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Volume 15 (2) * March/April 1999 * Original Article (abstract)

Worst-Fechner Biconcave Minus Power Phakic Iris-Claw Lens

OBJECTIVE

Evaluation of long-term results of correction of high myopia by implantation of a biconcave Worst-Fechner minus power iris-claw lens into phakic eyes.

METHODS

One hundred and twenty-seven eyes of 70 patients were implanted with the phakic IOL between November 1986 and November 1991. The mean preoperative spherical equivalent refraction was -14.29 ± 5.77 D (range -5.00 to -31.75 D). The total population decreased from 127 to 68 eyes (53.5%) at the 8-year examination. By this time, 26 of the 70 patients (37%) had been lost to follow-up for unknown reasons. Corneal endothelial density was estimated by comparing the image gained by non-contact specular microscopy with a graduated reticule (Karickhoff method).

RESULTS

At the 6-month examination, mean deviation of achieved from calculated refractive correction was +0.52 ± 1.46 D (range -2.25 to +6.50 D). Seventy-seven eyes (62.1%) deviated 1.00 D or less, and 15 eyes (12.1%) deviated by more than 2.00 D from the calculated correction. A refractive outcome of ±1.00 D was attempted in 68 eyes (54% of the 124 eyes) and was achieved in 51 eyes (75%). Mean spectacle-corrected visual acuity preoperatively was 0.54 ± 0.27 (range 1.20 to 0.05). At the 6-month examination it was 0.73 ± 0.3, and by the 8-year examination had decreased to 0.65 ± 0.26. Statistical analysis of corneal endothelial cell density revealed a significant correlation of endothelial cell loss with age (>45 years), anterior chamber depth (<3.4 mm), and IOL power (>-11.00 D). Seventeen eyes (13.4%) had a decrease in endothelial cell density and projection to 8-year follow-up resulted in a decrease in 27% of eyes. Four eyes needed a penetrating keratoplasty.

CONCLUSION

Implantation of a biconcave Worst-Fechner lens into a phakic eye effectively corrected high myopia with a stable refractive outcome, but 13.4% of implanted eyes suffered significant progressive reduction of endothelial cell density. This style lens is no longer in clinical use. [J Refract Surg 1999;15:93-105]

AUTHORS

From the Department of Ophthalmology, Robert Koch Hospital, Hannover-Gehrden, and the Center of Mathematics and Biostatistics, Wuerzburg University (Haubitz).

None of the authors has a financial interest in the intraocular lenses mentioned in this article.

Over the years many people were of great help to the authors. In particular they wish to thank Mrs. Silvia Baur, Benjamin Fechner, PhD, Professor Berthold Schneider, PhD, Professor Guenter Wricke, PhD, and Mrs. Anneke Worst.

Correspondence: Dr. P. U. Fechner, Schmiedestr. 41, 30159 Hannover, Germany.

Received: January 20, 1998

Accepted: November 24, 1998

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