Implantable Phakic Contact Lens: A Systematic Review.

Abstract

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 intra-ocular 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 done in PROSPERO (ID 546823).

Results: This review includes 28 articles and two lectures. IPCL implantation showed a reliable visual outcome with an efficacy index of 1,06. The average post-operative UDVA (0,23 logMAR) is worse compared to the ICL (UDVA -0,01 logMAR) but can be attributed to the suboptimal average pre-operative CDVA (0,29 logMAR). The diffractive IPCL, implanted in a presbyopic population (average age 48 years), provided good post-operative UDVA (0,06 logMAR) and UNVA (0,04 logMAR) with little visual side effects. No data on intermediate vision has yet been published.IPCL implantation is safe with a safety index of 1,23 and a post-operative CDVA (0,13 logMAR) clearly higher than the pre-operative CDVA. Cataract formation occurred in 0,46% of IPCL V2.0 cases and endothelial cell loss was 2,3% 12 months post-surgery, which is comparable to ICL implantation. No cases of acute glaucoma or retinal detachment after IPCL V2.0 implantation were found.

Conclusion: 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 pre-operative CDVA leading to worse post-operative UDVA compared to 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.