Visual And Refractive Outcomes Of Posterior Chamber Phakic Intraocular Lens Implantation In Myopic Eyes: A 3-Month Initial Experience

To report early visual and refractive outcomes, safety and practical surgical insights from the initial experience with posterior chamber phakic IOL (P-IOL) implantation in myopic eyes

Single-center, Tertiary eye care hospital, North India

This retrospective case series included 18 eyes of 9 patients with myopia −3.75 to −10.00 D who underwent EVO+ Visian Implantable Collamer Lens implantation for myopia & myopic astigmatism by a single surgeon.13 eyes received toric lens and 5 eyes non toric lens.Patients unsuitable for corneal refractive surgery or preferring lens-based correction were included.Exclusion criteria was inadequate anterior chamber depth (ACD), corneal or retinal pathology,glaucoma and age <21 years.Preoperative evaluation included UDVA,CDVA, manifest refraction,corneal topography,pachymetry and ACD measurement using Anterion.Lens sizing was based on white-to-white measurements.Postoperative assessment included UDVA, CDVA, refraction and IOP up to 3 months.

Most eyes achieved UDVA 6/6 on POD1, maintained at 1 month.At 3 months, refractive predictability was high;two eyes had mild residual error.Two patients lost to follow-up after 1 month.CDVA was maintained or improved in most, though eyes with complications had variable outcomes.Four eyes had complications:one early endophthalmitis (vision FC 2 m on POD2, improved to 6/18 post-intravitreal antibiotic injection and 6/6 by 1 month),one raised IOP due to malpositioned ICL haptic(6/12p on POD1, 6/6 at 1 month after repositioning),one eye with a small Descemet detachment during lens manipulation and one eye with air bubble under lens causing mild rotation (6/9 on POD1, 6/6 with correction at 1 month).No long-term sight-threatening sequelae seen.

P-IOL implantation provides excellent early visual recovery and favorable short-term refractive outcomes in low to high myopia. This initial experience highlights key surgical considerations to optimize outcomes and reduce learning curve related complications such as thorough viscoelastic removal to prevent IOP rise, early recognition,referral and management of intraocular inflammation and infection,adequate viscoelastic use during lens manipulation to avoid corneal touch and using irrigation rather than instrumentation beneath the lens for management of trapped airbubbles.Awareness of these practical strategies may enhance safety and efficiency for surgeons adopting this procedure. Larger studies with longer follow-up are warranted.