Phakic IOLs: Good benefit-to-risk ratio

Boston-The benefit-to-risk ratio of phakic IOLs is well-balanced, and while there is a risk of decreased endothelial cell counts in some eyes with certain phakic IOLs, the optical quality achieved is very good, said Thomas Kohnen, MD, PhD.

The 3-year results with the angle-supported AcrySof Cachet IOL (Alcon Laboratories), indicated for myopia and hyperopia, showed that the lens was placed well and remained stable. The accommodative effect remained the same from preoperatively to postoperatively, and the postoperative visual acuity was superior to the preoperative level.

In the FDA study, 106 eyes completed the 5-year evaluation and of those 1% had a two-line decrease in visual acuity. The visual acuity was maintained over a long period and the spherical equivalent was very stable. The endothelial cell loss was 1.1% annually, and the cells maintained their shape and size. The minimal ACD is 2.8 mm from the endothelium, said Dr. Kohnen, Department of Ophthalmology Goethe-University, Frankfurt, Germany.

With the iris-fixated Artisan IOL (Ophtec)-indicated for myopia, hyperopia, and astigmatism-the minimal ACD must be 3 mm from the epithelium. The 10-year follow-up showed good outcomes, but long-term endothelial cell loss. Occasional precipitates were seen on the eye with the foldable version of the IOL (Artiflex) possibly related to the silicone material, but the outcomes were good.

The posterior chamber sulcus-supported Visian ICL (STAAR Surgical), indicated for myopia and hyperopia, has a central hole that promotes more aqueous circulation through the pupil. The IOL is indicated for patients 21 to 45 years of age. The IOL provides stable refraction over the long term and the minimal ACD is 2.8 mm from the endothelium. Results showed 95% of patients within ±0.5 D and 100% within 1 D of intended correction. One drawback is cataract formation in young patients when the IOL without the central hole was implanted, Dr. Kohnen said.

Anatomic factors are crucial with these lenses, he noted, as they all provide optical quality and fast visual rehabilitation, but the disadvantages of each must be considered.

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