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““Cataract formation after implantation ofCataract formation after implantation of
phakic posterior chamber intraocular lenses:phakic posterior chamber intraocular lenses:
A brief overview and review of the literatureA brief overview and review of the literature””
Liliana Werner, MD, PhDLiliana Werner, MD, PhD
David J. Apple, MDDavid J. Apple, MD
FDA Ophthalmic Devices Advisory Panel Meeting
August 2, 2002, Rockville, MD
Center for Research on Ocular Therapeutics and BiodevicesCenter for Research on Ocular Therapeutics and Biodevices
Director:Director: David J. Apple, MD David J. Apple, MD
Director of Research:Director of Research: Liliana Werner, MD, PhD Liliana Werner, MD, PhD
Post-Doctoral Fellows:Post-Doctoral Fellows: Suresh K. Pandey, MD, Andrea M. Izak, MD Suresh K. Pandey, MD, Andrea M. Izak, MD
Storm Eye InstituteStorm Eye Institute
Medical University of South CarolinaMedical University of South Carolina
Charleston, SC, USACharleston, SC, USA
09/02:09/02: David J. Apple MD David J. Apple MD
Laboratories for Ophthalmic Devices ResearchLaboratories for Ophthalmic Devices Research
Directors:Directors: David J. Apple, MD, Nick Mamalis, MD David J. Apple, MD, Nick Mamalis, MD
Director of Research:Director of Research: Liliana Werner, MD, PhD Liliana Werner, MD, PhD
Clinical Directors:Clinical Directors: Randall J. Olson, MD, Alan S. Crandall, MD Randall J. Olson, MD, Alan S. Crandall, MD
Instructors:Instructors: Suresh K. Pandey, MD, Andrea M. Izak, MD Suresh K. Pandey, MD, Andrea M. Izak, MD
John A. Moran Eye Center, University of UtahJohn A. Moran Eye Center, University of Utah
Salt Lake City, UT, USASalt Lake City, UT, USA
Phakic posterior chamber IOLs
1. Cells involved in crystalline lens and capsular bag opacification2. Evolution of designs of PPCIOLs3. Relevant aspects of fixation and sizing4. Sizing issue: New studies5. Surgical implantation6. Relationship between cataract and myopia7. Cataractogenesis
• Specimens analyzed in our Center• Mechanisms• Review of the literature• Classification of cataracts after phakic IOL implantation?
Crystalline lens
Anterior capsule Epithelial cells(A-cells)
Cortical fibers
Area of active mitosis(E-cells)
Epithelial lens bow
Posterior capsule
Nucleus
Anterior subcapsular cataract(A-cells)
Interlenticular opacification(A-cells + E-cells)
Posterior capsule opacification(A-cells + E-cells)
Anterior capsule opacification(A-cells)
A-cells: Anterior capsule opacification
A-cells: Capsule contraction syndrome
A-cells: Anterior capsule opacification
Courtesy: Paul Koch, MD, Koch Eye Surgicenter, Inc., Warwick, RI, USA
A-cells: anterior subcapsular cataract after Staar ICL implantation
OD OS
Courtesy: Arturo Chayet, MD, Mexico
A-cells: anterior subcapsular cataract after Staar ICL implantation
Anterior Capsule Opacification
Anterior Subcapsular Cataract(Uveitis)
Anterior Subcapsular Cataract(Phakic IOL)
E-cells: Posterior capsule opacification
Rabbit eye
E-cells: Posterior capsule opacification
Cadaver eye
E-cells: Interlenticular opacification
E-cells: Interlenticular opacification
Cataractous lens
(Ocular Pathology
David J. Apple, Maurice F. Rabb
1998 - 5th Edition)
Material betweenpiggyback lenses
Phakic posterior chamber IOLs
• Cells involved in crystalline lens and capsular bag opacification• Evolution of designs of PPCIOLs• Relevant aspects of fixation and sizing• Sizing issue: New studies• Surgical implantation• Relationship between cataract and myopia• Cataractogenesis
• Specimens analyzed in our Center• Mechanisms• Review of the literature• Classification of cataracts after phakic IOL implantation?
Phakic Posterior Chamber Intraocular Lenses
-Introduced by Fyodorov in 1986
-Avoid potential problems associated with phakic anterior chamber IOLs, such as corneal descompensation and pupil ovalization
Courtesy: Professor Georges Baikoff,Marseille, France
First generation:Fyodorov “mushroom” lens
Courtesy: Dimitrii D. Dementiev, MD, Milano, Italy
First generation:Fyodorov “mushroom” lens
Courtesy: Dimitrii D. Dementiev, MD, Milano, Italy
Second generation:Chiron-Adatomed silicone lens