Phakic intraocular lens

Phakic intraocular lens
Intervention
Photo of an eye after PIOL-implantation, 24 hours after surgery. The lens is visible in front of the iris; the pupil is still small due to presurgery eyedrops.
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A phakic intraocular lens (PIOL) is a special kind of intraocular lens that is implanted surgically into the eye to correct myopia (nearsightedness). It is called "phakic" because the eye's natural lens is left untouched. This is in contrast to intraocular lenses that are implanted into eyes after the eye's natural lens has been removed during cataract surgery.

Phakic intraocular lenses are indicated for patients with high refractive errors when the usual laser options for surgical correction (LASIK and PRK) are contraindicated. Phakic IOLs are designed to correct high myopia ranging from −5 to −20 D if the patient has enough anterior chamber depth (ACD) of at least 3 mm.

Three types of phakic IOLs are available:

LASIK can correct myopia up to -12 to -14 D. The higher the intended correction the thinner and flatter the cornea will be post-operatively. For LASIK surgery, one has to preserve a safe residual stromal bed of at least 250 µm, preferably 300 µm. Beyond these limits there is an increased risk of developing corneal ectasia (i.e. corneal forward bulging) due to thin residual stromal bed which results in loss of visual quality. Due to the risk of higher order aberrations there is a current trend toward reducing the upper limits of LASIK and PRK to around -8 to -10 D. Phakic intraocular lenses are safer than excimer laser surgery for those with significant myopia.

Phakic intraocular lenses are contraindicated in patients who do not have a stable refraction for at least 6 months or are 21 years of age or younger. Preexisting eye disorders such as uveitis are another contraindication.

Although PIOLs for hyperopia are being investigated, there is less enthusiasm for these lenses because the anterior chamber tends to be shallower than in myopic patients. A hyperopic model ICL (posterior chamber PIOL) is available.

Corneal endothelial cell count less than 2000-2500 cells/mm² is a relative contraindication for PIOL implantation.

PIOLs have the advantage of treating a much larger range of myopic and hyperopic refractive errors than can be safely and effectively treated with corneal refractive surgery. The skills required for insertion are, with a few exceptions, similar to those used in cataract surgery. The equipment is significantly less expensive than an excimer laser and is similar to that used for cataract surgery. In addition, the PIOL is removable; therefore, the refractive effect should theoretically be reversible. However, any intervening damage caused by the PIOL would most likely be permanent. When compared with clear lens extraction, or refractive lens exchange the PIOL has the advantage of preserving natural accommodation and may have a lower risk of postoperative retinal detachment because of the preservation of the crystalline lens and minimal vitreous destabilization.