Pinhole Ic-8 Lens Implant In A Patient With A History Of Radial Keratotomy And Cataract

To describe the visual outcome of IC-8 lens implantation in a patient with a history of radial keratotomy (RK) and cataract, highlighting its pinhole effect in improving visual quality in cases of corneal irregularities.

Cornea Service, Barraquer Ophthalmology Center, Barcelona, Spain.

A 69-year-old female with a history of bilateral RK underwent cataract surgery with IC-8 lens implantation.

Preoperatively, uncorrected distance visual acuity (UDVA) in the right eye (RE) was 0.3, improving to 0.35 with correction (+0.75 D / -0.50 D at 160°). In the amblyopic left eye (LE), UDVA was 0.2. Near vision (NV) was 0.5 in OD and 0.2 in LE with a +3D addition in each eye. Slit-lamp examination revealed 8 radial incisions with a 3 mm central optical zone and a cortical-nuclear cataract with posterior subcapsular involvement in RE and cortical-nuclear cataract in LE. Corneal topography showed flat Ks (mean K-reading of 36.7D in RE and 39.5D in LE) and irregular astigmatism secondary to RK.

The surgery was sequential. In the RE, the IC-8 lens was implanted following phacoemulsification through a 3.5 mm scleral tunnel. One month later, the same technique was performed in the LE without complications. Postoperatively, UDVA in RE reached 1.1 for distance vision (DV), 1.0 for intermediate vision (IV), and 0.64 for NV, improving to 1.0 in NV with a +1.50 D addition. In the LE, UDVA was 0.3 in DV, 0.32 in IV, and 0.2 in NV, improving to 0.32 in NV with a +1.50 D addition. A significant improvement in visual quality was observed, with a reduction in aberrations induced by corneal irregularity.

The IC-8 is a hydrophobic intraocular lens that combines the pinhole optical principle with an aspheric monofocal optic. Its design includes an opaque ring with a 1.5 mm central aperture, allowing only central rays to pass through, thereby reducing optical aberrations associated with corneal surface irregularities. Its implantation represents a viable option for improving visual quality in patients with radial keratotomy and irregular astigmatism. Due to its pinhole effect, it provides increased depth of focus and improved visual quality. This case highlights its usefulness in the visual rehabilitation of patients with corneal alterations induced by prior refractive surgeries.