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Cataract formation after implantation ofphakic
posterior chamber intraocular lensesA brief
overview and review of the literature

• Liliana Werner, MD, PhD
• David J. Apple, MD
• FDA Ophthalmic Devices Advisory Panel Meeting
• August 2, 2002, Rockville, MD

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Center for Research on Ocular Therapeutics and
Biodevices Director David J. Apple, MD Director
of Research Liliana Werner, MD,
PhD Post-Doctoral Fellows Suresh K. Pandey, MD,
Andrea M. Izak, MD
Storm Eye InstituteMedical University of South
CarolinaCharleston, SC, USA
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09/02 David J. Apple MD Laboratories for
Ophthalmic Devices Research Directors David J.
Apple, MD, Nick Mamalis, MD Director of Research
Liliana Werner, MD, PhD Clinical Directors
Randall J. Olson, MD, Alan S. Crandall,
MD Instructors Suresh K. Pandey, MD, Andrea M.
Izak, MD
John A. Moran Eye Center, University of UtahSalt
Lake City, UT, USA
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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?

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Crystalline lens
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Anterior capsule
Epithelial cells (A-cells)
Cortical fibers
Area of active mitosis (E-cells)
Nucleus
Epithelial lens bow
Posterior capsule
Posterior capsule opacification (A-cells
E-cells)
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A-cells Anterior capsule opacification
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A-cells Capsule contraction syndrome
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A-cells Anterior capsule opacification
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A-cells anterior subcapsular cataract after
Staar ICL implantation
OS
OD
Courtesy Paul Koch, MD, Koch Eye Surgicenter,
Inc., Warwick, RI, USA
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A-cells anterior subcapsular cataract after
Staar ICL implantation
Courtesy Arturo Chayet, MD, Mexico
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Anterior Capsule Opacification
Anterior Subcapsular Cataract (Uveitis)
Anterior Subcapsular Cataract (Phakic IOL)
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E-cells Posterior capsule opacification
Rabbit eye
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E-cells Posterior capsule opacification
Cadaver eye
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E-cells Interlenticular opacification
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E-cells Interlenticular opacification
Material between piggyback lenses
Cataractous lens (Ocular Pathology David J.
Apple, Maurice F. Rabb 1998 - 5th Edition)
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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?

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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
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First generation Fyodorov mushroom lens
Courtesy Dimitrii D. Dementiev, MD, Milano,
Italy
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First generation Fyodorov mushroom lens
Courtesy Dimitrii D. Dementiev, MD, Milano,
Italy
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Second generation Chiron-Adatomed silicone lens