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Original Investigation |

Clinical Outcomes and Cataract Formation Rates in Eyes 10 Years After Posterior Phakic Lens Implantation for Myopia

Ivo Guber, MD1; Victoria Mouvet, MD1; Ciara Bergin, PhD1; Sylvie Perritaz, BScOptom1; Philippe Othenin-Girard, MD1; François Majo, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
JAMA Ophthalmol. 2016;134(5):487-494. doi:10.1001/jamaophthalmol.2016.0078.
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Importance  Intraocular collamer lenses (ICLs) are posterior chamber phakic lenses that provide a refractive surgery option for those with high myopia or astigmatism. The short-term and midterm results indicate good refraction stability, efficacy, and safety. Cataract has been suggested to be an important long-term complication of ICL implantation.

Objective  To report the rates of cataract development and refractive outcomes 10 years after ICL implantation.

Design, Setting, and Participants  The study included 133 eyes of 78 patients undergoing consecutive V4 model ICL implantations, which took place from January 1, 1998, through December 31, 2004, at Jules-Gonin Eye Hospital, Lausanne, Switzerland. Data analysis was performed from January 1, 2014, to May 31, 2014. The lenses implanted were as follows: 53 V4 model ICLs of −15.5 D or greater, 73 V4 model ICLs of less than −15.5 diopter (D), and 7 V4 model toric ICLs for myopia.

Main Outcomes and Measures  Rate of cataract surgery, lens opacity, ocular hypertension, refractive safety, predictability, and stability.

Results  A total of 133 eyes of 78 patients (34 men and 44 women, with a mean [SD] age of 38.8 [9.2] years at enrollment) met the inclusion criteria. The rate of lens opacity development was 40.9% (95% CI, 32.7%-48.8%) and 54.8% (95% CI, 44.7%-63.0%) at 5 and 10 years, respectively. Phacoemulsification was performed in 5 eyes (4.9%; 95% CI, 1.0%-8.7%) and 18 eyes (18.3%; 95% CI, 10.1%-25.8%) at 5 and 10 years after ICL implantation, respectively. The vault height (distance between the posterior ICL surface and anterior lens surface) measured a mean (SD) of 426 (344) μm immediately postoperatively, decreasing to 213 (169) μm at 10 years. A smaller vault height was associated with the development of lens opacity and phacoemulsification (P = .005 and .008, respectively). The intraocular pressure was 15 mm Hg postoperatively, and there was no significant increase in intraocular pressure observed until the 10-year follow-up (16 mm Hg, P = .02). At 10 years, 12 eyes (12.9%; 95% CI, 5.6%-19.6%) had developed ocular hypertension that required topical medication. At 10 years, the mean (SD) safety index was 1.25 (0.57), with a manifest spherical equivalent of −0.5 D at 1-year postoperatively vs −0.7 D at 10 years postoperatively in eyes aimed at emmetropia.

Conclusions and Relevance  This retrospective single center study indicates that ICL implantation provides good long-term safety and stability of refraction in patients with high myopia compared with similar short-term studies. However, the rates of cataract formation and ocular hypertension at 10 years have important clinical implications, and as such this information should be part of the available patient information before ICL implantation.

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Figure 1.
Safety Profile at Each Time Point
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Figure 2.
Kaplan-Meier Curves for the Rate of Lens Opacity and the Rate of Cataract Extraction Over Time
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