Insertion of Phakic IOL

What is it?

Insertion of intraocular phakic IOL is contemporary refractive surgery method, which frees the person from the need of wearing eyeglasses or contact lenses. Artisan/Artiflex IOLs are among the most widely used and most safe models of phakic IOLs. These IOLs enable to correct short-sightedness up to -23.0 dioptres and long-sightedness up to +10 dioptres. Also toric variants of these IOLs are available that simultaneously correct astigmatism up to 7 dioptres. Insertion of phakic IOL is most suitable option in patients below 40 years with short-sightedness over -8 dioptres, or in people with less pronounced short-sightedness whose corneal thickness is too small for laser correction. The suitability of a person for this type of operation will be ascertained by the consulting ophthalmologist during the visit. More information can be also found from the manufacturer’s homepage

What has to be taken into account?

In order to ensure the adequacy of the measurements done at pre-operative visit the patient should refrain from wearing soft contact lenses for at least two weeks before the planned visit. Suitable candidate for Artisan/Artiflex IOL should be in good general health and without eye diseases, except for short-sightedness or long-sightedness. Pregnancy, diabetes and chronic diseases are contraindications for phakic IOL insertion.

What will happen during the surgery?

During the operation Artisan/Artiflex IOL will be attached to the iris by pulling the iris fold through the lens clamp at two fixation points. Thus phakic IOLs will be inserted in front of the pupil between natural lens and cornea. The surgery will be performed under local anaesthesia (usually with injection) and lasts for about 8-15 minutes.

For the insertion of Artisan IOL some sutures will have to be inserted to the wound through which the IOL is introduced into the eye. These sutures will be removed after 1-2 months. Artiflex IOL can be folded; therefore, it can be introduced into the eye via a much smaller wound that usually does not need sutures. Artiflex IOL is more contemporary of the two models – vision acuity can be forecasted more exactly after the operation thanks to the smaller wound and there is also less risk for the eye in case of traumas. The eyes are usually operated with 1-7 day.

It is necessary to use anti-inflammatory eye drops for 4 weeks after the surgery. There are also limitations for physical activities during the same period (going to sauna, swimming in the swimming-pool and engaging in excess physical exercise). As with all surgical operations, the insertion of Artisan/ArtiflexIOLs can be associated with certain adverse events complications.

Most likely possible complications

  • Temporary increase of intraocular pressure that can usually be prevented.
  • Intraocular infection (no cases of infection resulting in loss of vision has been reported in patients who have undergone the insertion of Artisan IOL, but such possibility cannot be excluded).
  • Retinal detachment. This is condition that occurs approximately 40 times more often in people with short-sightedness in comparison with people with normal vision. This may be caused by ocular trauma, but the risk for the occurrence of this complication increases with every intraocular operation. Insertion of phakic IOL increases the statistical risk of the retinal detachment by about 0.5%. Retinal detachment can be treated with appropriate surgical procedure, but the results of this operation depend upon the form of the disease and timing of the operation. Often retinal detachment is associated with at least partial loss of vision.
  • Inflammation of the iris that can be treated with more intense treatment scheme if the patient does not have any predisposing general disease.
  • Bleeding from the iris or from the operation wound in early postoperative period. This does not pose any serious risks for the vision.
  • Development of cataract in case of complicated surgery. Cataract requires surgical treatment, but no cases have been reported after the insertion of Artisan/Artiflex IOLs.
  • Changes in pupil diameter or shape (e.g. oval pupil).

Possible adverse events

Although the quality of vision after the successful insertion of phakic IOL is generally very good, certain vision disorders are possible in dim light including halos (halation around the image of the source of light) or flashes of light in case of rapid change of vision direction. Such adverse events have been described in about 20% of patients, but have disappeared in practically all patients within 6 months after the surgery. The probability of their occurrence depends upon the pupil diameter and can be predicted to the patient by consulting ophthalmologist. Although Artisan/Artiflex IOL is invisible for the other people, an observant person may notice unusual reflection in certain light.

NB! Artisan/Artiflex IOL might become loose from its fixation points in case of ocular trauma. This may be recognized by abrupt decrease in vision acuity and it has to be reported to the ophthalmologist immediately. Additional lens can be reinserted in case of immediate surgical intervention. However, delayed reporting of the condition can cause irreversible corneal damage.

The advantage of additional lens insertion in comparison with laser surgery is that the condition is reversible, i.e. that the lens can be removed from the eye in case of problems.

Important information

Good vision achieved with the insertion of phakic IOL does not free from the need of using reading glasses when reaching at appropriate age (about 40-45 years of age). In the event that cataract or dimming of the lens develops in advanced age, both natural lens and phakic IOL have to be removed and replaced by another type of artificial lens. The information above does not include all possible complications or adverse events. Although phakic IOLs of this type have been inserted for more than 20 years globally, it does not preclude the occurrence of some unknown factors in the future. In spite of the fact that the statistical results of phakic IOL insertion surgeries are very good, we cannot guarantee that your vision acuity without correction would be 100% after the operation.

The operations are performed by surgeon Inger Heleen Viikna