Review/UpdatePhakic intraocular lens implantation for the correction of hyperopia
Section snippets
Prerequisites for phakic intraocular lens implantation
Generally, the following criteria result in better predictability and safety of pIOLs: age older than 21 years; stability of refraction (change <0.50 D per year); clear crystalline lens; satisfactory anterior chamber depth (ACD); adequate endothelial cell count (ECC); mesopic pupil size less than the pIOL optic; and absence of ocular pathologies such as uveitis, iris atrophy, cataract, glaucoma, and retinal pathologies.20, 21, 22, 23, 24
Specular microscopy should be performed for all cases. As
Types of phakic intraocular lenses for hyperopic correction
Two varieties of pIOLs are available based on the site of implantation: anterior chamber pIOLs (ACpIOLs) and posterior chamber pIOLs (PCpIOLs). The ACpIOLs can be further divided according to the fixation method into angle-fixated ACpIOLs and iris-fixated ACpIOLs.
Surgical technique
Generally, laser or surgical peripheral iridotomies are required when implanting an ACpIOL or PCpIOL to prevent pupillary block glaucoma. The procedure is usually performed under topical, peribulbar, or retrobulbar anesthesia.54, 55
The implantation of a pIOL does not require special instruments, and it is usually performed with instruments commonly used in cataract surgery. However, an enclavation needle is required for iris-fixated ACpIOLs.
Postoperative care
Antibiotics and steroid eyedrops are given for 2 weeks. Nonsteroidal antiinflammatory drug eyedrops can be used for 1 month. Some surgeons prescribed ocular hypotensives (eg, oral acetazolamide) for the first postoperative day. The procedure for the other eye is performed on the same day or at 1 to 2 weeks postoperatively.55
The postoperative examination is usually performed at 1 day, 1 week, 1 month, 3 months, 6 months, 1 year, and annually thereafter. It may include uncorrected distance visual
Description of evidence
Literature searches of PubMed and Google Scholar databases were conducted on January 15, 2019 using the MeSH (Medical Subject Headings) terms lenses, intraocular, hyperopia, hypermetropia, hyperopia/surgery, and hyperopia/therapy, and the keywords phakic, refractive, angle-fixated, angle-supported, iris-fixated, toric, implantable contact lens, implantable collamer lens, Visian, ICL, Artisan, Verisyse, Artiflex, and Veriflex. The searches were limited to English literature. The searches
Refractive outcomes, efficacy, and safety
The design of pIOLs, proper size, surgeon experience, and fulfilling the preoperative requisites are the factors that contribute to intraoperative and postoperative complications. Based on the location where pIOLs are implanted, theoretically the ECL will be greater with ACpIOLs and cataract formation is more common for PCpIOLs. Among ACpIOLs, angle-supported pIOLs have greater ECL than iris-fixated pIOLs and are more prone to rotate causing greater ECL and poor astigmatism correction. Trauma
First author:
Abdulaziz A. Alshamrani, MD
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Cited by (20)
Phaco with ICL in situ in a case of high hyperopia
2022, American Journal of Ophthalmology Case ReportsCitation Excerpt :Phakic IOLs are popular for correction of high refractive error in myopia and hyperopia where corneal ablative procedures are unsuitable.1
Toxic anterior segment syndrome following EyePCL implantation in a hyperopic patient
2022, Journal Francais d'OphtalmologieCitation Excerpt :Posterior chamber phakic IOL implantation is now being used frequently for treating moderate and high ametropias due to its safety and good refractive outcomes where classical keratorefractive procedures are contraindicated [1–3].
Accuracy of Intraocular Lens Calculation Formulas in Patients Undergoing Combined Phakic Intraocular Lens Removal and Cataract Surgery
2022, American Journal of OphthalmologyCitation Excerpt :The negligible impact of ACD measurement error on prediction accuracy in patients undergoing PIOL removal and cataract surgery may be explained by that highly myopic eyes are less sensitive to ACD errors, whereas short eyes are on the contrary.32 The PIOL can not only be used in high myopia patients, but also in hyperopia and low myopia patients,33 among whom the measurement error of ACD and LT by IOLMaster 700 might significantly affect the prediction accuracy. Thus, for those with measurement errors, manual calculations are needed (as described in the Methods section) to get the correct ACD and LT value.
Vault Height Is a Key Predictive Factor for Anterior Segment Measurement Error by IOLMaster 700 in Eyes With Phakic Intraocular Lens
2023, Translational Vision Science and Technology
First author:
Abdulaziz A. Alshamrani, MD
King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia