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  • Refractive Mgmt/Intervention

    Investigators assess the long-term correction of moderate to high myopia using a posterior chamber phakic IOL with a central port design.

    Study design

    This single-site retrospective chart analysis reviewed the 5-year clinical and refractive outcomes in patients who received the Visian V4c implantable collamer lens (ICL; Staar Surgical). Researchers included 83 patients (147 eyes) with a correctable range between -0.50 to -18.00 who had a clear central cornea and an otherwise normal exam. Astigmatism was managed with single or paired penetrating incisions.


    More than 95% of eyes achieved CDVA of 20/25 or better at 1 and 5 years, but there was a reduction in UDVA at 5 years due to progressive myopia. At 5 years, 67.4% of eyes and 90.1% of eyes were within ±0.5 D and ±1.0 D of intended target, respectively, and 25% of eyes improved at least 1 line in CDVA. There were no significant changes in IOP, and there were no cases of induced cataract or clinically significant loss of endothelial cell density. The mean vault had a reduction of 58.30 microns from 1 to 5 years, which was statistically significant.


    Of note, this was a chart review performed at a single site with only 1 experienced surgeon. Although there were no adverse events reported, it is important to remember that the surgery was performed by an experienced surgeon and there may be a learning curve for less experienced surgeons should lens becomes available in the United States. In addition, there was a wide range of refractions and anterior chamber depths, which the authors chose not to stratify.

    Clinical significance

    The ICL is an important option for refractive surgeons when treating moderate to severe myopes especially when they may not be a candidate for another refractive procedure. The rate of cataract or other complication with the version available in the United States is low, assuming proper sizing and well-placed peripheral iridotomies or iridectomies, but it is not zero. The findings here suggest that the newest iteration of ICL may offer even lower complication rates than the ICLs that are currently available on the market.