Iris-fixated Intraocular Lens Implantation Research Articles

Dynamic Stimulation Aberrometry: Objectively Measured Accommodation and Pupil Dynamics after Phakic Iris-Fixated Intraocular Lens Implantation

Anterior iris-claw phakic intraocular lens (pIOL) implantation is a treatment option for refractive, ametropic patients. However, the postoperative accommodative ability has not been systematically researched. Dynamic stimulation aberrometry allows the objective and dynamical measurement of accommodation by observing ocular aberrations during the accommodation process. We investigated the dynamic accommodative ability after pIOL implantation compared with a healthy age- and gender-matched control group. Clinical, comparative case-control study. We included patients aged 18-50 years that either underwent pIOL implantation > 1 month ago or served as a healthy, phakic control group. The accommodative ability and pupil dynamics of both groups were investigated using dynamic stimulation aberrometry. The method allows the analysis of dynamic parameters during accommodation, such as the accommodation speed. A 1:1 propensity score matching was conducted based on the patients' age and gender. Parameters of objective accommodation, such as accommodative amplitude and pupil dynamic during accommodation. Fifty-eight healthy, phakic eyes < 50 years of age and 21 eyes after pIOL implantation to correct myopia (pIOL, Verisyse, AMO, Inc) were enrolled. Patients that underwent anterior pIOL implantation were examined on average 24 ± 18 months after surgery. After matching, the mean age of both groups was not significantly different (35 ± 8 vs. 34 ± 8 years). No significant difference in dynamic parameters of accommodation or the accommodative amplitude (2.8 ± 1.4 and 2.9 ± 1.4 diopters [D] for pIOL and control group, P= 0.82) were seen. Maximum and minimum pupil sizes were not significantly different. The change in pupil size during deaccommodation was significantly faster in patients after pIOL implantation (P < 0.001). Dynamic stimulation aberrometry allowed the objective, dynamic, measurement of wavefronts in subjects with accommodative amplitudes up to 7 D. Phakic intraocular lens implantation does not impair the accommodative ability. It alters pupil dynamics during deaccommodation. Proprietary or commercial disclosure may be found after the references.

Scleral-fixated and iris-fixated intraocular lens implantation or fixation:meta-analysis.

Scleral fixation and iris fixation are common intraocular lens (IOL) implantation techniques performed because of zonulopathy. There is a lack of consensus regarding their comparative efficacy and safety. This study aims to compare the efficacy and safety outcomes after scleral-fixated (SF) vs iris-fixated (IF) IOL implantation or fixation in adults. A systematic literature search was conducted on Ovid MEDLINE, Embase, and Cochrane CENTRAL from 2005 to 2020. 785 eyes from 2 randomized controlled trials and 9 nonrandomized studies were included. There was no significant difference in the mean corrected distance visual acuity at the final follow-up ( P = .52) or absolute change in spherical equivalent ( P = .88) between SF IOL and IF IOL implantation. The incidence of vitreous hemorrhage was significantly higher in the SF IOL group (risk ratio = 3.66, 95% CI, 1.16-11.55, P = .03). There were no differences in visual acuity and refractive outcomes between SF IOL and IF IOL implantation or fixation. Trade-offs in complications exist between the 2 techniques.

Comparison between Refractive Outcome of Primary Piggyback Intraocular Lens versus Secondary Lens Iris Claw Lens in Posterior Microphthalmos.

Purpose To compare the refractive outcome of 2 different methods of intraocular lens implantation in cases of posterior microphthalmos, primary piggyback IOLs versus secondary iris claw lenses. Methods This study was a retrospective interventional comparative study that included 60 eyes of 30 patients. The included patients had bilateral microphthalmos with high axial hyperopia and had undergone a lens-based surgical procedure for hyperopia correction. The included patients were equally divided into two groups. The first group had undergone refractive lens exchange (RLE) with primary piggyback IOL implantation. The second group undergone RLE with maximum available IOL power implanted followed by a secondary implantation of Artisan iris-fixated IOL (Ophtec B.V., Groningen, the Netherlands). Results The 2 groups were highly comparable to each other regarding the mean age, axial length (AL), manifest refraction (MR), and K readings. Postoperatively, there was a statistically significant difference between the 2 groups regarding the manifest refraction spherical equivalent (MRSE), mean absolute error (MAE), and uncorrected distance visual acuity (UDVA). There was no significant difference between the 2 groups regarding the CDVA. At 36 months, 20% and 73% of the eyes were within ±0.5 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively. Fifty-three percent and 93% of the eyes were within ±1.0 D of intended refraction at 36 months in 1ry piggyback and 2ry Artisan groups, respectively (p=0.001). Conclusion Secondary procedure with implantation of iris-fixated intraocular lens yielded very good results for treatment of axial hyperopia in cases of posterior microphthalmos. The primary piggyback IOL showed less satisfactory results with cases of under correction and the possible complication of interlenticular opacification. Both groups showed good safety parameters.

Safety and efficacy of posterior iris claw intraocular lens fixation in aphakic patients

Purpose: To assess the indications and visual outcome of eyes undergoing posterior iris fixated intraocular lens (IFIOL) implantation for aphakia, to identify reasons for poor visual outcome, and report occurrence of complications.&#x0D; Methods: In this retrospective case series study, all cases of posterior IFIOL fixation performed over a 30-month period were identified retrospectively. Preoperative and postoperative evaluations comprised objective and subjective refraction, best corrected visual acuity (BCVA), slit lamp biomicroscopy, applanation tonometry, and dilated fundus examination.&#x0D; Results: Fifty-six eyes of 56 patients were analyzed. Mean age was 60.55 ± 17.2 years. The most common indication for IFIOL implantation was surgical aphakia following complicated cataract surgery (n = 33; 58.9%) followed by trauma (n = 10; 17.9%), dropped nucleus/IOL during primary surgery (n = 6; 10.7%), and subluxated/dislocated lens-induced glaucomas (n = 5; 8.9%). BCVA better than or equal to their preoperative BCVA was achieved in 96.43% patients. The surgical aphakia and paediatric/adolescent groups had the best visual results while the dropped nucleus/IOL group and subluxated lens-induced glaucoma groups fared poorly. On the long-term follow-up visit, the most common complication noted was pigment dusting on the corneal endothelium (65.7%).&#x0D; Conclusion: The long-term results suggest that posterior IFIOL implantation is a safe and effective method for correction of aphakia and can be used for a wide range of indications in eyes without adequate capsule support. It may be considered an easier and faster alternative with minimal manipulation to anterior segment structures in paediatric and post-traumatic aphakic eyes.

Artisan iris-fixated intraocular lens implantation in combination with pupilloplasty—correction of aphakia with pathologically large pupil and insufficient capsular support

ObjectiveThe aim of this study was to report the efficacy and safety of applying pupilloplasty in combination with Artisan iris-fixated intraocular lens (IOL) implantation in the treatment for aphakia with pathologically large pupil and insufficient capsular support. DesignThe study was a retrospective case series. ParticipantsTwenty-six aphakic eyes with pathologically large pupil and insufficient capsular support (from 26 patients) were included in the study. MethodsThe study patients underwent pupilloplasty in combination with Artisan iris-fixated IOL implantation. Follow-up appointments were scheduled at 1 week and at 1, 3, and 6 months postoperatively. ResultsThe mean uncorrected visual acuity was significantly improved from logMAR 1.15 ± 0.29 to logMAR 0.37 ± 0.17, and the mean manifest refraction spherical equivalent was significantly decreased from 12.07 ± 2.20 D to –0.69 ± 0.70 D at 6 month after surgery (p < 0.05). The pupil diameter decreased significantly, from 5.7 ± 1.1 mm preoperatively to 4.5 ± 0.8 mm at 6 months after pupilloplasty (p < 0.05). Patients experienced less photophobia postoperatively. The safety parameters, including endothelial cell count, intraocular pressure, corneal astigmatism, best-corrected visual acuity, and central corneal thickness, showed no significant differences in values before and after surgery. ConclusionsThe Artisan iris-fixated IOL implantation in combination with pupilloplasty can be used as an alternative way to correct aphakia with pathologically large pupil and insufficient capsular support.

The clinical efficacy of secondary implantation of iris-fixated intraocular lens for traumatic aphakia

Objective To evaluate the clinical efficacy of secondary implantation of iris-fixated intraocular lens for traumatic aphakia. Methods Postoperative outcomes of secondary implantation of iris-supported Artisan IOL in 18 unilateral aphakic patients with penetrating eye injuries or contusion were analysed retrospectively. The uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), spherical equivalents (SE), and endothelial cell density (ECD) were compared before and after the surgery. Results Mean postoperative follow-up time was (11.42±4.51) months. The UCVA was improved in all patients. The mean endothelial cell loss rate was 3.7% in the first 3 postoperative months. 18 eyes achieved the desired anatomic results. No intraoperative complication occurred. Transient high intraocular pressure occurred in 3 cases, 2 cases with iris depigmentation. And no retinal or choroidal detachment, macular edema, hyphema or vitreous haemorrhage was observed. Conclusion Secondary implantation of iris-fixated IOL is an effective and safe procedure for traumatic aphakia, which has good visual rehabilitation and low occurrence of complication. Key words: Aphakia, traumatic; IOL, iris-fixated; Implantation, secondary

Intraocular Lens Implantation Procedures in Aphakic Eyes With Insufficient Capsular Support Associated With Previous Cataract Surgery

The aim was to evaluate the results of three different secondary intraocular lens implantation (IOL) procedures in aphakic eyes without capsular support In this retrospective comparative case series, 90 eyes of 90 patients who underwent secondary IOL implantation for correction of aphakia were enrolled. Patients were divided into three groups based on the secondary IOL implantation procedure: anterior chamber iris-fixated IOL (AC-IFIOL), retropupillary iris-fixated IOL (RP-IFIOL), and scleral-fixated posterior chamber IOL (SF-PCIOL). The efficacy and safety of each procedure were assessed at follow-up. All eyes had aphakia caused by a previous cataract surgery. A final corrected distance visual acuity of 20/40 or better was achieved in 22 eyes (62.9%) implanted with an AC-IFIOL, in 12 eyes (50%) with an RP-IFIOL, and 18 eyes (58.1%) with an SF-PCIOL. At final visit, mean postoperative endothelial cell loss was 175 cells/mm(2) (7.2%) in the AC-IFIOL group, 255 cells/mm(2) (11.4%) in the RP-IFIOL group, and 135 cells/mm(2) (5.9%) in the AC-IFIOL group (P > 0.05). The study showed that AC-IFIOL, RP-IFIOL, and SF-PCIOL implantation had similar visual outcomes and mean corneal endothelial cell loss.

Visual Outcome and Changes in Corneal Endothelial Cell Density Following Aphakic Iris-Fixated Intraocular Lens Implantation in Pediatric Eyes With Subluxated Lenses

To evaluate the visual outcome and corneal endothelial cell density after Artisan aphakic intraocular lens (IOL) implantation (Ophtec, Groningen, the Netherlands) in pediatric eyes with subluxated lenses. Artisan aphakic IOLs were implanted in 18 eyes of 11 children with subluxated lenses. Idiopathic subluxations and ectopia lentis due to Marfan syndrome were included, whereas subluxations due to trauma or buphthalmos were excluded. Best-corrected visual acuity (BCVA) and endothelial cell density were monitored. Mean postoperative BCVA and endothelial cell density at last follow-up visit were calculated. The age of children at the time of Artisan aphakic IOL implantation ranged from 8 to 16 years (mean: 11.58 ± 2.9 years). Mean follow-up was 9.12 ± 4.30 months. Mean postoperative logarithm of the minimum angle of resolution BCVA was 0.26 ± 0.13 (P = .001) and mean postoperative endothelial cell density was 2,860 ± 435 cells/mm(2) (P = .000). Mean endothelial cell loss was 17.1%. Artisan aphakic IOL implantation is a safe surgical choice in the management of ectopia lentis in the pediatric age group. It has minimal complications and is less traumatic to pediatric eyes. However, long-term follow-up of these children is required.[J Pediatr Ophthalmol Strabismus 2013;50(3):178-182.].

Three-year follow-up of secondary anterior iris fixation of an aphakic intraocular lens to correct aphakia

To evaluate the efficacy, predictability, stability, safety, and complications of secondary anterior iris fixation of the Artisan iris-fixated intraocular lens (IOL) to correct aphakia in eyes without sufficient capsule support. Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China. Cohort study. Eyes having implantation of aphakic iris-fixated IOLs for aphakia correction were followed for 3 years. The study evaluated 72 eyes (72 patients). After 3 years, the uncorrected distance visual acuity improved in all eyes (P<.05); 53 eyes (73.6%) reached 20/40 or better. Two eyes had a postoperative corrected distance visual acuity (CDVA) worse than the preoperative CDVA due to postoperative ischemic optic neuropathy and retinal detachment, respectively. The mean spherical equivalent (SE) decreased from 11.65 diopters (D) ± 1.21 (SD) to -0.58 ± 0.56 D (P<.05); the SE at the last follow-up was within ±1.00 D of the target refraction in 63 eyes (87.5%). The mean endothelial cell loss 3 years postoperatively was 9.78%. There was no significant postoperative intraocular pressure increase throughout the follow-up. Twelve patients (16.7%) reported glare and halos during night driving. Iris pigment precipitates on the IOLs occurred in 4 eyes (5.6%) 3 years postoperatively. No other serious complications occurred. Three-year results indicate that secondary implantation of aphakic IOLs is effective, predictable, and safe for the correction of aphakia in eyes without capsule support. However, longer follow-up with a larger cohort is necessary to confirm these conclusions.

Iris-fixated intraocular lens implantation to correct moderate to high myopia in Asian-Indian eyes: Five-year results

To evaluate the efficacy, safety, predictability, and stability of iris-fixated phakic intraocular lenses (pIOLs) to correct high myopia in an Asian-Indian population. Tertiary eyecare center. Interventional case series. Eyes with myopia from -5.5 to -24.0 diopters (D) had pIOL implantation and were examined postoperatively at 1 day, 1 week, 1, 3, and 6 months, and yearly for 5 years. Parameters evaluated were postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability, efficacy, stability of mean spherical equivalent (SE), and endothelial cell loss. The study enrolled 85 eyes (44 patients). The mean CDVA improved from 6/10 preoperatively to 6/7 postoperatively and the mean UDVA, from 6/319 to 6/9. Postoperatively, the mean SE was -0.63 ± 0.55 D. Of the 51 eyes completing a 4-year follow-up; 19 (37.3%) had a mean SE of 0.50 D or less and 37 (72.5%) had a mean SE of 1.00 D or less. The CDVA improved 1 line or more in 35 eyes (68.6%); 14 eyes (27.5%) had postoperative CDVA similar to the preoperative CDVA. At 4years, the safety index was 1.46 and the efficacy index, 0.96. Thirty-six eyes (70.6%) had a postoperative UDVA better than the preoperative CDVA. The mean endothelial cell loss at 1, 3, 6, 12, 24, 36, and 48 months was 4.3%, 5.7%, 7.1%, 7.6%, 8.7%, 9.2%, 11.07%, and 12.4% respectively. Twenty eyes (23.5%) had reenclavation for spontaneous or traumatic disenclavation. Postsurgical refractive outcomes of iris-fixated pIOL implantation for myopia were fairly predictable and stable in an Asian-Indian population. No author has a financial or proprietary interest in any material or method mentioned.

Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients' satisfaction after implantation. Prospective, nonrandomized, and comparative (self-controlled) trial. A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively. At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation. At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.

Simultaneous Descemet Stripping Automated Endothelial Keratoplasty and Aphakic Iris-Fixated Intraocular Lens Implantation: A Case Series

To report 3 cases of simultaneous Descemet stripping automated endothelial keratoplasty (DSAEK) and aphakic iris-fixated intraocular lens (IOL) implantation in patients with aphakia and bullous keratopathy. We retrospectively documented the clinical characteristics of patients before and after simultaneous DSAEK and aphakic iris-fixated IOL implantation undergoing operation between November 2008 and September 2009. None of the cases showed any intraoperative complications. During the postoperative period, the corneal lenticule was clear and well-attached, and the iris-fixated IOL was well-positioned. Simultaneous DSAEK and aphakic iris-fixated IOL implantation can be used successfully and simultaneously in patients with aphakia and bullous keratopathy.

Correction of extreme hyperopia: artisan iris-fixated intraocular lens implantation for pseudophakia after clear lens extraction.

A 22-year-old patient suffering from both-side extreme hyperopia with amblyopia was corrected with an Artisan iris-fixated intraocular lens (IOL) implantation followed to clear lens extraction (CLE) with posterior chamber (PC)-IOL implantation. The preoperative refraction values were +17.75DS -1.50DC × 168° for the right eye and +17.25DS -0.75DC × 8° for the left eye. The uncorrected visual acuity (UCVA) was 20/200 bilaterally and the spectacle-corrected visual acuity (BSCVA) was 20/50 bilaterally. One year after Artisan iris-fixated IOL implantation, bilateral BSCVA was 20/50 with a refraction of +1.25DS -0.75DC × 13° for the right eye and +1.50DS -1.00DC × 55° for the left eye. The outcomes of an Artisan iris-fixated IOL implantation followed to CLE with PC-IOL implantation were encouraging for the correction of extreme hyperopia. Long term follow-up examinations were necessary for further determination of the efficacy and safety of this combinational procedure.

Long-term follow-up of the corneal endothelium after aphakic iris-fixated IOL implantation for bilateral cataract in children

To evaluate the long-term corneal endothelial cell density (ECD) and outcomes after iris-fixated aphakic intraocular lens (IOL) implantation in children after bilateral congenital or juvenile cataract extraction and to compare the outcomes with data in the literature. Academic Medical Centre, Amsterdam, The Netherlands. Case series. This retrospective study evaluated the charts and endothelial photographs of children who had Artisan aphakic IOL implantation. The main outcome measure was the ECD at the last follow-up visit. The mean age of the 10 patients (20 eyes) at IOL implantation was 7.4 years (range 4.3 to 11.1 years) and at the last follow-up, 19.6 years (range 14.3 to 26.6 years). After a mean follow-up of 12.3 years (range 10.0 to 15.6 years), the mean ECD was 2702 cells/mm(2) (range 1382 to 3974 cells/mm(2)). Although this is comparable to the mean normal endothelial cell counts in this age group reported in the literature, a wider range of ECD was found in the current study. The mean corneal ECD after more then 10 years of follow-up was comparable to the mean normal ECD for this age group reported in the literature. The high standard deviation of the mean ECD in the current study highlights the importance of prospective studies on the ECD after iris-fixated aphakic IOL implantation in young patients.

Long-Term Follow-Up of the Corneal Endothelium After Artisan Lens Implantation for Unilateral Traumatic and Unilateral Congenital Cataract in Children

To retrospectively estimate the long-term corneal endothelial cell loss in children after perforating corneal trauma and implantation of an iris-fixated anterior-chamber intraocular lens (IOL), either the Artisan aphakia lens or the Artificial Iris Implant, and to compare this corneal endothelial cell loss to that in children who received an Artisan aphakia lens to correct aphakia after cataract extraction for unilateral congenital cataract. A retrospective study was performed, evaluating the charts and endothelial photographs of 6 patients with unilateral traumatic cataract, with a mean age at IOL implantation of 9.5 years (range: 5.8-12.8 years) and a mean follow-up after IOL implantation of 10.5 years (range: 8.0-14.7 years), and of 3 children who were operated on for unilateral congenital cataract at a mean age of 2.7 years and who received an Artisan aphakia IOL, with a mean follow-up after IOL implantation of 9.5 years (range: 4.7-14.5 years). Parameters that were studied were central endothelial cell density (CECD) in both the operated and the normal eye at the last follow-up visit, percentage of cell loss in the operated eye compared with the normal eye, and length and location of the corneal scar in the injured eye. : In the traumatic cataract group, CECD was, on average, 41% (range: 22%-58%) lower in the operated eye (1.647 +/- 322 [SD] cells/mm) than the normal eye (2.799 +/- 133 cells/mm). A significant negative linear correlation was found between the length of the corneal perforation scar and CECD. In the congenital cataract group, no statistical difference in CECD was found between the operated (3.323 +/- 410 cells/mm) and the unoperated (3.165 +/- 205 cells/mm) eye. Endothelial cell loss 10.5 years after iris-fixated IOL implantation for traumatic cataract was substantial and related to the length of the corneal scar of the original trauma. In children operated on for congenital cataract, no difference was found in CECD in the operated and unoperated eyes 9.5 years after Artisan aphakia IOL implantation.

Cocooning of an iris-fixated intraocular lens in a 3-year-old child after perforating injury: Clinicopathologic correlation

We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.

Untersuchungen der vorderen Augenkammer mittels optischer Kohärenz-Tomographie (OCT)

Optical coherence tomography (OCT) represents a high-resolution diagnostic method which can be used to precisely image the anterior eye segment. Further developments in scanning technology and data evaluation allowed to visualize the entire anterior eye segment in one image, and the purpose of this study was to clinically evaluate this new system. The studied OCT system was adapted to a slit-lamp and allowed us to image the anterior segment with an axial resolution of 10 microm at a scanning rate of 200 Hz with a depth of 7 mm and a maximal width of 15 mm. In selected cases the clinical value of anterior segment OCT was assessed. The reproducibility and level of agreement of anterior chamber depth measurements were assessed during the preoperative examination in 49 cataract surgery patients and compared to ultrasound (US) biometry (10 MHz). The studied anterior segment OCT allowed the cross-sectional imaging of the entire anterior eye segment. Changes of the anterior chamber before and after cataract surgery or surgical iridectomy were visualised. Furthermore, the findings of the anterior chamber after implantation of an iris-fixated intraocular lens (IOL) and an iris prosthetic system could be assessed. The reproducibility of the anterior chamber depth measurement was +/- 22 microm (OCT) and +/- 76 microm (US). The mean difference between optical and acoustic values was 1 microm (0.03 % p = 0.921) and the limits of agreement (95 % confidence interval) were 260 microm (8.58 %). The anterior segment OCT proved to be a helpful diagnostic method. The cross-sectional visualisation of the entire anterior chamber allowed us to assess important values for the implantation of iris-fixated IOL and other changes after surgical procedures. The resolution and reproducibility were higher than for conventional ultrasound biometry.

Phakic intraocular lenses and refractory lensectomy for myopia.

Phakic intraocular lens implantation (IOLs) and clear lens extraction for high to extreme myopia have grown in popularity recently as a consequence of potentially unsatisfactory results with corneal refractive surgery in higher ranges of refractive errors. The refractive outcome of these alternative modalities has been encouraging to date, yet the potential for significant complications exists. Current evidence shows that the risk of retinal detachment after clear lens extraction for myopes is high. Trials with angle-supported phakic IOLs revealed unacceptable rates of pupillary ovalization, IOL rotation, and endothelial cell loss. Iris-fixated and posterior chamber phakic IOLs have proven sufficient safety, but long-term follow-ups of current cohorts are still to be awaited. The implantation of either of the latter two phakic IOLs followed by laser in situ keratomileusis or photorefractive keratectomy (bioptics) provides another option in refractive surgery for high ametropia.