Phakic IOLs may make cataract surgery more challenging

For extremely nearsighted patients who are seeking independence from glasses and contact lenses, implantation of a phakic IOL can be a reasonable choice. In the U.S., we have access to two different types of phakic IOLs: anterior chamber iris-clip phakic IOLs and posterior chamber sulcus-fixated phakic IOLs. Both of these options can correct extreme degrees of myopia, as much as –20 D, and they are both designed to stay inside the eye for many years. At some point, however, when a cataract develops, the phakic IOL will need to be explanted at the same time as the cataract surgery. Then a single in-the-bag pseudophakic IOL can be implanted to address the refractive state of the eye. This is more complicated than a standard cataract surgery, and care must be taken at every step in order to achieve the best visual outcome.These thin and flexible phakic IOLs are placed in the posterior chamber and wedged into the ciliary sulcus for stability. The incision from the phakic IOL surgery is typically 3 mm wide or smaller and made in the limbus or cornea. The cataract change can be age-related and unrelated to the phakic IOL, or it can be a direct result of the phakic IOL touching the anterior lens capsule of the crystalline lens, thereby inducing cataractous changes. As the cataract opacity progresses, there can be enlargement of the lens, particularly in the anterior-posterior dimension. This will lead to less space for the phakic IOL and could lead to touch of the anterior lens capsule.