Moran CORE

Corneal Decompensation Secondary to Verisyse Lens Implantation

Home / External Disease and Cornea / Clinical Approach to Depositions and Degenerations of the Conjunctiva, Cornea, and Sclera

Title: Corneal Decompensation Secondary to Verisyse Lens Implantation
Author: Caroline Brereton, MSIV at University of Nevada, Reno
Photographer: Majid Moshirfar, MD
Date: 08/25/2022
Keywords/Main Subjects: corneal decompensation, Verisyse lens, bullous keratopathy

Diagnosis:  Bullous keratopathy

Description of Case:

History of Present Illness: A 57-year-old male with a history of bilateral Verisyse lens implantation presented to the clinic in April of 2022 with gradually decreasing vision in his left eye.  The patient denied ocular pain or discomfort.  He developed bullous keratopathy in his right eye in 2013 secondary to the Verisyse lens implant.  Consequently, he underwent Verisyse lens removal and cornea transplant DSAEK OD.  The patient has been monitored closely for corneal decompensation in his left eye since 2013.  He also has a history of retinal detachment OD and buckle placement at 15 years of age.

Initial examination: The patient’s visual acuity with correction was 20/20-2 in the right eye and 20/200 in the left eye.  Intraocular pressures were 24 in both the right and left eyes. The patient did not have a relative afferent pupillary defect.  His confrontation visual fields and extraocular movements were full and intact bilaterally.  The anterior slit lamp examination was significant for 2+ central and inferior corneal edema in the left eye.  The Verisyse lens in the left eye was in good position, enclavated superiorly and inferiorly.  He had a trace nuclear sclerotic cataract in his left eye.  The fundus exam showed a posterior vitreous detachment as well as pigmentary changes in the periphery of the left eye.

Diagnosis and treatment: The patient was diagnosed with bullous keratopathy OS secondary to placement of the Verisyse lens.  He underwent Verisyse lens removal in August of 2022, as well as phaco/IOL placement and DSAEK.

Discussion: The Verisyse lens was first implanted in a phakic patient in 1986.  It eventually gained FDA approval in 2006 in the United States for its use in myopic patients, earning its trade name the Verisyse lens.¹ The lens is placed in the patient’s anterior chamber.  It has two claws on the either side of the lens that are incorporated into the med-periphery, non-dilatory portion of the iris tissue in a process called enclavation. ² The design of the lens allows for a “one-size fits all,” due to its incorporation of the mid peripheral region of the iris.  It is also farther away from the patient’s native lens, therefore placing the patient at a decreased risk of cataract formation.  If complications occur, such as bullous keratopathy or recurrent iritis, the lens is removable. ³ Although it has been successfully used in patients for moderate to severe myopia, it has been associated with corneal endothelial cell loss in patients.

Studies have shown that the Verisyse lens can lead to a decrease in corneal endothelial cell density following lens implantation.  Corneal decompensation can be attributed to various causes.  Literature suggests that peri-operative trauma may lead to endothelial cell density loss in patients.  The contact between the patient’s corneal endothelium and the Verisyse lens during implantation or an inflammatory reaction secondary to a foreign body in the anterior chamber are also plausible explanations for the corneal endothelial cell loss seen in patients.⁴ A study by Menezo, José L, et al demonstrated a 17.9% decrease in endothelial cell density over the span of five years after implantation.⁵ However, other studies suggest that the endothelial cell loss seen a few years after the procedure is statistically insignificant and eventually stabilizes over time.⁶^,⁷ There is conflicting data and evidence regarding corneal decompensation secondary to the Verisyse lens.  Further research is needed to determine the impact the lens has on the integrity of the patient’s corneal endothelium.

Figure 1: Pictured is the Verisyse lens in the patient’s right eye prior to its removal in 2013.

Figure 2: On slit lamp examination, 2+ corneal edema is noted centrally and inferiorly in the patient’s left eye. The lens is in proper position, enclavated superiorly and inferiorly.

Summary of the Case: A 57-year-old man with a history of bilateral Verisyse lens implantation presented with gradual decreased vision in his left eye.  The patient developed bullous keratopathy secondary to the Verisyse lens implant in his right eye in 2013 and subsequently, underwent removal of the lens and a corneal transplant DSAEK.  Years later, he presented with similar symptoms in his left eye and he was ultimately diagnosed with bullous keratopathy.  The Verisyse lens in his right eye was surgically removed and a cataract extraction, placement of an IOL, and corneal transplant (DSAEK) were also performed.

References:

1. Verisyse™: Ophtec. Ophtec flag. https://usa.ophtec.com/products/verisyset. ​
2. Güell JL, Morral M, Kook D, Kohnen T. Phakic intraocular lenses. Journal of Cataract and Refractive Surgery. 2010;36(11):1976-1993. doi:10.1016/j.jcrs.2010.08.014 ​
3. Lovisolo CF, Reinstein DZ. Phakic Intraocular Lenses. Survey of ophthalmology. 2005;50(6):549-587. doi:10.1016/j.survophthal.2005.08.011
4. Gierek-Ciaciura, Stanislawa, et al. “Correction of High Myopia with Different Phakic Anterior Chamber Intraocular Lenses: ICARE ANGLE-Supported Lens and Verisyse Iris-Claw Lens.” Graefe’s Archive for Clinical and Experimental Ophthalmology, vol. 245, no. 1, 2006, pp. 1–7., https://doi.org/10.1007/s00417-006-0374-7.
5. Menezo, José L, et al. “Iris Claw PHAKIC Intraocular Lens for High Myopia.” Journal of Refractive Surgery, vol. 13, no. 6, 1997, pp. 545–555., https://doi.org/10.3928/1081-597x-19970901-11.

Identifier: Moran_CORE_126023

Copyright statement: Copyright 2022. Please see terms of use page for more information