Phakic IOL Implantation

samar
17 Sep, 2024
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9 Mins Read

IOL is designed to be placed in the ciliary sulcus, which is an anatomical part of the eye.
It is maintaining the physiological function of the eyes as naturally as possible,
and this is the main goal of the Phakic IOL Implantation Training Course: to teach
how to apply these principles to practice.

IOL stands for intraocular lens, and these lenses have been used in cataract surgery for many years,
providing patients with good distance vision, although this is always given to the patients.
But cataract surgery itself makes all the patients reliant on reading specs since it renders
the natural lens far, and the patients lose the ability to accommodate the near vision.

So phakic IOL is different since it is designed to go alongside the natural lens in the eye,
in either the anterior chamber, which is the front part of the eye, or the posterior chamber,
which is behind the iris but in front of the natural lens.

As the Phakic IOL Implantation is a comprehensive training course,
it is broken down into discrete sections.

First, in the introduction to the course, an overview of the course content and importance is provided.
Next, the concept of phakic IOL surgery will be discussed,
followed by indications for surgery and the potential patient selection process.
Well-detailed preoperative assessment and investigation methods are included,
such as anterior chamber depth calculations and endothelial cell density measurements.

The Phakic IOL Implantation aims to consolidate existing knowledge of anterior segment
and refractive surgery and to lead doctors through the process of becoming modern,
independent, and skilled practitioners in the area of phakic IOL surgery and other anterior chamber implants.
By covering in detail many of the aspects of clinical care required before entering a phakic IOL patient
into the operating list, the surgical day itself, and the postoperative management,
it is hoped that you will begin to appreciate just how meticulous you need to be to achieve
successful outcomes in these exciting and life-changing procedures.

In reality, the concept of peripheral anterior chamber lenses has been in existence
in various iterations since the late 1960s.
Over the years, most of the nuances of the original procedure have been replaced with safer
and more predictable surgical techniques, and these advances
have led to a resurgence of interest in phakic IOLs, with very high patient satisfaction rates
being reported with the most modern implant designs.

Purpose of the Phakic IOL Implantation Training Course:

The Phakic IOL Implantation Training Course is to provide instruction and training in the principles
and practice of ocular surgery and in the theoretical and practical aspects of operating
on the human eye for the insertion of a Phakic IOL.

The course will cover both the anterior and posterior chamber phakic IOL implantation
and it is the first in the country to cover the posterior chamber phakic IOL.

Surgeons of the course will gain valuable experience and practice in the theory and method
of phakic IOL, which can translate across the broader spectrum of ocular surgery
and will pave the way for future similar surgeries and new techniques.

Overview of Phakic IOL Implantation Training Course: An Introduction to the Procedure

First, the participants at the Phakic IOL Implantation Training Course will provided with insight
into what a phakic intraocular lens (IOL) implantation is and its unique benefits
in contrast to other vision-improving procedures.

Phakic IOLs are implanted directly into the eye’s posterior chamber, in front of the eye’s natural lens,
and are designed to provide a quality of vision that is comparable to having contact lenses.
Unlike contact lenses, which need to be removed and cleaned regularly,
a phakic IOL is with the patient at all times and cannot be felt.

The Phakic IOL Implantation course will later discuss in more detail its specific target patient population.
As a general rule, phakic IOLs work best for patients who have moderate to severe
myopia and are between 21 and 45 years of age.
Myopia, or nearsightedness, is a condition that leads to greater difficulty focusing
on objects at a distance than those up close.

While several myopic patients can be satisfactorily treated with glasses or contact lenses,
phakic IOLs offer the potential for an unassisted, active lifestyle,
providing independence from glasses and contacts.
This is particularly appealing to patients who lead an active lifestyle or who have occupations
or hobbies that are inhibited by glasses or contacts.

Lastly, The Phakic IOL Implantation course will familiarize participants with the equipment used,
the procedure, informed consent, and some possible complications that may arise from the procedure.

Fundamentals of Phakic IOL Implantation

First, the participants are provided with insight into what a phakic intraocular lens (IOL) implantation
is and its unique benefits in contrast to other vision-improving procedures.
Phakic IOLs are implanted directly into the eye’s posterior chamber,
in front of the eye’s natural lens, and are designed to provide a quality
of vision that is comparable to having contact lenses.
Unlike contact lenses, which need to be removed and cleaned regularly,
a phakic IOL is with the patient at all times and cannot be felt.

The anterior chamber of the human eye is the fluid-filled space inside the eye between
the iris and the cornea’s innermost surface, the endothelium.

This space is most commonly used for the placement of phakic intraocular lenses.
The term “phakic” is used to differentiate intraocular lenses that are placed safely
in the eye in this position from intraocular lenses that are placed in the space left after
removal of the eye’s natural lens during cataract surgery.

The human eye is filled with aqueous humor, which provides the intraocular
pressure to maintain the shape of the eye.
The aqueous humor also helps to nourish the human eye and brings the essential
nutrients to the cells inside the human eye as well as removing the waste product.

The production, movement, and drainage of aqueous humor need to be balanced to maintain
the normal intraocular pressure and ensure that the human eye functions properly.
The inspection results from corneal topography and wavefront aberrometry
can form the basis of the diagnosis and refractive corrections.

It is the first non-laser intraocular refractive surgery introduced in the UK in 2005
and is used for the correction of myopia in patients who are not suitable for laser refractive surgery.

The phakic intraocular lenses are generally contraindicated in patients who have had previous
intraocular refractive surgery and previous corneal laser refractive surgery.

Anatomy of the Eye

The lens is unique amongst the structures in the eye in that it is lacking in blood vessels.
All the nutrients needed to maintain a healthy environment are instead brought in with the aqueous
humor in the anterior chamber and the vitreous in the posterior chamber, as well as the tears in the external eye.

Excess fluid in the eye is drained out through a drainage angle formed between the cornea and the iris.
If this angle closes, the fluid buildup in the eye can cause a sudden increase in pressure and acute glaucoma.

The anatomical wet lab training session forms a major part of the “Phakic IOL Implantation Training Course”.
The wet lab is where trainees will gain some experience in making the main incision
and entering the anterior eye, performing the capsulorhexis, and implanting the IOL.

A corneal section should be placed in such a way that it would avoid the visual axis
of the eye since any scarring of the cornea due to the surgical wound would then not affect our vision.

Indications and Contraindications

During the Phakic IOL Implantation Training Course, it will discuss the Indications and Contraindications

There are certain contraindications for phakic IOL implantation.
For example, patients with a history of ocular disease, such as keratoconus, glaucoma,
uveitis, cataracts, or retinal detachment, may not be the ideal candidates for this procedure.

Other contraindications may include patients with an anterior chamber depth of less than 3.2 mm,
endothelial cell density of less than 2,500 cells per square millimeter,
or optical coherence tomography, or OCT, findings indicating abnormal angle anatomy.
Additionally, the use of phakic IOLs in patients with poorly controlled diabetes,
connective tissue disease, autoimmune disease, taking medications such as corticosteroids
that may induce cataracts, or patients who are pregnant or nursing should be avoided
due to the higher risk of intraoperative and postoperative complications.

The surgeon needs to determine whether the patient is suitable for having phakic IOL implantation,
and not only from the refractive perspective.
That being said, by understanding the refractive, corneal, and ocular biometry findings and thoroughly
assessing the general medical and ocular history of the patients,
the surgeon will be able to provide a more comprehensive assessment for the patients
and better determine the patient’s suitability for phakic IOL implantation.

Complications and Management

Due to the nature of phakic IOL implantation, patients have to make sure that they attend
all follow-up appointments as well as contact their clinicians in case of any problems.

Doctors need to learn how to manage post-operative complications,
in case of any persisting visual problems, the clinicians should diagnose and institute appropriate
management procedures to optimize the visual acuity.
Phakic IOL patients are at risk of developing several complications.

These complications vary significantly and might affect vision in the latter stages.
Good examples of immediate postoperative complications that help define phakic IOL include
severe corneal edema, pupillary block, acute rise in intraocular pressure, and anterior uveitis.

Such conditions must be diagnosed and managed as early as possible to improve the visual outcome.
In many cases, all of the mentioned immediate complications are effectively managed
with drugs and do not lead to serious long-term visual problems.

There are various strategies out there for managing such complications.
For instance, chronic intraocular inflammation can be managed through intensive
use of topical steroids or immunosuppressive agents.

It is there important that clinicians share with patients the different available options
for managing long-term complications to make treatment choices that reflect the patient’s needs.

The Phakic IOL Implantation Training teaches us that in case of any distressing visual symptoms,
clinicians must make an urgent referral to enforce proper management.
Patients must be put on intensive preoperative as well as postoperative control
of intraocular pressure to prevent acute angle-closure attacks.