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      Vertically Fixated Posterior Chamber Phakic Intraocular Lens Implantation Through a Superior Corneal Incision


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          To assess the 1-year outcomes of vertically fixated posterior chamber phakic intraocular lens implantation through a superior corneal incision.


          This pilot study comprised 78 eyes of 53 consecutive patients undergoing vertically fixated implantable collamer lens (ICL) implantation through a superior corneal incision to correct moderate to high myopia and myopic astigmatism. We prospectively determined the safety, efficacy, predictability, stability, and adverse events preoperatively, and at 1 week and 1, 3, and 12 months postoperatively.


          The mean follow-up period was 10.4 ± 5.4 months. Uncorrected and corrected visual acuity were −0.20 ± 0.10 and −0.25 ± 0.07 logMAR, respectively, at 1 year postoperatively. At 1 year postoperatively, 98% and 100% of eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. A nonsignificant change in manifest refraction of −0.01 ± 0.08 D occurred from 1 week to 1 year. The manifest astigmatism decreased significantly, from 0.69 ± 0.73 D preoperatively to 0.21 ± 0.27 D at 1 year postoperatively (Mann–Whitney U test, p < 0.001). No vision-threatening complications occurred at any time in this series.


          According to our experience, the vertically fixated ICL through a superior incision achieved good results, without significant complications. Considering that younger patients requiring ICL surgery tend to have with-the-rule astigmatism, this surgical technique may be a viable option for reducing astigmatism without using toric ICLs.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40123-022-00470-6.

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          Most cited references19

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          Early clinical outcomes of implantation of posterior chamber phakic intraocular lens with a central hole (Hole ICL) for moderate to high myopia.

          To assess the early clinical outcomes of an ICL with a central hole (Hole ICL) implantation for the correction of moderate to high myopia.
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            Posterior chamber phakic intraocular lens implantation: comparative, multicentre study in 351 eyes with low-to-moderate or high myopia

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              U.S. Food and Drug Administration clinical trial of the Implantable Contact Lens for moderate to high myopia.

              To assess the safety and efficacy of the Implantable Contact Lens (ICL) to treat moderate to high myopia. Prospective nonrandomized clinical trial. Five hundred twenty-three eyes of 291 patients with between 3 and 20.0 diopters (D) of myopia participating in the U. S. Food and Drug Administration clinical trial of the ICL for myopia. Implantation of the ICL. Uncorrected visual acuity (UCVA), refraction, best spectacle-corrected visual acuity (BSCVA), adverse events, operative and postoperative complications, lens opacity analysis (Lens Opacity Classification System III), subjective satisfaction, and symptoms. Twelve months postoperatively, 60.1% of patients had a visual acuity of 20/20 or better, and 92.5% had an uncorrected visual acuity of 20/40 or better. Patients averaged a 10.31-line improvement in UCVA, 61.6% of patients were within 0.5 D, and 84.7% were within 1.0 D of predicted refraction. Only one case (0.2%) lost > 2 lines of BSCVA. Gains of 2 or more lines of BSCVA occurred in 55 cases (11.8%) at 6 months and 41 cases (9.6%) at 1 year after ICL surgery. Early and largely asymptomatic, presumably surgically induced anterior subcapsular (AS) opacities were seen in 11 cases (2.1%); an additional early AS opacity (0.2%) was seen because of inadvertent anterior chamber irrigation of preservative-containing solution at surgery. Two (0.4%) late (> or = 1 year postoperatively) AS opacities were observed. Two (0.4%) ICL removals with cataract extraction and intraocular lens implantation have been performed. Patient satisfaction (very/extremely satisfied) was reported by 92.4% of subjects on the subjective questionnaire; only four patients (1.0%) reported dissatisfaction. Slightly more patients reported an improvement at 1 year over baseline values for the following subjective symptoms: quality of vision, glare, double vision, and night driving difficulties. Only a 3% difference between pre-ICL and post-ICL surgery was reported for haloes. The results support the safety, efficacy, and predictability of ICL implantation to treat moderate to high myopia.

                Author and article information

                Ophthalmol Ther
                Ophthalmol Ther
                Ophthalmology and Therapy
                Springer Healthcare (Cheshire )
                4 February 2022
                4 February 2022
                April 2022
                : 11
                : 2
                : 701-710
                [1 ]GRID grid.410786.c, ISNI 0000 0000 9206 2938, Visual Physiology, School of Allied Health Sciences, , Kitasato University, ; 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa 252-0373 Japan
                [2 ]GRID grid.410786.c, ISNI 0000 0000 9206 2938, Department of Ophthalmology, School of Medicine, , Kitasato University, ; Kanagawa, Japan
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                Original Research
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                © The Author(s) 2022

                astigmatism,efficacy,evo-icl,phakic iol,predictability,safety,stability,superior incision,vertical fixation


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