Posterior Chamber pIOL Research Articles

Bibliometric and visualized analysis of posterior chamber phakic intraocular lens research between 2003 and 2023.

Myopia is causing a major public health concern, with its prevalence increasing globally. This study aimed to discuss posterior chamber phakic intraocular lens (pIOL) research publication trends and hotspots over the past 20 years. Bibliometric analysis was performed using the Web Science Core Collection to investigate posterior-chamber pIOL research publication trends. The extracted records were analyzed, and a knowledge map was built using VOSviewer v.1.6.20. The analysis included visualizing the annual publication count, countries/regions distribution, international and institutional collaborations, author productivity, and journal contribution, in addition to identifying knowledge bases and hotspots. Burst keywords were extracted using CiteSpace v.6.1.R. In total, 791 articles on posterior chamber pIOLs published between 2003 and 2023 were retrieved. China had the highest number of publications, whereas Japanese papers received the most citations. Fudan University had the highest number of publications, with articles from Kitasato University having the highest number of citations. Regarding individual research, Xingtao Zhou has published the most significant number of articles, and Shimizu Kimiya had the highest number of citations. The top productive/influential journal was 'Journal of Cataract & Refractive Surgery'. The top cited references primarily focused on reporting the clinical outcomes of implantable collamer lens (ICL) for individuals with moderate to high myopia. The keywords primarily formed four clusters: posterior chamber pIOL clinical outcomes for myopic astigmatism correction, posterior chamber pIOL implantation complications, ICL size selection and postoperative vault predictions, and postoperative visual quality following posterior chamber pIOL implantation. This study presents the first bibliometric analysis of research trends in posterior chamber pIOL over the past two decades. We investigated the current state and emerging trends of global collaboration and research focal points in this field, offering fresh insights and guidance for researchers.

Retinal complications post posterior chamber phakic intraocular lens implantation at a tertiary eye hospital in the Eastern Province of Saudi Arabia.

Phakic intraocular lenses treat higher degrees of myopia not possible previously with conventional refractive surgery. The aim of this study is to report the incidence and risk factors of retinal complications after posterior chamber PIOL implantation and assess the differences in biometric parameters between patients who developed such complications versus those who did not. This retrospective study recruited 514 patients who underwent ICL implantation to correct myopia at a tertiary eye hospital center in the Eastern province of Saudi Arabia. Follow up period was at least one year. Medical records of the patients were reviewed to obtain the required data. Associations between respondents' characteristics and retinal complications were evaluated using the Chi-squared test. The mean (SD) age was 27.7 (± 6.5) years ranging from 18 to 47. Laser treatment was performed in 14 cases (2.7%). Retinal complications occurred in six cases (1.2%). The risk of retinal complication was significantly higher among patients with high axial length (OR = 1.3, 95% CI 1.2, 1.4) and patients with high pre-spherical equivalent before ICL (OR = 1.09, 95% CI 1.03, 1.4). Patients with higher axial length and higher pre-spherical equivalent before ICL implantation are at high risk of retinal complications.

Seven-Year clinical outcomes after implantation of Eyecryl posterior chamber phakic intraocular lenses for high myopia.

To evaluate the long-term clinical outcomes, safety and efficacy of Eyecryl posterior-chamber phakic intraocular lens implantation (pIOL) implantation in patients with high myopia. Patients with myopia between -6.00 and -20.00 dioptres and with endothelial cell density (ECD) was ≥2300 cells/mm2 were included. Preoperative and postoperative first, fourth, and seventh years of refraction, uncorrected/corrected distance visual acuity (UDVA/CDVA), ECD, central vault were detected. Thirty-six eyes were analyzed. The mean UDVA and CDVA in postoperative seventh years were 0.25 ± 0.31 and 0.13 ± 0.24 logMAR, respectively. The safety and efficacy indices were 1.55 ± 0.54 and 1.24 ± 0.53, respectively. The mean cumulative ECD loss was 6.96% (p < 0.001). The central vault at the 1st and the 7th year were 0.52 ± 0.14 and 0.49 ± 0.14 mm, respectively (p = 0.25). These findings supported the long-term stability, efficacy, safety of the Eyecryl pIOL for high myopia. Eyecryl posterior chamber pIOL is one of the effective refractive options in correcting high myopia.

Phakic intraocular Lens implantation in keratoconus patients.

Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1. pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

Diagnostic Techniques to Increase the Safety of Phakic Intraocular Lenses.

Preoperative and postoperative diagnostics play an important role in ensuring the safety of patients with phakic intraocular lenses (pIOLs). The risk of endothelial cell loss can be addressed by regularly measuring the endothelial cell density using specular microscopy and considering the endothelial cell loss rate and the endothelial reserve in accordance with the patient's age when deciding whether to explant a pIOL. The anterior chamber morphometrics, including the anterior chamber depth and the distance between the pIOL and the endothelium, measured using Scheimpflug tomography and anterior segment optical coherence tomography (AS-OCT), can help to assess the risk of the endothelial cell loss. In patients undergoing posterior chamber pIOL implantation, accurate prediction of the vault and its postoperative measurements using AS-OCT or Scheimpflug tomography are important when assessing the risk of anterior subcapsular cataract and secondary glaucoma. Novel approaches based on ultrasound biomicroscopy and AS-OCT have been proposed to increase the vault prediction accuracy and to identify eyes in which prediction errors are more likely. Careful patient selection and regular postoperative follow-up visits can reduce the complication risk and enable early intervention if a complication occurs.

Numerical simulation of aqueous flow in a novel posterior chamber phakic intraocular lens versus its counterparts

Phakic intraocular lenses (pIOLs), particularly posterior chamber pIOLs, are becoming important for patients with high myopia and thin corneas. By phakic intraocular, we mean the ocular environmental conditions, where the natural lens is unremoved. A new posterior chamber pIOL, the sine wave phakic refractive lens (SW-PRL), is in the development stage, and its aqueous humor (AH) dynamics and the effects of intraocular geometry on the flow characteristics are not well understood. To analyze the adaptability and functionality of SW-PRL, a comparison study is made with its counterparts, the posterior chamber phakic refractive lens (PC-PRL), PC-PRL combined with peripheral iridotomy [PC-PRL(PI)], and implantable collamer lens with a central hole (ICL V4c). The result demonstrates that SW-PRL has a positive effect on AH flow circulation. Interestingly, there is a relationship between a posterior chamber flow and the type of pIOLs with vault variation. With an increase in vault, the flow between the lens and pIOLs slowed down after ICL V4C implantation but accelerated after PC-PRL (PI) implantation with little change after SW-PRL implantation. On the rear surface of the iris, the wall shear stress (WSS) was lower for PC-PRL(PI), SW-PRL, and ICL V4c (5.6 × 10−4, 6 × 10−3, and 8.2 × 10−3 Pa, respectively) compared to the PC-PRL (0.14 Pa), and on the front surface of lens, the WSS was lower for PC-PRL and SW-PRL (1.16 × 10−5 and 9.7 × 10−6 Pa, respectively) compared to the ICL V4c (8.2 × 10−4 Pa). WSS on the cornea surface was similar for each pIOL. These might provide a fresh viewpoint on the clinical decision of different intraocular lenses.

Phakic intraocular lenses: an update and review for the treatment of myopia and myopic astigmatism in the United States.

To review all phakic intraocular lenses (pIOLs) available in the United States for the correction of myopia or myopic astigmatism and offer a clinical approach to their proper use, postoperative follow-up, and analysis of visual and adverse outcomes. In March 2022, the FDA approved the EVO/EVO+ Visian ICL for widespread use, adding this lens to the two others available (Verisyse, Visian ICL). Cataract formation, endothelial cell loss (ECL) and surgical reintervention remain the most common adverse events. There are discrepancies between studies on ECL following implantation with pIOLs, although trends can be deduced with meta-analysis. Posterior Chamber-pIOLs (PC-pIOLs), especially the EVO/EVO+, have an overall lower mean adverse effect and subjective patient symptom profile when compared to Iris Fixated-pIOLS (IF-pIOLs). Advancements in PC-pIOL sizing have provided a noticeable difference in visual and safety outcomes. All pIOLs available in the United States provide high-quality visual correction of moderate to high myopia and/or myopia with astigmatism. Proper follow-up for ECL and cataract formation is warranted.

Bilensectomy: An updated review.

Phakic intraocular lenses (pIOLs) have been widely implanted and are a great option for the correction of high refractive errors. There are three types of pIOLs: angle-supported, iris-fixated, and posterior chamber pIOLs. Regardless of the pIOL type, all of them will be explanted at some point, mainly due to cataract development. Therefore, it is important to know the visual and refractive outcomes of bilensectomy (pIOL explantation following cataract surgery and intraocular lens implantation). The aim of this article is to review the visual outcomes and complications of bilensectomy.

Ретроспективный анализ отдаленных клинико-функциональных результатов имплантаций заднекамерной ФИОЛ отечественного производства

Introduction. The use of phakic intraocular lens (PIOL) for the correction of high ametropia is reflected in the works of both domestic and foreign ophthalmologists. In spite of this, there are very few publications which are devoted to the long-term outcomes of the use of domestically produced models of PIOL such as RSK-1(3) and RSK-3. Purpose. The main aim of this work is to assess the clinical and functional outcomes of the use of domestically produced models of PIOL such as RSK-1(3) and RSK-3. Material and methods. A retrospective analysis of the long-term results of PIOL implants performed at the Fyodorov Eye Microsurgery Federal State Institution was carried out from 1994 to 2001. The analysis involved 122 eyes of 84 patients with high myopia from who were implanted with posterior chamber negative PIOL with two haptic elements (RSK-3) and PIOL with three haptic elements (RSK-1(3). Results. Analysis of the dynamics of postoperative refractive data in compare with preoperative parameters showed us that in all cases there was a significant increase in uncorrected and corrected visual acuity. Long-term outcomes of implantation were found in 25 patients (43 eyes). The average duration of PIOL in the eye was 14.30±1.3 g (from 2 to 30 years). In all cases, the reducing cell density of the corneal epithelium did not exceed 4.0% in the early postoperative period. At the same time, the main complication in the distant postoperative period was the development of subcapsular cataracts. Conclusions. This method of ametropia correction can be recommended to young patients, who are not suitable for keratorefraction interventions. Key words: phakic intraocular lens, high myopia.

Reasons for explantation of phakic intraocular lenses and associated perioperative complications: cross-sectional explant registry analysis

BackgroundWe discuss the safety, since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications.MethodsThis retrospective, cross-sectional study included 69 pIOLs, explanted at a single tertiary center between July 2005 and March 2020: 34 angle-supported (G1), 28 iris-fixated (G2) and seven posterior chamber (G3) pIOLs. Case data including the reason for explantation was taken from the patient records. Intra- and postoperative complications were evaluated for an association with the pIOL.ResultsThe mean duration in the eye was 10.4 (0.2–28) years. Cataractogenesis and subsequent surgery that required pIOL explantation was the reason in 42% of all cases. In 22%, cataract in combination with endothelial damage prompted explantation, with 26, 18 and 14% for G1, G2 and G3 respectively. The second most common reasons were corneal damage alone in the angle-supported group (26%), IOL subluxation in the iris-fixated group (18%), and photopic disturbance in the posterior chamber group (29%). In 68% of all explantations, the surgical course was unremarkable, while in the remaining cases perioperative complications were associated with the lens in 45.7%.ConclusionOverall, the need for cataract surgery was the most common reason for pIOL explantation. Corneal complications were more frequent in the angle-supported pIOLs and their removal was associated with higher rates of complication compared to the other groups.

Refractive outcomes and complications following angle supported, iris fixated, and posterior chamber phakic intraocular lenses bilensectomy.

The manuscript presents a review of published studies regarding the outcomes, causes, and complications of phakic intraocular lens (pIOLs) bilensectomy.All pIOLs will be explanted at some point, therefore is important to know the visual and refractive outcomes following bilensectomy. There are few publications about the outcomes following pIOL bilensectomy; in all of them, cataract remains the main cause of bilensectomy. Other causes are endothelial cell density loss and pupil ovalization. The mean time between pIOL implantation and bilensectomy is longer in eyes implanted with an anterior chamber pIOL than in eyes implanted with a posterior chamber pIOL. There is a significant improvement in uncorrected and corrected distance visual acuity after bilensectomy. Some sight-threatening complications like retinal detachment and low endothelial cell density (ECD) after surgery have been reported. Current publications suggest that endothelial cell density loss is more frequent in eyes that underwent bilensectomy for an anterior chamber pIOL. Good visual and refractive outcomes are achieved after bilensectomy, regular endothelial cell density measurements should be performed in all patients implanted with an anterior chamber pIOL to perform a safe bilensectomy.

Safety and visual outcomes following posterior chamber phakic intraocular lens bilensectomy

BackgroundTo evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens – pIOL – explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOLs.MethodsThis multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months. The uncorrected and best corrected distance visual acuities (UDVA, CDVA), endothelial cell density before and after bilensectomy were assessed, as well as the cause of bilensectomy and intra or postoperative complications.ResultsThere was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy (p = 0.00). The main reason for bilensectomy was cataract development (93.1% of the cases), followed by miscalculation of lens size, and corneal edema. The endothelial cell count remained stable without a statistically significant change after surgery (p = 0.67). The refractive efficacy index was 0.8, none of the patients lost lines of CDVA after surgery, 73% of the patients were within ±1 D (spherical equivalent) of the target refraction. Intraoperative complications were one posterior capsule rupture with the intraocular lens (IOL) implanted in the sulcus, and 3 eyes required the use of pupil expanders for adequate pupil dilation. Postoperatively, one eye developed retinal detachment. The three pIOLs models explanted were the Implantable Collamer Lens (ICL), Implantable Phakic Contact Lens (IPCL) and the Phakic Refractive Lens (PRL).ConclusionsGood safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses (PC pIOLs). There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Phakic intraocular lenses: Recent advances and innovations

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Three-Year Effect of Phakic Intraocular Lenses on the Corneal Endothelial Cell Density.

PurposeTo compare the effect of three different phakic intraocular lenses (pIOLs) on the corneal endothelial cell density (ECD).Patients and MethodsThis was a prospective observational cohort study that included 60 eyes (30 patients) with axial myopia of −6.50 to −22.00 diopters (D). The Verisyse anterior chamber (AC) rigid iris fixated pIOL, the Veriflex (AC) flexible iris fixated pIOL, and the Visian posterior chamber (PC) implantable collamer lens (ICL) were implanted in three equal groups of patients. The effect of the three pIOLs on the ECD was compared over a follow-up period of one week, and one, three, and six months, and one, two, and three years. Specular microscopy was done to evaluate the cornea before the surgery and throughout the study. Changes were statistically analyzed and compared.ResultsIn the first three postoperative months, Verisyse and Veriflex pIOLs induced almost the same amount of endothelial cells loss of 10.3% and 10.6%, respectively, while ICLs showed endothelial cells loss of 3.5%. At the end of the three-year study, Veriflex pIOLs induced the highest rate of endothelial cell loss of 25%, while Verisyse and ICL lenses showed endothelial cells loss of 15.7% and 13.4%, respectively. The main effect of time and type of lens was statistically significant (p<0.001).ConclusionAll pIOLs cause a decrease in ECD. The AC pIOLs tend to be associated with more cell loss than PC pIOLs. Surgical insult is the important factor responsible for the early endothelial cell loss, while the material from which the pIOL is made may be an important factor for the continuous corneal endothelial cell loss over a long time.

Posterior chamber phakic intraocular lens for the correction of presbyopia in highly myopic patients.

To report the initial experience with a new presbyopic phakic intraocular lens (pIOL) in the correction of high myopia and presbyopia. Gemini Eye Clinic, Zlin, Czech Republic. Prospective cohort study. Presbyopic eyes with moderate to high myopia were implanted with a presbyopic posterior chamber pIOL (IPCL). The visual acuities at near and distance, endothelial cell density, and ocular condition were examined 1 week, 3 months, 1 year and 2 years postoperatively. The mean uncorrected distance visual acuity improved significantly from 1.25 logarithm of the minimum angle of resolution (logMAR) (1.15 to 1.35 95% confidence interval [CI]) to 0.11 logMAR (95% CI, 0.03 to 0.17) (P < .0001). No eye lost 1 or more lines of corrected distance visual acuity. The mean distance refraction improved significantly from -6.9 diopters (D) (range -8.6 to -5.3 D) preoperatively to -0.35 D (range -0.55 to -0.15 D, P < .0001) with less than -0.5 D residual refraction in 11 of 17 eyes. Fifteen of 17 eyes had improved uncorrected near visual acuity to J1 (Jaeger chart) at the 2-year follow-up. The near addition at the 2-year follow-up decreased from preoperatively +1.26 D (range 0.19 to 2.34 D) to +0.39 D (range 0.18 to 0.60 D). The mean endothelial cell density was reduced from 2552 cells/mm (range 2421 to 2682 cells/mm) to 2299 cells/mm (range 2108 to 2490 cells/mm) after 2 years. All patients were subjectively satisfied with the outcomes. The new pIOL provided good visual outcomes in near and far distances in an initial case series of patients.

Use of low-vault posterior chamber collagen copolymer phakic intraocular lenses for the correction of myopia: a 3-year follow-up.

Phakic intraocular lens (pIOL) models have indicated an association between cataract formation and inadequate vaulting. In this study, the efficacy and safety of low-vault posterior chamber pIOLs in the correction of myopia were examined over 3years. From 316 patients undergoing surgery, 14 eyes with a low vault (≤ 150μm) were examined from 14 patients. After implanting the Visian Implantable Collamer pIOL for the correction of myopia (moderate and high), the pIOL vault, endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), and detrimental events were examined over 3years. Based on the findings, the mean spherical equivalent reduced from - 8.15 ± 3.29 before surgery to - 1.02 ± 0.75 diopters 3years after the surgery. In terms of visual outcomes, the mean UDVA (Log MAR) significantly increased from 0.95 ± 037 to 0.27 ± 0.28, and the mean CDVA also increased from 0.99 ± 0.11 to 0.06 ± 0.08 (P < 0.05). The mean indices of safety and efficacy were respectively 1.075 and 0.748. The eyes lost not more than two visual acuity lines. Based on the findings, 82% achieved 0.80 or better CDVA, while the total endothelial cell loss was 7.96% during 3years. Overall, vision-threatening conditions were not reported. The introduced pIOL can be considered a safe and efficient method for myopia at moderate to high levels.

Femtosecond laser–assisted cataract surgery in eyes with foldable anterior or posterior chamber phakic intraocular lenses

We describe a technique for the application of femtosecond laser-assisted cataract surgery in eyes with cataract and previous implantation of a foldable anterior or posterior chamber phakic intraocular lens (pIOL). In 2 eyes with an anterior chamber pIOL (angle-supported Acrysof Cachet) and 3 eyes with a posterior chamber pIOL (2 eyes with an Implantable Collamer Lens pIOL; 1 eye with a Phakic Refractive Lens), a femtosecond laser was used to create a capsulotomy, perform lens fragmentation, and create corneal incisions with the pIOL insitu. In all cases, the capsulotomy was created successfully. Lens fragmentation was complete in 4 eyes and incomplete in 1 eye, where trapped cavitationbubbles in the space between the posterior chamber pIOL and anterior lens capsule were evident as a result of a shallow vault of the pIOL.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia.

To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia. This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred. Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit. Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.

Comparison of iris-claw and posterior chamber collagen copolymer phakic intraocular lenses in keratoconus

To evaluate the visual and refractive outcomes, predictability, and stability of phakic intraocular lens (pIOL) implantation in keratoconic eyes and compare the results of 2 pIOL models. Vissum Instituto Oftalmologico, Alicante, Spain. Retrospective case series. An iris-claw (Artiflex) or collagen copolymer posterior chamber pIOL (PC pIOL) (Implantable Collamer Lens) was implanted in eyes with stable keratoconus. The main outcome measures were postoperative changes from the preoperative manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, and endothelial cell count. Alpins vectorial analysis was performed. Twenty eyes received an iris-claw pIOL and 28 eyes, a PC pIOL. The mean spherical equivalent was -9.31 diopters (D) ± 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 ± 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). No patient lost lines of CDVA. The mean decimal UDVA was 0.08 ± 0.09 preoperatively and 0.71 ± 0.26 postoperatively and the mean decimal CDVA, 0.77 ± 0.24 and 0.87 ± 0.98, respectively (P<.001). The mean efficacy index was 0.90 ± 0.26 and the mean safety index, 1.19 ± 0.29. The mean efficacy index was not statistically different between the PC pIOL (0.88 ± 0.28) and the iris-claw pIOL (0.96 ± 0.22) (P=.058). Refraction was stable during the follow-up. Phakic IOL implantation is a suitable refractive surgical option for stable keratoconus. It may be especially indicated for the management of high ametropia and showed good efficacy and safety. Refractive and keratometric stability was confirmed.

Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to −24 diopters (D) and 0 to −6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was −10.35 ± 5.1 D (+8 to −24) and the postoperative sphere was −0.09 ± 1.06 D (+3.25 to −6.5), p < 0.001. Preoperative cylinder was −2.63 ± 1.44 (0 to −6.5 D) and postoperative cylinder was −0.97 ± 0.89 D (0 to −3.5), p < 0.001. The preoperative mean spherical equivalent was −11.6 ± 5.12 D (+7.875 to −25.625) and postoperative spherical equivalent was −0.52 ± 1.03 (+2.25 to −6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.