Implantation of iris-fixated intraocular lenses (IOLs), such as the Artisan/Artiflex, is a reliable option to correct refractive
defects in phakic myopes and hyperopes with or without astigmatism and patients with aphakia. However, the advantages of the
IOL design could be limited by or even become disadvantages through decentration or rotation of the lens.1
This is particularly true in the case of toric IOLs as it has been estimated that an off-axis rotation of just one degree
results in a loss of up to 3.3% of the lens cylinder power, and a rotation of more than 10 degrees implies a reduction of
the intended astigmatic effect by more than 30%.2,3
Advantages of the VacuFix system
Techniques for iris enclavation
Traditionally, there have been two different techniques for iris enclavation of iris-claw IOLs. The first approach was using
an enclavation needle introduced through a superior side-port incision, and the second one was using enclavation forceps through
a side-port incision located 90 degrees from the main incision. The majority of surgeons starting with iris-fixated IOLs find
that the enclavation step is the most difficult part of the procedure.
Figure 1: The VacuFix system comprises two holders with an aspiration tip that can be attached to any phaco machine.
The BO150 VacuFix (Ophtec, The Netherlands) is a new vacuum enclavation system designed to fix the lens to the iris in a fast,
precise and reproducible way for all iris-claw IOLs including Artisan (both phakic and aphakia) and Artiflex models. This
system comprises two disposable handpieces (purple for the right haptic and orange for the left one) finishing in a blunt
aspiration tip with an oval hole that is used to aspirate a fixed amount of iris tissue (Figure 1). The VacuFix is compatible
with all phaco machines: a vacuum is created to clip a replicable amount of iris tissue between the haptics of the lenses.
Figure 2: The VacuFix is introduced through a side-port incision located next to the main incision.
The vacuum method (Figure 2) is useful for surgeons starting with iris-claw IOLs, but, in my opinion, it also proves advantageous
to more experienced surgeons looking for a more reproducible enclavation technique. The precision of the procedure allows
more exact placement of the lens, which is especially important in the case of toric phakic IOLs (Figure 3). Additionally,
I found that gripping iris tissue in cases of aphakic eyes that usually have a more fibrotic iris is also easier.
Figure 3: The blunt aspiration tip finishing in an oval hole is used to aspirate a fi xed amount of iris tissue to easily
fi x the iris-claw IOL in a fast, precise and reproducible way.
The Artisan toric phakic IOL has shown good results, with 63% to 73% of eyes within 0.50 D of the predicted correction, and
a best corrected visual acuity improvement in 65.7% to 70% of eyes.4,5 The Artiflex phakic IOL has also been shown to be effective and predictable for the correction of myopia.6,7 However, preventing lens misalignment, both decentration and rotation, is a fundamental requisite for effective refractive
correction with toric phakic IOLs (Figure 4).
Figure 4: Artifl ex IOL perfectly centred on the patient’s pupil.
One of the main advantages of the iris-fixated phakic IOL design in the correction of high astigmatic defects is that it should
provide excellent rotational stability as a result of the level of fixation achieved, which is not possible using other types
of phakic IOLs. I believe that the new VacuFix method will contribute to the expansion of the iris-fixated phakic IOL capabilities
by further enhancing stability and reproducibility of lens implantation.
Dr Gonzalo Muñoz, medical director, Refractive Surgery Department, Clínica Oftalmológica Marqués de Sotelo, Valencia, Spain. He can be reached
by E-mail: email@example.com
Dr Muñoz indicates no conflict of interest with the subject matter of this article.
1. R. Montes-Mico, A. Cervino and T. Ferrer-Blasco, Curr. Opin. Ophthalmol., 2009; 20(1):33–36.
2. A. Viestenz, B. Seitz and A. Langenbucher, J. Cataract Refract. Surg., 2005; 31:557–561.
3. J. Mendicute et al., J. Cataract Refract. Surg., 2008; 34:601–607.
4. H.B. Dick et al., Ophthalmology, 2003; 110:150–162.
5. M. Tehrani et al., J. Cataract Refract. Surg., 2003; 29:1761–1766.
6. H.B. Dick et al., Ophthalmology, 2009; 116:671–677.
7. L.A. van Philips, J. Refract Surg., 2010; 26:423–429.