Binkhorst Lecture: Are phakic IOLs the wave of the future?

Lucio Buratto, MD, of Milan, Italy, was the 2004 recipient of the Binkhorst Medal. In his address to the European Society of Cataract and Refractive Surgeons, Dr. Buratto reviewed the history of phakic IOLs, the major designs, their indications, visual outcomes, and associated complications.

ParisLucio Buratto, MD, of Milan, Italy, was the 2004 recipient of the Binkhorst Medal. In his address to the European Society of Cataract and Refractive Surgeons, Dr. Buratto reviewed the history of phakic IOLs, the major designs, their indications, visual outcomes, and associated complications.

About 100,000 phakic IOLs have been implanted worldwide and the vast majority (82%) is either the Verisyse/Artisan phakic IOL (AMO/Ophtec) or the Implantable Contact Lens (ICL) (STAAR Surgical). According to Dr. Buratto, they are a very attractive refractive surgery option for patients with myopia of 6 D and greater.

The most recent development is the introduction of toric phakic IOLs for astigmatism. The unknown factor in the implantation of these lenses is that because so many patients are lost to follow-up after lens implantation, there is no knowledge of the long-term effects of the lenses after 36 months after implantation.

When the decision has been made to implant a phakic IOL, Dr. Buratto emphasized that the most important consideration is that surgeons choose a lens with the lowest rate of complications.

He recounted that anterior chamber IOLs have not remained on the market for longer than 3 years and none has been submitted for FDA approval. Iris-fixated IOLs have a long follow-up and proven track record; because of their location, they can remain in place for a long time with no side effects.

There are numerous posterior chamber IOLs on the market; however, these lenses are associated with a high incidence of cataract formation because of contact with the crystalline lens. Glaucoma is another possible complication, but the potential can be reduced by performing an iridectomy; reduced endothelial cell count and possible corneal decompensation also may occur.

Dr. Buratto's first and second choices for implantation are the Verisyse/Artisan phakic IOL and the ICL, respectively.

"Phakic IOLs have a great future in refractive surgery," Dr. Buratto said. "However, companies must make better IOLs, and importantly, surgeons must follow patients for as long as possible after surgery to detect any side effects that can be addressed."

He also emphasized the need for more phakic IOLs on the market that are foldable and cause lower aberrations in the eye.