Phakic Intraocular Lens Implant
Phakic intraocular lens implant is a type of refractive surgery in which special type of artificial intraocular lenses are implanted in the eye either in the anterior chamber or posterior chamber in order to correct high refractive errors. The difference between them and those that implanted during cataract eye surgery is that they are implanted in the presence of the natural crystalline lens in order to correct refractive errors while in cataract surgery, the natural lens which became opacified will be removed and replaced by artificial intraocular lens. Patients can do them when they are not good candidates for lasik or PRK because they have high refractive errors and undergoing those surgeries can increase the risk of post-operative complications. Criteria for Phakic IOLIn order to decrease post operation complications, patients should be good candidates and should be selected for phakic intraocular lens implant according to certain criteria.1- Stable refractive error in the last 6 months with less than 0.5 D change. 2- The natural crystalline lens should be clear. 3- Patient have high refractive errors. 4- Patient is not happy with his vision with spectacles or contact lenses. 5- Patient is not a good candidate for excimer laser surgery. 6- Patient has no ocular diseases or pathology. 7- Has deep anterior chamber which should be greater than 3.0 mm. The upper limits of lasik and PRK for correction of myopic patient are -12D to -14D, +4D to +6D for hyperopia and 4-5D for astigmatism because behind those limits, the risk of complications of them will increase. Phakic IOL can correct high myopia of around -20D to – 30D, hyperopia up to +3.0D. Till now, only spherical correction by Phakic IOL is approved by FDA but astigmatism can be corrected by using toric Phakic IOL. What are the advantages of Phakic IOLs?1- Correction of high refractive errors.2- Patient can preserve accommodation because the natural crystalline lens is not removed. Natural crystalline lens is the one responsible for accommodation and patients who undergo cataract surgery will loss their accommodation. 3- Less high order aberration compared to lasik.
What are the disadvantages?1- This is an intraocular procedure with the risk of infection which is called endophthalmitis.2- Can cause irreversible damage to cornea by reducing the number of endothelial cells especially with those Phakic IOL that implanted in the anterior chamber. 3- Damage to the natural clear lens causing cataract. 4- Can cause elevation of intraocular pressure which can be transient or can become chronic causing glaucoma. Causes of this high intraocular pressure are: inadequate removal of viscoelastic during surgery causing high intraocular pressure in the early postoperative day. Acute angle glaucoma can occur due to pupillary block which occur more with posterior chamber lens than anterior chamber lens. That is way laser or surgical iridectomy is indicated pre-operative or during surgery. 5- Uveitis which can be acute and transient or can be chronic. 6- Retinal detachment can occur after surgery with an incidence of 2.8% of patients with Phakic IOL.
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