PURPOSE: To review the peer-reviewed literature reporting postoperative complications of the most recent models of Visian Implantable Collamer posterior chamber intraocular lenses (ICL, STAAR Surgical Co). METHODS: A literature search of the PubMed database was performed to identify all articles related to ICL complications. Articles were obtained and reviewed to identify those that reported complications using the latest ICL designs. RESULTS: Cataract was the major postoperative complication reported: 136 (5.2%) in 2592 eyes. Of those, 43.4% (n=59) were reported within 1 year, 15.4% (n=21) between 1 and 3 years, and 35.3% (n=48) >3 years after ICL implantation. Twenty-one (15.4%) cataracts were reported as surgically induced, 46 (33.8%) eyes had poor vault ( ,200 µm), and cataract surgery was carried out in 27.9% (n=38) of eyes. Early acute intraocular pressure increase was also reported to be relatively frequent, whereas acute pupillary block was less frequent and mostly resolved with additional iridotomies. A total of 42 ICLs were explanted due to cataract and IOP. Reported endothelial cell loss varied from 9.9% at 2 years to 3.7% 4 years postoperatively. This loss was reported to be more pronounced within the fi rst 1 to 2 years, with stability or lower progression after that time. CONCLUSIONS: The majority of reported complications after ICL implantation are cataract formation. The improvements in lens geometry and more accurate nomograms applied to the selection of the lens to be implanted, in addition to the surgeon’s learning curve, might be factors in the decreased occurrence of postoperative complications reported currently. [ J Refract Surg . 2011;xx(x):xxx-xxx.] doi:10.3928/1081597X-20110617-01 C urrently, phakic intraocular lenses (PIOLs) are generally accepted as an alternative treatment for ametropia correction among various refractive ranges, and their implantation is an emerging technique within the fi eld of refractive surgery. Faster visual recovery, high effi cacy and stability of visual quality, preservation of accommodation, and reversibility are several advantages that have been attributed to PIOL implantation. 1,2

/pdf/implantable-collamer-posterior-chamber-intraocular-lenses-a-3k5go24h5c.pdf

Implantable collamer posterior chamber intraocular lenses: a review of potential complications.

The second part of a review of phakic intraocular lenses (pIOLs) addresses results and complications with current pIOL models. Phakic IOLs demonstrate reversibility, high optical quality, potential gain in visual acuity in myopic patients due to retinal magnification; correction is not limited by corneal thickness or topography. With proper anatomical conditions, pIOLs also show good results in hyperopic patients. Toric pIOL designs enable spherocylindrical correction. Complications are rare and primarily related to pIOL position and type. The main complications of anglesupported anterior chamber pIOLs are glare and halos, pupil ovalization, and corneal endothelial cell loss; of iris-fixated anterior chamber pIOLs, chronic subclinical inflammation, corneal endothelial cell loss, and dislocation or pupillary block glaucoma; and of posterior chamber pIOLs, anterior subcapsular cataract formation, pigment dispersion, and luxation or pupillary block glaucoma. No causative relationship between pIOL implantation (of any pIOL type) and retinal detachment has been established. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Phakic intraocular lenses: Part 2: Results and complications

In this 2-part overview, the current status of phakic intraocular lens (pIOL) surgery to correct refractive errors is reviewed. Three types of pIOLs, categorized by their intraocular position, are included: angle-supported anterior chamber, iris-fixated anterior chamber, and posterior chamber (usually fixated in the ciliary sulcus). Part 1 reviews the main models of each pIOL type, the selection criteria, and the surgical techniques, with emphasis on currently available pIOLs. Bioptics, adjustable refractive surgery, and enhancements are addressed, and applications of the new anterior segment imaging techniques are reviewed.

Phakic intraocular lenses part 1: historical overview, current models, selection criteria, and surgical techniques.

An intraocular lens assembly for use in the phakic or aphakic eye is provided. In the preferred embodiment, the intraocular lens assembly is suitable for the correction of myopia, hyperopia, astigmatism. The lens assembly has a lens having a circumferential edge, and a first haptic and a second haptic, which extend from the edge of the lens. Each of the haptics has a first leg extending from the lens edge to a distal end, and a second leg extending from the lens edge to distal end, and a transverse member extending between the distal ends of each first and second leg. The transverse member can be substantially straight or bowed inward toward the lens. Each leg has a footplate at its distal end. Each leg of each haptic may be in inwardly bowing, straight, and outwardly bowing. Additionally, each leg may have the same or different shape from the other legs. In a one embodiment, the first and second legs of the first and second haptics are outwardly bowing. In another embodiment, the first and second legs of the first and second haptics are inwardly bowing. The intraocular lens assembly is made from a flexible material. Preferably the material is hydrogel, collagen, collamar, collagel, acrylate polymers, polymethylmethacrylate polymers, silicone polymers, and composites thereof. In another embodiment, the intraocular lens assembly is foldable. In another embodiment, the intraocular lens assembly is firm.

Phakic intraocular lenses

Background

The aim of this study was to determine whether implantable collamer lens (ICL) implantation to correct myopia is an effective and safe surgical option even after long-term follow up.



Design

A retrospective observational study was carried out.



Participants

A total of 281 eyes of 145 myopic patients were included in the study.



Methods

Patients underwent ICL implantation and had the follow-up period of at least 5 years (87 ± 18.9 months).



Main Outcome Measures

Outcome measures included uncorrected and corrected distance visual acuities, refraction for the evaluation of efficacy, safety, stability and predictability, ICL vault and adverse events.



Results

The final mean logMAR uncorrected and corrected distance visual acuities were 0.02 ± 0.19 and −0.12 ± 0.13, respectively. The mean efficacy and safety indices were 1.04 ± 0.32 and 1.20 ± 0.26. The mean spherical equivalent decreased from −8.74 ± 2.27 diopter (D) to −0.58 ± 0.72 D, and there was high predictability with 69.8% and 87.2% having a postoperative refraction within 0.5 D and 1.0 D, respectively. The mean postoperative vault was changed from 2.53 ± 0.6 to 2.00 ± 0.7. Six (2.1%) eyes developed cataract, and the mean endothelial cell loss was 7.8 ± 8.3%. Increased intraocular pressure was found in two (0.7%) eyes that required the exchange of lenses with different sizes.



Conclusions

Implantable collamer lens implantation to correct myopia was an effective and safe surgery with high predictability and stability during long-term follow up. Slight myopic shift and cataract formation related with change in vault should be further evaluated.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ceo.12691

Long-term clinical results of posterior chamber phakic intraocular lens implantation to correct myopia.

Background: To report on 1-year follow up of a series of 126 eyes implanted with a spherical implantable collamer lens (ICL).

Methods:  Retrospective case note review of 126 eyes (68 patients) undergoing ICL placement by a single surgeon (TG) to correct preoperative mean spherical equivalents between +8.88 and −20.50 D. Main outcome measures included uncorrected visual acuity (UCVA), refraction, best spectacle-corrected VA, unaided binocular vision, adverse events, operative/postoperative complications and patient symptoms.

Results:  Complete data were available at 1 year on 121 of the 126 eyes (65 out of 68 patients). At 12 months 86% (104/121) had postoperative UCVA better than or equal to preoperative best spectacle-corrected VA, and 98% (118/121) had UCVA within one line of preoperative best spectacle-corrected VA. Ninety-six per cent (116/121) had postoperative UCVA of 6/9 or better, and 100% had postoperative best-corrected visual acuity of 6/12 or better. Ninety-eight per cent (64/65) patients had unaided binocular vision at 1 year of 6/7.5 or better. Average myopia treated was −8.83 D (116 patients), and average hyperopia +7.14 D (10 patients). Two ICLs were replaced because of high vaulting; one eye had increased intraocular pressure that resolved with smaller ICL placement. Four patients had visually insignificant pigment deposits on the ICL at 3/12, but no pigmentary glaucoma. Five patients noticed haloes around lights at night, none preventing driving.

Conclusions:  One-year results from this study, the largest reported clinical investigation of the use of ICLs in New Zealand, support the safety, efficacy and predictability of ICL to treat both hyperopic and myopic spherical refractive errors.

Spherical implantable collamer lenses for myopia and hyperopia: 126 eyes with 1-year follow up.

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Spherical implantable collamer lenses for myopia and hyperopia: 126 eyes with 1-year follow up.