Phakic Intraocular Lenses

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The use of phakic intraocular lenses (PIOLs) is a small but emerging area in refractive surgery. For patients with high myopia and inadequate vision with glasses or intolerance to contact lenses, options are limited. Corneal refractive surgery such as LASIK can safely and reliably correct myopia up to approximately −12 diopters,1,2 but at higher diopters it achieves less satisfactory results along with increased risks of corneal ectasia.3–5 In addition, intraocular lens (IOL) implantation with lensectomy yields loss of accommodation, along with increased risks of retinal detachment in high myopes. The advent of PIOLs offers the possibility of refractive correction without the loss of accommodation. However, their insertion is not without challenges. The incisional surgery required for implantation can lead to complications that include endophthalmitis, induced astigmatism, damage to the corneal endothelium, iris ovalization secondary to ischemia or entrapment, chronic uveitis, pupillary block glaucoma, pigment dispersion syndrome, and cataracts. Other considerations are the special techniques required for lens calculation and surgical lens implantation, usually preceded by peripheral laser iridotomy. Furthermore, because this is still an emerging area of refractive surgery, long-term outcomes are unknown6,7 and data are limited. This article aims to review the most recent reports on the 3 types of phakic intraocular lenses: angle-supported PIOLs, iris-supported PIOLs, and posterior chamber PIOLs.
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