Unpredictable Outcomes Post Phakic Iol Implantation

Phakic IOL implantation is a viable option for high myopic errors and has promising visual outcomes. However, despite meticulous pre operative planning and calculations one may encounter unpredictable outcomes post phakic IOL implantation. At such times, it becomes difficult to decide whether to intervene or not. We hereby present a compilation of four such cases and their management.

A Tertiary care centre in North India

Cataract and Refractive Services, Centre For Sight, New Delhi, India

Records of all patient who underwent phakic IOL implantation in the refractive department of our institute in past 2 years (Jan 2021 to Dec 2022) were reviewed. All cases who had any significant finding in the early post operative period in terms of decreased visual acuity, raised intra ocular pressure, findings on Anterior Segment Optical Coherence Tomography (AS-OCT) were included. Those who underwent additional surgical intervention post phakic IOL implantation were also included.

Four eyes of 4 patients were included. Out of the 4 eyes, 1 eye underwent toric phakic IOL implantation and remaining 3 eyes underwent spherical phakic IOL implantation. The eye with toric phakic IOL was found to have  residual cylindrical error in early post operative period. It underwent redialling twice and was ultimately explanted to be replaced with a larger size phakic IOL. Out of the remaining 3 eyee, 1 eye had reverse orientation and required re surgery for proper orientation. One eye had extremely high vault (~ 1200µm) and was kept under observation. One eye had extremely low vault (~ 52µm) and needed phakic IOL explantation with a larger size phakic IOL but still yielding a persistent low vault (136 µm).

Meticulous and accurate measurements are needed while planning a phakic IOL procedure. Despite best efforts one may land up into unpredictable outcomes. Decision to intervene depends primarily on clinical examination and imaging (AS OCT) findings in such cases.