Phakic lens implantation: Indication, technique, complications &; management by dr suresh k pandey ; dr vidushi sharma suvi eye institute kota india

1. 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

2. Kota Divisional Ophthalmic Society (KDOS)
Kota, Rajasthan, India, July 16, 2016

3. The authors have
no financial interest in
the subject
matter of this
presentation

4. Spectrum of Refractive Surgeries
REFRACTIVE SURGERIES
CORNEA BASED LENTICULAR BASED COMBINED(BIOPTICS)
-R.K.
-PRK
-LASIK
-EPILASIK
-LASEK
-Conductive
Keratoplasty
-Corneal
Inlays and
rings
-Clear Lens
extraction for
myopia
-Phakic IOL
(ICL/IPCL/EPL)
- PreLex Clear
Lens Extraction
with use of
Multifocal/Toric
MF IOL
Combination
of the two

5. 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)

6. 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

7. 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

8. 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 <480µ
 Cornea not too flat or steep.<36D
or>49D(Poor Optics).

9. Currently Available Phakic IOLs
 ICL (Visian- Centraflow Technology)
 IPCL (Care Group, India)
 Phakic Lens (Eyecryl, Biotech)
 RIL- Refractive implantable Lens (Appasamy)

10. 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

11. 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

12. 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

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

14. WHITE TO WHITE
MEASUREMENT

15. SULCUS TO SULCUS
MEASUREMENT (UBM)

16. 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

17.  VIDEO LINKS:
Implantable Collamer Lens (ICL)
https://www.youtube.com/watch?v=2y0
PfTEAywc
IPCL- Care Group India:
https://www.youtube.com/watch?v=La7
m9mjoLpY
Presbyopic Multifocal Phakic Lens:
https://www.youtube.com/watch?v=-
9USKyDw_9o
Phakic IOLS: Surgical
Technique

18. 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)

19. 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

20. 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

21. 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

22. 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

23. Increase Phakic Lens Vault
 Causes-
 Oversized Phakic Lens
 Sequale
 Glaucoma
 Management
 Phakic Lens
explantation and
Exchange (0.25
Micron= 150 Microns)

24. Decrease Phakic Lens Vault
 Causes-
 Undersized Phakic
Lens
 Sequale
 Anterior subcapsular
cataract
 Management
 Phakic Lens
explantation and
Exchange (0.25
Micron= 150 Microns)

25. Phakic Lens Explantation/Exchange

26. 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.

27. 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