Dr. Georges D. Baikoff

Georges Baikoff, MD
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My special guest in this column is Georges Baikoff, MD, of France to explain this development.
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Georges Baikoff, MD, can be reached at Centre DOphtalmologie Cinique Monticelli, 88 Rue du Commandant Rolland, 13008 Marseille, France; 33-49-116-2223; fax: 33-49-116-2225; e-mail: g.baik.opht@wanadoo.fr.

My special guest in this column is Georges Baikoff, MD, of France to explain this development.
...
Georges Baikoff, MD, can be reached at Centre DOphtalmologie Cinique Monticelli, 88 Rue du Commandant Rolland, 13008 Marseille, France; 33-49-116-2223; fax: 33-49-116-2225; e-mail: g.baik.opht@wanadoo.fr.

George Baikoff, MD
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George Baikoff

Long-term follow-up with several models of phakic IOLs shows that none of them is completely safe, as far as endothelial cell loss is concerned.

"The decrease can be sudden and dramatic and may occur several years after implantation," George Baikoff, MD, said at the meeting of the French Society of Ophthalmology.

Causes are unknown, but there are reasonable suspicions that they might be related to the lens material rather than to the geometry of the implants.

In a retrospective study, Dr. Baikoff included 1,370 phakic IOLs (500 NuVita from Bausch & Lomb, 150 Vivarte from IOLTech, 120 NewLife from IOLTech and 600 Artisan from Ophtec) implanted over 20 years, from 1987 to 2007.In the past 5 years, 86 of these lenses were explanted.

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More than half of the removals (51%) were due to endothelial cell loss, he said.
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Our retrospective study confirms that both the material and the design of the lens were, in fact, good," Dr. Baikoff said.

Endothelial cell loss was the cause of explantation in 2.6% of the cases.

Dr. Baikoff said this was, "definitely less than with the new generation angle-supported lenses."

The iris-claw Artisan phakic IOLs are known for having a low complication rate.In reality, according to Dr. Baikoff, they also have potential complications and need constant surveillance.

Pigment dispersion, possibly due to a too-high crystalline lens rise, cataract and endothelial cell loss are reported.

"With the Artisan lens, the main cause of endothelial cell loss seems to be the small anterior chamber diameter in myopic patients.Being a one-size-fits-all, this lens can be too large for these eyes," he said.

In his study, the explantation rate with Artisan IOL was 5%, the same as NuVita.Explants due to endothelial cell loss were 1.8% of the total.

"The characteristic pattern of the Artisan lens, both myopic and hyperopic, is a certain amount of endothelial cell decrease due to surgery, a slight recovery around month 5 and then a progressive decrease," Dr. Baikoff said.

The mean interval between implantation and removal was just more than 2 years.

Toric Artisan IOLs were not included in the study because there was no case of explantation in the past 5 years.

"This is probably due to the limited indications of these lenses, which entail a more accurate measurement of anterior segment dimensions," Dr. Baikoff said.

Vivarte and NewLife

The more recently developed angle-supported phakic IOLs, Vivarte and NewLife, underwent an unexpected number of explants in the past 5 years.

"Of 150 Vivarte and 120 NewLife, respectively, 14 (9.33%) and 17 (14.17%) were removed," Dr. Baikoff said.
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This would explain why we didn't have a similar effect with the NuVita IOLs, which had a similar geometry but were made of the old PMMA," Dr. Baikoff said.

He concluded that none of the phakic IOLs that have so far been developed is absolutely safe.

He recommended caution in performing new implantations and the use of optical coherence tomography to have a well-defined picture of all safety distances within the anterior segment of the eye.

All patients should be made aware that close monitoring, once a year or even once every 6 months, is mandatory with all types of phakic IOLs, Dr. Baikoff said.

For more information:

George Baikoff, MD, can be reached at Clinique Monticelli, 88, Rue du Commandant Rolland, 13008 Marseilles, France; e-mail: g.baik.opht@wanadoo.fr.Dr. Baikoff is a paid consultant for Carl Zeiss Meditec.

Georges Baikoff, MD

Georges D. Baikoff, MD, developer of the NuVita lens made by a Bausch & Lomb Surgical satellite company in Lyon, France, is an advocate of anterior chamber phakic implants.He argues that there is not enough room in the posterior chamber for a phakic implant.

He said anterior chamber placement takes advantage of a large space that allows placement in the angle or the iris, with less risk for the crystalline lens or for the uvea than in posterior chamber implantation.

Dr. Baikoff recommends his NuVita lenses for patients with between 8 D and 25 D of myopia.He compared refractive results in patients implanted with a phakic IOL with those who underwent LASIK (see graphs at left).He studied two groups with either phakic IOLs or LASIK for 2 years.His LASIK group had 48 eyes and the phakic anterior chamber IOL group 80 eyes.

In the NuVita group, the uncorrected visual acuity average was 0.64, equal to about 20/32 Snellen visual acuity.The best corrected vision was 0.75 D, equal to about 20/25 Snellen acuity, and 73% of cases gained at least one line of visual acuity, Dr. Baikoff said.

LASIK patients required enhancements in 33% of cases, while phakic IOLs needed a lens exchange about 4% of the time for lens power or size.

The patients who received NuVita lenses generally performed better than LASIK pa tients in the first 6 months, he said.By 6 months, LASIK patients generally received enhancements and their results matched the NuVita lens group.

"The postop best corrected visual acuity is a little better with the NuVita group, but don't forget that this NuVita group is higher myopes," Dr. Baikoff said."The best corrected visual acuity pre operatively is less than the LASIK group, but after surgery, their visual acuity is better."

Dr. Baikoff said that after 2 years' follow-up, he did not find any incidence of cataract, glaucoma, corneal edema or uveal detachment.

"The endothelial study is really good because after 1 week, there is 4% cell loss due to surgery and this cell loss is stable with time," he said."At the present time, we can tell that NuVita is safe to correct high myopia because there is no more endothelial damage observed."

Evolving design

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Georges D. Baikoff, MD, practices at Clinique Monticelli, 88 Rue Du Commandant Rolland, Marseille 13008 France; (33) 4-911-62228; fax: (33) 4-911-62225.Dr. Baikoff has a direct financial interest in the Nuvita lens.He is a paid consultant of Bausch & Lomb.