 1997, initially overseas and later as part of the FDA clinical trials. In Europe, the Verisyse lens has been the subject of multicenter prospective trials with more than 15 years of follow-up, and the IOL may be available in the US as soon as the spring of 2004.
ABOUT THE LENS
The Verisyse lens is intended for the treatment of myopia ranging from 5.00 to 23.00 D (maximum of 20.00 D for the FDA trials), and it is available in 1.00-D increments. The IOL is available in two sizes: 5 mm for patients whose refractive error exceeds 15.00 D and 6 mm for individuals with lesser ametropias. The surgeon fixates the IOL onto the midperipheral iris.
IMPLANTATION TECHNIQUE
I place limbal marks just below the midline of the iris for positioning the entry site (Figure 1). The marks are not radial but point toward the 6-o'clock position. Next, I instill Miochol (CIBA Vision, Duluth, GA) eye drops to reduce the pupil size and inject Healon GV (Pfizer Inc., New York, NY) into the anterior chamber in order to maintain the shape of the eye. I then enlarge the opening of the entry site and perform a peripheral iridotomy. Next, I refill the eye with viscoelastic solution before inserting the Verisyse lens.
I rotate the lens from the 12- and 6-o'clock positions to the 3- and 9-o'clock positions. The surface markings enable me to attach the lens just below the midline of the iris, a position I favor because the IOL tends to migrate upward. In a process called enclavation, I feed tiny fragments of anterior iris stroma into the haptic (Figure 2). When the lens is well centered over the pupil, just below the purple marking, I close the entry site with a few microscopic stitches. I then perform two-port I/A and remove all viscoelastic. Next, I hydroseal the paracenteses openings so that the eye can resume its natural shape.
TIPS FOR BEGINNING SURGEONS1. Place limbal centration (ink) markings.
2. Pharmacologically constrict the pupil in order to protect the crystalline lens.
3. Use a high-viscosity viscoelastic to maintain chamber depth.
4. Enclavate the IOL's temporal haptic first, because the pupil is nasally decentered in all eyes.
5. Perform a peripheral iridotomy in all eyes.
6. Use a two-port I/A system to evacuate all viscoelastic.
CONCLUSION
Long experience with the Verisyse lens in humans has proven the phakic IOL's biocompatibility and confirmed the stability and predictability of the results. Published, European multicenter trials1,2 have not found this lens to induce endothelial cell loss, cataracts, pigment dispersion, or glaucoma.
1. Budo C, Hessloehl JC, Izak M, et al. Multicenter study of the Artisan phakic intraocular lens. J Cataract Refract Surg. 2000;26:1163-1171.
2. Dick HB, Alio J, Bianchetti M, et al. Toric phakic intraocular lens: European multicenter study. Ophthalmology. 2003;110:150-162.
