Kota Divisional Ophthalmic Society (KDOS)

Kota, Rajasthan India, July 16, 2016

Implantable Phakic IOLs: Indication,
Technique, Complication(s) & Management
Dr. Suresh K. Pandey
Dr. Vidushi Sharma
SuVi Eye Institute &
Lasik Laser Center, Kota,
Rajasthan, India
Email:suvieye@gmail.com
Website: www.suvieye.com
Phone +91 9351412449

Kota Divisional Ophthalmic Society (KDOS)

Kota, Rajasthan, India, July 16, 2016

The authors have

no financial interest in
the subject
matter of this
presentation

Spectrum of Refractive Surgeries

REFRACTIVE SURGERIES

CORNEA BASED

-R.K.
-PRK
-LASIK
-EPILASIK
-LASEK
-Conductive
Keratoplasty
-Corneal
Inlays and
rings

LENTICULAR BASED

-Clear

Lens
extraction for
myopia
-Phakic IOL
(ICL/IPCL/EPL)
- PreLex Clear
Lens Extraction
with use of
Multifocal/Toric
MF IOL

COMBINED(BIOPTICS)

Combination
of the two

Introducing Phakic Lens in your

practice- What are Challenges
Faced by Ophthalmic Surgeon?
Young healthy patients
High expectations
Lack of equipment for pre-op
evaluation
Inability to manage complications
Fear of starting something new
High cost of phakic lens (e.g. ICL)

Question Need to be addressed about

Phakic Lens in this presentation

What are the indications of Phakic IOLs?

Inclusion and exclusion criteria for phakic IOLs.
Preoperative evaluation & patient work up
Surgical Technique/Importance of Vault
Post operative Medications & Follow up
Management of Complications- Explantation, if Required

What are Indications

for Phakic Lens?
Myopia
Myopia of minus3 to -25 Diopters

Astigmatism up to 8 Diopter

Hyperopia
Other Indications

Presbyopia (Multifocal IPL)

Post RK/Post PK
Stable Keratoconus
Management of refractive surprise after cataract
surgery

Phakic Lens: An Option for Correction of

Refractive Error where LASIK is not
Feasible

Phakic Lens- Cornea Saving,

Reversible Option
Preserve accommodation
Can be used when Lasik is not
feasible
Very high refractive error
Corneal thickness <480
Cornea not too flat or steep.<36D
or>49D(Poor Optics).

Currently Available Phakic IOLs

ICL (Visian- Centraflow Technology)

IPCL (Care Group, India)
Phakic Lens (Eyecryl, Biotech)
RIL- Refractive implantable Lens (Appasamy)

Who are Suitable Candidate

For Phakic Lens?
Age above 18 years
Stable refraction for one year
Patients not suitable for LASIK/LASEK
due to high powers or thin corneas
Anterior Chamber depth 2.80 mm
Endothelial count >2000cells/cumm
No other ocular/retinal pathology

Exclusion Criteria
Endothelial cell count <2000cells/cu mm
Anterior chamber depth less than 2.8
mm
History of uveitis
Presence of anterior/posterior synechiae
Glaucoma or IOP higher than 20 mmHg
Evidence of cataract/nuclear sclerosis
Personal or family history of retinal
detachment

Phakic Lens
Pre-op Work Up

Vision (UNVA/BCVA)
IOP/Gonioscopy
Keratometry Reading (K1, K2)
Central Corneal Thickness (CCT)
White to White Hori. Corneal Diameter
Ant. Chamber Depth (from Endothelium)
Axial length
Ant Seg/Retina Examination/OCT
Pre-operative YAG PI- Not needed with latest
design

Pre-Op Work Up
White-To-White Measurement Using Calipers

WHITE TO WHITE MEASUREMENT

SULCUS TO SULCUS
MEASUREMENT (UBM)

Surgical Technique

Loading of Phakic Lens

Incision (side-port & Main)
Intracameral injection of Lignocaine
Injection of HPMC
Insertion of Phakic Lens
Removal of OVD
Stromal Hydration
Intracameral Injection of Moxifloxacin

Phakic IOLS: Surgical

Technique
VIDEO LINKS:
Implantable Collamer Lens (ICL)
https://www.youtube.com/watch?v=2y0
PfTEAywc
IPCL- Care Group India:
https://www.youtube.com/watch?
v=La7m9mjoLpY
Presbyopic Multifocal Phakic Lens:
https://www.youtube.com/watch?v=9USKyDw_9o

Post-op Medication
Follow your normal cataract routine
Antibiotic 3-4x / day for 4 weeks
Steroids 4x / day for 4 weeks tapering
weekly
Lubricating Eye drop for few months
Systemic Acetazolamide for 3 days
Topical pressure lowering eye drops (in
case of IOP spike)

Our Experience at SuVi Eye

Institute, Kota, India
54 eyes (27 patients)
Age 22 to 34 years
Refractive error Minus 3 to -25D with cyl up
to 3D
Pre-op Yag PI done only in initial 2 cases (4
eyes)
Phakic Lenses were easily implanted in all eyes
Postoperative UCVA between 6/9 to 6/5 in 50
eyes (92%), 2 eyes had amblyopia

Our Experience at SuVi Eye

Institute, Kota, India
In 2 patients, (3 eyes),
postoperative pressure
spike was noted, which was
controlled on medication
In high refractive errors,
postop vision was better
than preop BCVA (as in all
refractive surgeries)
Explantation/exchange- 1

Our Experience at SuVi Eye Institute, Kota, India

Vault was between
280 to
740 microns in all cases except 1 case with
100 microns (recommended between 250 &
750 microns)
Two cases (4 eyes) had some deposits over
the surface of IPCL on first postop day
(thought to be viscoelastic residue), which
resolved over the next 2-3 days

Complications of
Phakic Lens
Intraoperative
Damage to Optic/haptic while loading/insertion
Upside down implantation (Enlarge incision 3.2 mm
Remove the lens- reinsert it
Haptic above the iris (use pilocapine to constrict the
pupil)

Postoperative
OVD Precipitation
Increase IOP
Phakic lens rotation/decentration
High Vault-Pupillary block/
Pigment dispersion
Low Vault-Subcapsular cataract

Increase Phakic Lens Vault

Causes Oversized Phakic Lens

Sequale
Glaucoma

Management
Phakic Lens
explantation and
Exchange (0.25
Micron= 150 Microns)

Decrease Phakic Lens Vault

Causes Undersized Phakic
Lens

Sequale
Anterior subcapsular
cataract

Management
Phakic Lens
explantation and
Exchange (0.25
Micron= 150 Microns)

Phakic Lens Explantation/Exchange

Conclusion
Phakic IOLs remains useful option for
correction of refractive error
The benefits are definitely optical
quality, rapid visual rehabilitation,
and reversibility.
Close follow-up is important- cataract
formation, glaucoma, endothelial cell
loss, peropheral retinal evaluation.

THANK YOU

Implantable Phakic IOLs: Indication,

Technique, Complication(s) & Management

For any query, please contact

Dr. Suresh K. Pandey
Dr. Vidushi Sharma
SuVi Eye Institute &
Lasik Laser Center, Kota,
Rajasthan, India
Email:suvieye@gmail.com
Website: www.suvieye.com
Phone +91 9351412449