Objective: To evaluate the efficacy, safety and stability of three kinds of phakic intraocular lens implantation for the correction of high myopia.
Methods: This study included 208 eyes of 110 patients with a mean age of 31 years (21 - 53) from December 2003 to December 2009. Angle-supported lens (Phakic 6H, OII) were inserted into 113 eyes, iris-fixated lens (Artisan, OPHTEC) were inserted into 53 eyes and implantable contact lens (ICL) (V4, STAAR) were inserted into 41eyes. The average follow-up time of the three groups were 54.0 months (3 - 72 months), 15.7 months (3 - 24 months) and 7.2 months (3 - 15 months) respectively.
Results: At 3 months and 12 months, the efficacy indexes of the three groups were all above 1.00. Only the angle-supported group was followed up to 72 months postoperatively when the efficacy index dropped to 0.85, but still UCVA was 1.0 (20/20) or better in 16% eyes and 0.5 (20/40) or better in 85% eyes. The safety indexes of the three groups were always above 1.00 during the follow up. In the angle-supported group, 46% eyes were within ± 0.50 D of the desired refraction and 68% eyes were within ± 1.00 D at 5 years postoperatively. In the iris-fixated group, 78% eyes were within ± 0.50 D of the desired refraction and 100% eyes were within ± 1.00 D at 1 years postoperatively. In the ICL group, 95% eyes were within ± 0.50 D of the desired refraction and 100% eyes were within ± 1.00 D at 3 months postoperatively. No statistically significant differences were found between preoperative and 3-month postoperative endothelial cell density in the ICL group. Also, there was no statistically significant reduction in endothelial cell density at 1 years in the iris-fixated group. However, when preoperative and 5-year postoperative measurements were compared in the angle-supported group, the total decrease in cell density is statistically significant (t = 9.769, P = 0.000). 16 eyes developed high IOP within 1 month postoperatively which resolved after intervention. In the three groups (angle-supported, iris-fixated and ICL), the most common complications were pupil ovalization, iris atrophy plus pigment dispersion and lens opacification respectively.
Conclusion: Although phakic IOL implantation is predictable and safe for treatment of high myopia in short-term, the long-term complications should be concerned and treated well.
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Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
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School of Applied Psychology & Centre for Mental Health, Griffith University, Mt Gravatt, Australia.
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