Article
KEY NOTE LECTURE: Phakic IOLs – Review of published studies
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Authors
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Gerd U. Auffarth
- Universitätsklinik Heidelberg, Direktor der Augenklinik, Heidelberg
| Published: | June 9, 2015 |
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Outline
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Purpose: In addition to the refractive laser surgery of the cornea, the use of so-called phacic lenses has been established in refractive surgery over many decades. Over the many years important insights into the advantages and disadvantages of the lens designs and in particular of the different implantation sites were conducted in different studies.
Methods: So-called phacic anterior chamber (AC) lenses with fixation of the haptics in the AC angle were used for many years and are among the first phacic lenses that were implanted historically.
Phacic lenses are usually used in cases of high grades of ametropia especially high myopia. According to the KRC-guidelines, refractive corneal surgery can be performed up to -8 D to – 10 D depending on the corneal thickness. Higher myopia can be basically only treated by a phacic lens or a clear lens exchange procedure. However, phacic lenses are nowadays at least in Europe and in many parts of the world obsolete. The direct morphologiocal changes of the AC angle, the pupil distortion and in particular the corneal decompensation were recurring problems in spite of refinement of the design and material.
Results: The use of the iris-fixated AC lenses (the iris claw lens) kept going. Experience herewith has extended over 40 years in the field of cataract surgery, and over a long time in the field of refractive surgery. The standard use of iris-fixated lenses was that of the toric version. Also here, a close follow-up of the endothelial cells is necessary due to the vicinity of the lens to the corneal endothelium.
Likewise, the use of phacic posterior chamber lenses has become widespread worldwide due to its elegant simple surgical technique. These are offered as toric lenses. The main risk exists in the cataract formation. Endothelial decompensation is not as important in this case.
Conclusion: All in all, a large variety of phacic lenses were developed in the past 20 years, from which some disappeared from the market. Phacic posterior chamber lenses are the only model ultimately left. A major problem still consists in the treatment of hyperopic refraction states. In this case, phacic lenses are difficult to use.
