Phakic IOLs = long-term failures?

Phakic intraocular lenses (IOLs) have failed to live up to their promise, according to an opinion expressed at this year's meeting of the French Society of Ophthalmology (SFO).

Joseph Colin, MD, president of the SFO, urged caution about the hype surrounding newer models of phakic IOLs, stressing that, despite positive short-term results, these lenses are essentially unproven until long-term results are known.

Dr Colin cited the inauspicious recent history of angle-supported phakic IOLs, including the 2007 market withdrawals of the NewLife (IOLTech/Carl Zeiss Meditech), Vivarte (IOLTech/Carl Zeiss Meditech) and Icare (Corneal) lenses, which were withdrawn because of significant endothelial cell loss, to reinforce his argument. In these cases, complications presented two to three years postoperatively, necessitating explantations in a statistically significant percentage of patients.

Despite these complications, the popularity of phakic IOLs continues to grow. Dr Colin believes phakic IOLs still have a place (particularly among thin cornea patients for whom laser refractive surgery is not indicated) and measures are in place to improve long-term success and avoid complications: postoperative endothelial cell evaluations have now been mandated to allow for timely explantations, for instance, and stringent criteria for patients receiving angle-supported lenses (anterior chamber depth ≥3 mm; corneal diameter ≥11 mm; IOL power ≤20 D).

In spite of these new measures, and the promising short-term results from lenses including the AcrySoft phakic IOL (Alcon) - not just in terms of minimal endothelial cell loss but also in terms of adverse events, stability of refraction and visual acuity - Dr Colin continued to advocate vigilance, saying, "Current models must not be used until the results of retrospective studies provide more reliable information on the safety of these implants."