The Toric Artiflex IOL (Ophtec BV, Groningen, Netherlands; Figure 1) is a foldable phakic IOL with a silicone optic and PMMA haptics. It is available in spherical powers from -2.00 to -14.50 D and cylinder powers from 1.00 to 5.00 D. The Toric Artiflex represents a potential improvement over the Toric Artisan IOL (Ophtec), a rigid PMMA phakic IOL that has been reported to induce corneal astigmatism postoperatively due to the large incision needed to implant the lens.1,2
Crucial to success with the Toric Artiflex, as with any phakic IOL, is careful patient selection. Patients with anterior chamber depths (ACDs) of less than 3 mm are contraindicated for the lens. We use the Visante OCT (Carl Zeiss Meditec, Jena, Germany) to ensure sufficient ACD for implantation. It is important to use an instrument such as the Visante OCT, rather than conventional ultrasound biometry because ultrasound can overestimate ACD in patients with thick corneas. Additionally, the Visante can also be used to assess the movement and position of the iris, which is also important in patient selection.
Our experience in the multicenter study of the Toric Artiflex to date includes 22 eyes. Preoperative subjective refraction in these eyes ranged from -1.00 to -9.00 D of spherical error and -1.00 to -3.50 D of cylinder. At both 1 (n=18) and 3 months (n=13) postoperative, spherical results are within ±1.00 D of emmetropia, and cylinder is less than -1.00 D in all eyes.
We now have 5 years' experience with the nontoric foldable Artiflex IOL, and we have found that it provides safe correction of high myopia. The Toric Artiflex now also exhibits promising results. The Visante OCT helps to ensure that an important contraindication for Artiflex lens implantation is respected, improving patient selection and, as a result, patient satisfaction.
Camille Budo, MD, is an Associate Professor at the University of Maastricht, Department Ophthalmology, and in practice in Sint-Truiden, Belgium. Dr. Budo states that he is a consultant to Ophtec BV and Carl Zeiss Meditec and is also a medical mentor for Ophtec BV. He may be reached at tel: +32 11 689684; fax: +32 11 688286; e-mail: firstname.lastname@example.org.
- Dick HB, Ali? J, Bianchetti M, et al. Toric phakic intraocular lens: European multicenter study. Ophthalmology. 2003;110(1):150-162.
- Bartels MC, Santana NT, Budo C, van Rij G, Mulder PG, Luyten GP. Toric phakic intraocular lens for the correction of hyperopia and astigmatism. J Cataract Refract Surg. 2006;32(2):243-249.