Neuroadaptation Following Posterior Chamber Phakic Iol Implantation In Adult Refractive Amblyopia

To evaluate visual acuity outcomes and functional neuroadaptation following posterior chamber phakic IOL implantation in adults with refractive amblyopia—an uncommon and non-standard indication for refractive lens correction.

Single-center interventional case series, Casablanca, Morocco.

Eight adult patients (14 eyes) with refractive amblyopia and significant anisometropia underwent implantation with Eyecryl Phakic or Eyecryl Phakic Toric IOLs. Preoperative and postoperative assessments included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, vault measurement, rotational stability, intraocular pressure (IOP), and endothelial cell density (ECD). Line gain and binocular functional improvement were analyzed over 3–24 months of follow-up.

Preoperative BCVA ranged from 0.5/10 to 7/10. Postoperatively, UCVA improved to 7–10/10 in most eyes. A gain of 1–2 Snellen lines was observed in the majority of amblyopic eyes, with marked improvement in severe anisometropic cases. No eye lost BCVA. Residual refractive error was generally within ±0.75 D.

Mean 1-month vault was approximately 470 µ (range 420–510 µm), remaining stable over time. Toric rotation was <5°, IOP remained clinically stable, and ECD loss was <3%.In all cases, the postoperative VA ,was significantly superior to the best corrected visual acuity before the phakic implant,highlighting the benefit of reducing aniseikonia and neuroadaptation through the phakic implant, as opposed to other means of ametropia correction.

Although amblyopia is not a conventional indication for pIOL implantation, posterior chamber phakic IOLs demonstrated meaningful visual gain and stable anatomical outcomes in selected cases. Reduction of anisometropia may promote postoperative neuroadaptation and expand the clinical versatility of phakic IOL technology.