Review/Update
Phakic intraocular lens implantation for the correction of hyperopia

https://doi.org/10.1016/j.jcrs.2019.05.051Get rights and content

The prevalence of myopia is much higher than hyperopia. Hence, there are relatively few studies investigating phakic intraocular lens (pIOL) implantation for the correction of hyperopia. This review aimed to summarize the available relevant literature on the efficacy and safety of pIOL implantation for the correction of hyperopia and hyperopic astigmatism. At present, two types of pIOLs are used to correct hyperopia and hyperopic astigmatism: anterior chamber iris-fixated pIOLs and posterior chamber implantable collamer lenses. Both have been found to be safe and effective. No serious events (eg, retinal or choroidal detachment, endophthalmitis) were reported in the reviewed articles. Implantation of pIOLs might be the optimal refractive surgery for the correction of high 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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      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

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      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 Ophthalmology
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      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.

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    First author:

    Abdulaziz A. Alshamrani, MD

    King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

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