Accurate sizing, patient selection make phakic IOLs safer than laser, surgeon says

TOKYO — Phakic IOLs, including the Visian ICL from STAAR Surgical, present many advantages over corneal surgery, from better predictability to higher quality of vision and better safety, because they leave the cornea untouched and avoid the risk of ectasia, according to one surgeon.

“Implantation is technically demanding, and inaccurate surgery is, in fact, a major risk factor for complications, but when we tell our patients that laser is not surgery and has no risks, we are misleading them,” Alaa El Danasoury, MD, said at the World Ophthalmology Congress.

Alaa El Danasoury

The success of phakic IOLs closely depends on careful selection of the eyes suitable for the procedure. Anterior chamber depth should mandatorily be between 2.8 mm and 3 mm and endothelial cell density not less than 2,200 cells/mm² to 3,000 cells/mm² at the center of the cornea.

“We have seen cases of endothelial decompensation, the worst threat even after 10 to 15 years. However, when we measured anterior chamber depth, it was not adequate in most of these cases,” El Danasoury said.

Sizing is also crucial, and current technology now allows for accurate sulcus-to-sulcus and white-to-white measurements.

Cataract formation, a major threat with posterior chamber phakic lenses, has decreased considerably as a complication due to the central hole of the V4c model of the ICL and subsequent better aqueous flow.

“In my hands, the rate of cataract following ICL implantation is less than 0.5%,” El Danasoury said.

“I now use these lenses not only for high, but also for mild to moderate myopia, and the toric model for astigmatism,” he said.

Disclosure: El Danasoury is a consultant to STAAR Surgical and Nidek.