Phakic Intraocular Lenses

Phakic IOLs (intraocular lenses) are an alternative to LASIK and PRK eye surgery for
correcting moderate to severe myopia (nearsightedness), and in some cases produce better
and more predictable vision outcomes than laser refractive surgery.
Phakic IOLs are clear implantable lenses that are surgically placed either between
the cornea and the iris (the colored portion of your eye) or just behind the iris, without removing
your naturallens. Phakic lenses enable light to focus properly on the retina for clearer vision
without corrective eyewear. Implantable lenses function like contact lenses to correct
nearsightedness. The difference is that phakic IOLs work from within your eye instead of sitting
on the surface of your eye. Also, phakic IOLs offer a permanent correction of myopia, unless the
lens is surgically removed. Unlike contact lenses, you can't feel a phakic intraocular lens in your
eye (much like you don't feel a dental filling for a cavity) and, apart from regular eye exams,
phakic IOLs typically do not require any maintenance.

Three types of Phakic IOLs are currently available:

 Angle-Supported - These lenses are called angle-supported because the footplates of the
lens rest in the irido-corneal angle.


 Iris-Fixated - is fixated to the anterior iris surface by enclavation of a fold of iris tissue into
the two diametrically opposed claws of the lens. The fixation sites are located in the
midperiphery of the iris, which is immobile during pupillary movement.


 Implantable Collamer Lens - is a soft, flexible gel-lens used in refractive surgeries for the
permanent correction of myopia (nearsightedness),

 .
Indication

 Myopia (Near-sightedness)
 Hyperopia (Far-sightedness) still being studied

Contraindication

 Uveitis
 Stable refraction for at least 6 months
 21 years of age or younger
 Disease or medications that may affect wound healing. (e.g. SLE, RA, HIV, Steroids, etc)

Procedure

The procedure is performed under local anesthesia with the patient awake throughout
the operation. The flexibility of the ICL enables the lens to be rolled for insertion into the soft
silicone tip of the micro incision injector through a very small incision (2.2mm) thus avoiding the
need for stitches. Once injected, the ICL unfolds in the eye and the haptics are gently pushed
under the iris with a blunt spatula. A peripheral iridectomy is performed to prevent pupillary
block and finally the wound is hydrated.

This procedure usually takes less than 30 minutes in the hands of an experienced
ophthalmologist.

Prior to the surgery, the ICL must be loaded into the microinjector cartridge. The lenses
are checked under an operating microscope to ensure correct anterior-posterior orientation
before they are loaded into the injector with the dome side of the lens facing up to avoid
damage to the haptic legs.

Following the procedure, most people have immediate use of their eyes. The full
recovery period is typically 1–2 days with minimal discomfort and most people are able to go to
work the next day. After surgery, the common advice is to avoid driving home and to visit the
attending ophthalmologists regularly for several months so as to monitor the implants.
Possible Risk

 PIOL dislocation or decentration – These can happen when eye is subjected to jarring or
sudden trauma.

 Glare and halos – These mostly occurs in patients with larger pupil diameters.

Nursing Management

Preoperative stage:

1. Encourage patient to verbalize feelings to the unfamiliar procedure, to take action

on anxiety and provide support
2. Assess and supplement the patient’s level of understanding regarding the
upcoming surgical procedure and other necessary information.
3. Edify the importance of compliance to prophylactic antibiotics to prevent infection
and/or anti-inflammatory drops to prevent inflammation to put in your eye for a
few days before surgery.

Postoperative Stage:

1. Instruct the patient to Protecting the eye from injury: Patients should use
protective goggles during the day and a protective shield at night, if available.
Assist patient in applying eye drops to avoid hitting the eye and other
complications.
2. Aid and instruct client in the cleaning of the eye; the corners of the eye and the
surrounding area may be cleaned with sterile cotton swabs. Remind patient to be
careful when bathing, so as not to spill bathing water into the eye.
3. Reassure patient that there are restrictions for activities such as watching
television or reading are indicated. It is optimal for the patient to use the operated
eye/s as normally as possible to aid in evaluating its effectiveness and monitor
for aberrations or complications

Sources:
o Lovisolo, CF; Reinstein, DZ (Nov-Dec 2005) “Phakic Intraocular lenses” Survey
of ophthalmology vol.50 is.6 pgs.549-587.
o Azar, DT; Gatinel, D (2007) Refractive surgery (2nd ed.). pp. 397–463.
o Yanoff, M; Duker, JS (2009). Ophthalmology (3rd ed.) pp. 186–201
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