• Written By:
    Cataract/Anterior Segment, Refractive Mgmt/Intervention

    This large prospective case series assess factors relating to explantation of iris-fixated phakic IOLs.

    Study design

    Researchers followed 1,037 cases performed by a single surgeon and generated survival curves for iris-fixated phakic IOLs. Patients received an iris-fixated Artisan or Artiflex phakic IOL at a single clinic in the Netherlands between 1998 and 2016. The mean follow-up time was 13 years.


    The explantation rate was 12% after a mean of 166 months, most often due to cataract (59%) or endothelial cell loss (32%). Statistically significant risk factors were a higher preoperative age (HR 1.07/year), longer axial length (HR 1.10/mm) and smaller anterior chamber depth (HR 4.47/mm). The authors noted a steep increase in explantation rates after 10 years.


    This case series combines the outcomes of multiple different iris-fixated phakic IOLs (rigid myopic, rigid hyperopic, rigid toric, flexible myopic, and flexible toric). The paper displays survival curves, but it is not clear how it derives them given the low percentage of explanted eyes.  Loss of patients to follow up was not addressed.

    Clinical significance

    By extending the postoperative follow up of iris-fixated phakic IOLs to longer than 10 years for a significant number of patients, this study provides valuable information on the long-term complications of this technology.