PHAKIC IOL

AS A NEW OPTION
In High Myopia

Dr. Abizar Iskandar SpM

Lasik & Refractive Surgery Center, Pondok Indah Hospital
Jakarta

Person who wearing thick glasses

Facing some problem
Poor

cosmetic
Minification of images
Aberrations
Heavy load for nose & ear
Limitation of the visual field

The solution is :
RK

Lasik

PRK

PIOL

CLE

Target :
especially for moderate to
high refractive anomally

Every type of surgery has:

Advantages
Disadvantages

RK
Simple

procedures
Not stable
Radial corneal scar formation
Unpredictable

PRK
Not

stable
Scar formation / Haze
Less predictable
High cost investation

CLE
Simple

procedures

Lack

of accomodation

High

incidence of PCO

LASIK
Restricted

of the ability
Depend on corneal thickness
High cost investation
Predictable
Good patient satisfaction

PIOL
Predictable
Simple

procedures

Stable
Low

cost investation
Good patient satisfaction

Base on result :
RK

NO SUCCESS
PRK

Today still approved :

LASIK
CLE
PIOL

PIOL can correction :

Myopia
Hyperopia
Astigmatism

Phakic IOL

PIOL most popular for myopia more

than 10 D

PIOL is implanted lens in front of natural

lens, as a correction refractive anomally

History
Strampelli &Barraquer(1950s):Introduced a
biconcave angle supported lens
Dveli(1980s):Restarted phakic myopia lens
Baikoff(1980s):Angle supported lens with Kelman
type haptics
Jan Worst & Fechner(1986):Phakic myopia lens of
iris claw design
Fyodorov:Introduced implantable contact lens

Phakic IOLs
Anterior chamber angle supported IOL
NuVita

ZSAL-4

Vivarte
I Care
Kelman Duet Vision Membrane

Iris fixated phakic IOL

Verisyse/Artisan
Posterior chamber lens (sulcus fixation)
Staar ICL
PRL (Ciba)

Several product has been launched by

several manufacture
Which one is the best ??
Until nowI dont know

Type of PIOL
1.

Anterior chamber
a.
b.

2.

Angle support
Iris enclavation (verisyse)

Posterior chamber (sulcus fixation)

PIOL (Angle support)

Kelman Duet
Material=Optic:Silicone
Haptic:PMMA
Optic

=5.5mm

Length =12-13.5mm
Power =-8 to 20D

PIOL (Angle support)

Vivarte Foldable IOL
Company=Ciba Vision
Material= Hydrophilic acrylic
Optic=

5.5mm

Length=

12-13mm

Powers=

-7.0 to-25.0

PIOL (Angle support)

The Vision Membrane Lens
Company: Vision membrane
technologies

Material: Silicone
Optic:

7.0mm

PIOL (Angle support)

NuVita Phakic IOL
Company=Bausch & Lomb
Material= PMMA
Optic=

5.0mm

Length= 12to13.5mm
Power=

-3.0to-23.0

PIOL (iris enclavation)

Verisyse phakic IOL

Marketed by AMO as Verisyse & by Ophtec as Artisan lens

Verisyse Lenses
Myopia Models

VRSM 50
Myopia Lens
optic diameter
5 mm
Introduced 1991:
Model 206W
ARTISAN Myopia

VRSM 60
Myopia Lens
optic diameter
6 mm
Introduced 1997:
Model 204W
ARTISAN Myopia

Hyperopia

VRSH 50
Hyperopia Lens
optic diameter
5 mm
Introduced 1992:
Model 203W
ARTISAN
Hyperopia

Posterior chamber lens

Staar ICL
Material=Collagen+Hemacopolymer
-3.0 to 20.0=4.5-5.5=11.5-13.0
+3.0to+17.0=4.5-5.5=11.5-13.0
Sits in the ciliary sulcus

PRL (Phakic Refractive Lens)

Material-Silicone
Single piece
Width=6.0mm
Length=11.3mm
Power=-3.0 to-20.0
PRL myopic lens

Marketed by Ciba vision

PRL hyperopia IOL

Material-Silicone
Single piece
Width=6.0mm
Length=10.6mm
Power=+3.0 to+15.0
PRL hyperopic lens

Indication
18 years old
Stable correction (min. 1 year)
Some problem with glasses and contact
lens
Age

Contraindication :
Any

type of cataract
History retinal detachment
Abnormal pupil, corneal, iris
Endothelial cell count 2000/mm2
Chronic or recurrent uveitis/iritis
Rubeosis iridis
Pupil size > 5 mm (mesopic condition)
IOP > 21 mmHg

Lens Power Calculation

a.
b.
c.
d.
e.
f.

Based on Vericalc 1.1 by AMO

Input data :
Subjective refraction (sphere and cyl)
K. value : K1, K2 and mean value
K Index (1.3315 or 1.3375)
ACD
Scotopic pupil
Vertex distance (standard)

Verisyse Calculation Sample

PIOL Surgery:
Steps :
Small pupil (pilocarpin 2%)
Approach 12oclock
Scleral tunnel
Clear corneal incission

Lens possition horizontal (except PTIOL)

Iris enclavation
Peripheral iridectomy
Corneo scleral suture
Antibiotic/steroid

Instrument for verisyse PIOL

implantation:
Implantation
Verisyse

Forceps

IOL Manipulator
Enclavation Needle
Enclavation Forceps

Instrumentation
Implantation
Forceps

Instrumentation
Enclavation Needle

Instrumentation
Enclavation Forceps

Instrumentation
Verisyse IOL Manipulator

Phakic IOL

Complication
Intra-operative
Early Post-operative
Late Post-operative

Complications
Intra-operative complications:
Endothelial damage
Hyphema
Iridodialysis
Difficult enclavation
Haptic breakage
Lenticular damage

Complications
Early post operative period:

Wound leak & shallow AC

Corneal edema
Iridocyclitis
Pupillary block & iris bombe
Secondary glaucoma
Lens decentration/Dislocation
Infection

Complications
Late post operative period:

Unacceptable residual refractive error

Induced astigmatism
Loss of BCVA
Corneal edema,Bullous keratopathy
Rubeosis iridis
Cataract
CME, Retinal detachment

Result
Generally good

Some expert comment :

PIOL : better than Lasik for higher

myopia
PIOL : give good refractive outcomes
and is very well tolerated
PIOL : long term safety and predictability
PIOL : may help refr. Amblyopia (can use
bellow 18 years old)

Important
Good result also depend on, when performed
by a senior anterior segment surgeon

Suggestion

If you interest ..please try it