““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