Preop and postop imaging vital for phakic IOLs

Preop and postop imaging and endothelial cell counts are vital to check the position and performance of a phakic IOLs, Dr David Hardten told colleagues.

"Why do I use phakic IOLs? Well, it is a very good technique to correct very large errors while retaining accommodation, in both myopia as well as hyperopia," he said.

In general, as was shown in the FDA clinical trial, he said, the results with just minimal imaging, spectral microscopy and central anterior chamber depth, were actually quite good in respect of safety and the effects of the implant, both in clinical trials where phakic IOLs were iris fixated as well anterior chamber implants.

But complications do occur, and imaging can help to minimise the risk of them happening, "Phakic IOLs require the usual refractive work-up including refraction and others," said Dr Hardten. "But you also need the anterior chamber depth, and you should look for it at both the periphery as well as the centre."

Dr Hardten showed the audience how ultrasound with the A-Scan, optics with the Orbscan (Bausch & Lomb) or Pentacam (Oculus), or OCT could provide that information. Other key metrics are the angle-to-angle and sulcus-to-sulcus measurements. Surgeons can use ultrasound, optical or OCT to obtain these figures.

Dr Hardten noted that postoperative imaging was very important too. "Analyse clearance between IOL and endothelium, and between the IOL and the crystalline lens. You also need to check the IOL position in relation to the ciliary sulcus and finally, you must continue with your cell counts."