Potential Harms of Posterior Chamber Phakic IOL: A Systematic Review and Meta-Analysis of Complication Incidence.

Purpose: To compare visual acuity and contrast sensitivity between Posterior Chamber Phakic Intraocular Lens (ICL) and Iris-Claw Anterior Chamber Phakic Intraocular Lens (Artiflex) implantation for moderate to high myopia. Setting: Dr. Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Participants: Sixty eyes of 30 myopic patients were included in the study. Thirty eyes of 15 patients underwent implantation of ICL (24)/ toric ICL (6) and 30 eyes of 15 patients underwent implantation of Artiflex. Methods: Preoperative and postoperative 1, 6 and 12 months, logarithm of the minimum angle of resolution (log MAR) uncorrected visual acuity (UCVA), log MAR best spectacle-corrected visual acuity (BSCVA), manifest refraction, intraocular pressure (IOP), endothelial cell density (ECD) and complications were evaluated. Contrast sensitivity (CS) was also evaluated at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree spatial frequencies by CC-100 Topcon LCD preoperative and postoperative 1-year. Main outcome measures: Improvement in visual acuity (VA) and CS, percentage change in ECD and IOP. Results: Preoperatively, there was no significant difference in the mean UCVA, BSCVA and CS between the ICL and Artiflex groups (p=0.798; 0.672; 0.510) and the mean spherical equivalent (SE) was significantly better in the ICL group than the Artiflex group (p=0.003). One year postoperatively, the mean UCVA and BSCVA were significantly better in the ICL group than the Artiflex group (p=0.002; 0.0001). We found no significant difference in the mean SE between the ICL and Artiflex groups (p=0.809). The mean photopic CS increased considerably at all spatial frequencies compared with preoperative levels in the ICL and Artiflex groups (p=0.0001) Conclusion: After 1-year follow-up, the phakic IOLs performed well in correcting moderate to high myopia. Preoperatively and 1-year postoperatively, there was no significant difference in the mean photopic CS between the ICL and Artiflex group at all spatial frequencies. No vision-threatening complications occurred during the observation period.

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Rhegmatogenous Retinal Detachment in Phakic Eyes After Posterior Chamber Phakic Intraocular Lens Implantation for Severe Myopia

To evaluate contrast sensitivity after posterior chamber phakic intraocular lens (PIOL) implantation for the correction of high myopia. Twenty eyes of ten patients had a posterior chamber phakic intraocular lens (Staar ICL) implanted to correct high myopia. Mean preoperative myopia was -14.10+/-2.70 D. Follow-up was 24 months for all patients. Contrast sensitivity was tested with best spectacle-corrected visual acuity preoperatively and 3, 6, 12, 18, and 24 months postoperatively. Contrast sensitivity increased after surgery in all spatial frequencies. Normal values were achieved for low and intermediate spatial frequencies (3 and 6 c/deg). However, in spite of the improvement, values were still below normal for high spatial frequencies (12 and 18 c/deg). When the first postoperative examination was not considered, there were no statistically significant differences in contrast sensitivity values at different postoperative periods. Contrast sensitivity increased after posterior chamber phakic intraocular lens implantation (Staar ICL) in all spatial frequencies when compared to preoperative contrast sensitivity (best spectacle-corrected).

Objective To investigate long-term efficacy and safety ofa posterior chamber phakic intraocular lens (PCPIOL) implantation for high myopia. Methods A consecutive group of 66 eyes in 41 patients with -15.12± 3.93 diopters (D) of myopia was implanted with the ICL PCPIOL (STAAR), and was examined preoperatively and 1, 2, 3 years postoperatively. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, intraocular pressure, and complications were evaluated. Results The implantation was successful in all of 66 eyes. Compared with preoperative data, UCVA, BCVA, and spherical equivalent (SE) were improved significantly. At 3-year postoperatively, UCVA in 86% eyes was 0.5 or better, in 43% was 0.8 or better; No loss of BCVA was found, 11% gained 1 line, and 68% gained 2 lines or more; SE in 96%, 57% eyes was within ± 1.00 D, ± 0.50D of attempted, respectively. At 1-, 2-, 3-year follow-up, the corneal endothelial loss was 9.26%, 12.84%, 18.54%, respectively. No severe complications occurred expect 1macular hemorrhage due to CNV. Conclusions At 3-year follow-up, the implantation of the PCPIOL proved to be safe and effective for the correction of myopia in phakic eyes. Key words: Lens; Intraocular; Ophthalmologic surgical procedures; Myopia

Purpose: To evaluate the effects of angle-supported, iris-fixated and posterior chamber phakic intraocular lens (PIOL) implantation on contrast sensitivity (CS). Methods: This prospective study included 69 eyes of 41 consecutive cases of high myopia which received an angle-supported (Phakic-6H; 26 eyes), iris-fixated (Verisyse; 23 eyes) or posterior chamber PIOL [phakic refractive lens (PRL); 20 eyes]. Photopic, mesopic and mesopic with glare CS were evaluated preoperatively and at least 6 months postoperatively. Results: In the PRL group, the mean postoperative CS at all frequencies and across all lighting conditions increased. These changes were significant for 6, 12 and 18 cycles per degree (cpd) under both photopic and mesopic conditions (p < 0.01) and for all the tested frequencies under mesopic with glare condition (p < or = 0.01). The average CS was relatively low in the PRL group. These changes were significant for 6 and 12 cpd between the Verisyse and PRL group under photopic condition (p < 0.05), for 3 and 6 cpd under mesopic condition (p < 0.01, p = 0.01) and under mesopic with glare condition (p < 0.01, p < 0.05). Conclusions: Improvements in postoperative CS confirm that PIOL implantation is a promising alternative for correction of high myopia. In comparison to posterior chamber PIOLs, angle-supported and iris-fixated PIOLs seem to produce a better visual quality in terms of CS, which needs to be warranted by further investigations.

Aim: to evaluate the efficacy and safety of posterior chamber phakic intraocular lens (pIOL) implantation for the high myopia correction. Patients and Methods: 37 patients (55 eyes) aged 20 to 43 years were included in the study. All patients underwent the following ophthalmic examinations before surgery: visometry, autorefractometry, biometry, tonometry, optical coherence tomography, evaluation of corneal endothelial cell density, peripheral retinal exam using a Goldmann lens. pIOL power calculation was conducted using a modified vergence formula. All surgeries were performed by one surgeon according to the standard procedure. Patients were examined after surgery after 1 day, 1 month, 3 months, then every 6 months for 3 years. Visometry was performed 1 day and 1 month after the surgery. During subsequent visits, all of the listed examinations were performed, except for peripheral retinal exam using a Goldmann lens. Results: all patients completed the study. There were no intraoperative complications. No cases of cataracts or other postoperative complications were observed during 3-year follow-up. Uncorrected visual acuity 3 years after surgery was 18.4% higher than the maximum corrected visual acuity before surgery, and target refraction was observed in 86% of the eyes. Intraocular pressure during 3-year follow-up was within the normal range and averaged 17.04 mmHg. Fluctuations in the lens vault from the pIOL posterior surface to the anterior surface of the lens (VAULT) were within the normal range. Corneal endothelial cell density decreased by an average of 0.09% 3 years after surger During 3-year follow-up, there were no clinically significant changes in the anterior chamber depth of the eye. The average change in the axis orientation was also &lt;6° for all visit intervals. At the same time, the patients did not notice a change in the pIOL orientation up to 10°. Conclusion: pIOL implantation is a safe and effective method for high myopia surgical correction. Keywords: myopia, myopia correction, implantation, phakic intraocular lens, VAULT, endothelial cell density, anterior chamber of the eye. For citation: Saliev I.F., Yusupov A.F., Mukhamedova N.I. Three-year experience of posterior chamber phakic intraocular lens implantation in the high myopia correction. Russian Journal of Clinical Ophthalmology. 2022;22(3):156–160 (in Russ.). DOI: 10.32364/2311-7729- 2022-22-3-156-160.

Lens opacities after posterior chamber phakic intraocular lens implantation

Posterior chamber phakic intraocular lens implantation is a type of intraocular surgery. With advancements in implant materials and design, this procedure has seen rapid adoption and widespread use in ophthalmology clinics in recent years. However, the changes in surgical techniques and the occurrence of postoperative complications have raised safety concerns that require significant attention in clinical practice. This paper aims to address the key factors influencing the safety of posterior chamber phakic intraocular lens implantation, exploring relevant characteristics, mechanisms, and current challenges. By emphasizing the importance of this surgery and proposing effective measures, it aims to provide guidance for clinical practice, enhance the safety of posterior chamber phakic intraocular lens implantation, and foster the healthy advancement of this surgical technique.

To evaluate the efficacy, safety and stability of posterior chamber phakic intraocular lens implantation for the correction of extreme myopia. This study included 216 eyes of 113 patients with a mean age of 30 years (18 approximately 49) from January 1997 to December 2005. An implantable contact lens (ICL V2 and V4, Staar Surgical Inc.) was inserted. Patients were examined preoperatively and followed at 1 day, 1 week, 1, 3, 6, 12, 24, and 36 months postoperatively. The examination content included the uncorrected visual acuity, best corrected visual acuity (BCVA), slitlamp examination, refraction, intraocular pressure, endothelial cell morphometry, etc. Spherical equivalent was (17.78 +/- 3.88) diopters before the operation. Surgical implantation was performed through a 3.2 mm clear corneal sutureless incision using paraocular anesthesia. The mean follow-up period was 18.2 months (ranged 6 to 24 months) for refractive data and 24.3 months (ranged 6 to 36 months) for the complications. Successful implantation was achieved in all patients. Postoperatively, all eyes had a significant increase in uncorrected visual acuity. The mean spherical equivalent refraction at the last examination was (-1.00 +/- 1.40), within +/- 1.00 D of the targeted refraction in 191 eyes (88.4%) and within +/- 0.50 D in 165 eyes (76.4%). In eyes in which the preoperative myopia was less than 20.00 D (n = 151), the achieved refraction was within +/- 1.00 D of the intended refraction in 145 eyes (96.0%) and within +/- 0.50 D in 128 eyes (84.8%). The refraction remained stable with a statistically insignificant change (P > 0.05) at each interval during the follow-up. The best corrected visual acuity (BCVA) improved by 1 or more lines in 168 eyes (77.8%) at 1 year after the operation. Four eyes (1.85%) lost 1 line of BCVA. Pupillary block glaucoma requiring surgical intervention occurred in 4 eyes (1.85%). Three eyes (1.39%) developed cataract 1 year after ICL (V2) implantation, all ICLs in these eyes were removed, and the refractive errors were corrected by lensectomy and implantation of low-power posterior chamber IOLs. BCVA was mentioned in all of these eyes. Posterior chamber phakic intraocular lens implantation appears to be an effective, safe and reliable method for the correction of extreme myopia.

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

Cataract formation after silicone PCL implantation

BackgroundPosterior chamber phakic intraocular lens are widely recognized as an effective treatment for refractive errors, yet they are not without risks. One notable complication that can emerge years after reverse implantation is cataract formation. In these intricate scenarios, femtosecond laser-assisted cataract surgery presents itself as a remarkably precise and safer approach for the extraction of cataracts, especially when the ICL is in a reverse position.Case presentationThis report details the extraordinary case of a 33-year-old woman who, ten years after undergoing posterior chamber phakic intraocular lens implantation, experienced a decline in visual acuity in her left eye. She chose to undergo femtosecond laser-assisted cataract surgery in conjunction with posterior chamber phakic intraocular lens removal to address an anterior subcapsular cataract. The procedure encountered unique challenges, including biometric inaccuracies caused by the pre-existing posterior chamber phakic intraocular lens and difficulties in laser targeting. Manual adjustments were necessitated during the laser application. A trifocal intraocular lens was successfully inserted. At her three-month follow-up, the patient exhibited a remarkable improvement, achieving an uncorrected visual acuity of 20/20 in the treated eye. She expressed high satisfaction with the outcome, acknowledging only minor occurrences of halo effects.ConclusionsThis report confirms the feasibility of FLACS in treating cataracts in patients with reversely implanted posterior chamber phakic intraocular lens. Compared to typical cataract cases, the surgical procedure did not present significant additional challenges. However, meticulous preoperative measurements, laser scanning, and intraoperative alignment remain essential. With thorough preoperative preparation and precise posterior intraocular lens power calculation, the surgical outcomes can fully meet.

"Retinal detachment associated with posterior chamber phakic intraocular lens implantation." Clinical and Experimental Optometry, 97(5), pp. 471–472

To examine the efficacy, predictability, stability, and safety of posterior chamber phakic intraocular lens (IOL) implantation in patients with extreme myopia. We analyzed the results of 124 eyes that received a posterior chamber hydrogel collagen plate phakic IOL (Staar Collamer Implantable Contact Lens, ICL) for the correction of their myopia. The target postoperative spherical equivalent refraction was emmetropia. Mean follow-up was 11 months (range 1 to 36 mo). The mean preoperative spherical equivalent refraction was -13.38 +/- 2.23 D (range, -8.50 to -18.63 D). Mean postoperative spherical equivalent refraction at last examination was -0.78 +/- 0.87 D (range, +1.63 to -3.50 D), with 69% (86 eyes) within +/-1.00 D and 44% (55 eyes) within +/-0.50 D of emmetropia. The refraction remained stable with a statistically insignificant change (p > 0.05 at each interval) during follow-up. A gain of two or more lines of spectacle-corrected visual acuity was seen in 36% (45 eyes) at last examination. One eye (0.8%) lost two or more lines of spectacle-corrected visual acuity from a retinal detachment. Posterior chamber phakic IOL implantation with the Staar Collamer plate lens is an effective and safe method for reducing or correcting myopia between -8 and -19 D. Gains in spectacle-corrected visual acuity were common, and results suggested good refractive stability. Improvements in phakic IOL power calculation formulas are needed to improve the predictability of refractive outcome.