Implantable phakic contact lens: systematic review.

TOPIC

To assess the visual outcome and safety of the (diffractive) implantable phakic contact lens (IPCL). Comparative data to the implantable collamer lens (ICL) will be provided whenever possible.

CLINICAL RELEVANCE

The IPCL is a more recent posterior-chamber phakic intraocular lens (pIOL) which is less expensive, offering a more cost-efficient alternative to the well-known ICL. The IPCL has more sizing options, can be customized to a larger optical zone, and is implanted through a smaller incision than to ICL. For presbyopia correction, the diffractive IPCL is currently the only multifocal posterior-chamber pIOL available.

METHODS

A systematic literature search using PubMed and Google Scholar was performed, and lectures on international conferences were screened for additional data. Only original studies were considered. Prospective registration was performed in PROSPERO (ID 546823).

RESULTS

This review includes 28 articles and 2 lectures. IPCL implantation showed a reliable visual outcome with an efficacy index of 1.06. The average postoperative uncorrected distance visual acuity (UDVA) (0.23 logMAR) is worse compared with the ICL (UDVA -0.01 logMAR) but can be attributed to the suboptimal average preoperative corrected distance visual acuity (CDVA) (0.29 logMAR). The diffractive IPCL, implanted in a presbyopic population (average age 48 years), provided good postoperative UDVA (0.06 logMAR) and uncorrected near visual acuity (0.04 logMAR) with little visual side effects. No data on intermediate vision have yet been published. IPCL implantation is safe with a safety index of 1.23 and a postoperative CDVA (0.13 logMAR) clearly higher than the preoperative CDVA. Cataract formation occurred in 0.46% of IPCL V2.0 cases, and endothelial cell loss was 2.3% 12-month postsurgery, which is comparable with ICL implantation. No cases of acute glaucoma or retinal detachment after IPCL V2.0 implantation were found.

CONCLUSIONS

The (diffractive) IPCL is a promising pIOL, with current published data showing overall good results. Interpretation of the monofocal IPCL is hampered by the suboptimal preoperative CDVA leading to worse postoperative UDVA compared with the golden standard ICL. Direct comparative studies show similar results in both groups. Further research is needed to draw a more definitive conclusion on safety, efficacy, and repeatability of both the monofocal and diffractive IPCL.