Phake implant – Myopic implant – ICL
Phakic implants, or phakic artificial lenses (ICLs or IPCLs), are soft polymer or silicone lenses permanently implanted in the eye to correct vision. Phakic implants are often called myopic implants because their primary use is correcting myopia that is not a candidate for laser surgery. They eliminate the need for glasses or contact lenses. The term "phakic" refers to implanting the lens in the eye without removing the natural lens. The procedure involves making a 2.8 mm incision to insert the custom-calculated and ordered corrective lens. The lens is placed behind the iris, is invisible, and stabilizes automatically. The procedure takes only a few minutes under local anesthesia in the operating room. It corrects myopia and astigmatism that cannot be corrected with laser surgery. Visual recovery is rapid, and the after-effects are painless.
What are phakic implants?
Phakic implants are soft artificial lenses designed to correct vision problems normally corrected with glasses or contact lenses. Therefore, after phakic implant surgery, you no longer need to wear your corrective lenses, as they are directly integrated into your eyes.
The refractive errors corrected are myopia and astigmatism. Hyperopia and presbyopia can also be treated, though less frequently.
There are two companies in the world that manufacture this type of implant. They are marketed under the names ICL and IPCL.
What do phakic ICL implants treat?
Phakic lenses are used to correct refractive errors that are not suitable for laser techniques. They modify the eye's focusing power so that images are projected sharply onto the retina.
Phakic implants correct:
Myopia – Including extreme (up to – 28 D).
Astigmatism.
Hyperopia.
They even compensate for presbyopia (IPCL multifocal model).
Why choose phakic implants?
It's important to understand that this procedure should be considered as a therapeutic option after laser techniques, if these are not feasible. Surgery is more invasive and more expensive. Phakic implants should be considered in cases of:
Myopia greater than -10.
Cornea too thin for laser treatment.
Corneal scar contraindicating any laser surgery.
Astigmatism that is too irregular for laser treatment.
Why do we talk about a myopic implant?
The primary indication for phakic implants is high myopia that cannot be corrected with laser surgery. This is precisely why they were developed. Improvements in the manufacturing process have allowed their use to be extended to astigmatism, hyperopia, and presbyopia.
Eligibility for ICLs
To undergo phakic implant surgery, you must meet certain conditions:
The first is not being eligible for a laser technique.
Must be at least 25 years old.
The space between your cornea and your lens must be sufficient to allow the implant to pass through.
Your cornea should not show any signs of premature aging such as Fuchs' dystrophy.
You must not have glaucoma or ocular hypertension.
Your expectations must be in line with the desired final results.
You must understand the post-operative procedures and agree to comply with the planned treatments and check-ups.
Contraindications and ineligibility
Some patients have contraindications to refractive surgery with phakic implants. These include people who have:
An unstable (changing) refractive error – particularly progressive myopia.
Significant amblyopia – Vision limited to 8/10 with correction.
Endothelial cell deficiency – Guttata
Uncontrolled diabetes – Note well, well-controlled diabetes is not a contraindication.
Advanced or unstable glaucoma.
A cataract – In this case, it is better to operate on the cataract.
an ongoing pregnancy or breastfeeding.
An active eye infection.
Your ophthalmologist will discuss with you the indications and contraindications for surgery after a thorough examination.
Pre-operative assessment and examinations
To determine if you are a candidate for phakic lens implant surgery, your ophthalmologist will examine your eyes. Here's what will be done:
Refraction – Measurements will be taken of your eyes and glasses.
Clinical examination – Dry eye, cataracts or fundus abnormalities will be sought.
Topography – Measurements with 3D reconstruction of your cornea and lens allow us to calculate the space in your eye.
Biometrics – Measurements such as those used for cataract surgery allow the size of the implant (width) to be calculated and its future positioning to be estimated.
Specular microscopy – Your cornea, and especially its deepest layer called the endothelium, is assessed to look for any degeneration that would be aggravated by the operation.
Cycloplegia – Refraction will be controlled with drops that relax accommodation (Skiacol) to ensure perfect correction.
Procedure for phakic implant placement
Before the operation
The goal of any refractive surgery is to meet your visual expectations and needs. The pre-operative consultation will be the time to ensure that your needs and expectations are well aligned with the surgical technique.
At the end of the consultation, the secretary will give you a consent form, a quote, an anesthesia consultation date and an operating date for each eye (2 hospitalizations spaced 7 days apart on average).
Once the upfront payment for the implant has been made, the surgeon will order it from the manufacturer. Delivery can sometimes take several weeks.
Here are some recommendations:
Contact your health insurance provider and assess their potential contribution to the reimbursement. Social security does not cover any costs.
Take 2 to 3 days off work after the operation; no sick leave will be issued as this is considered “functional” surgery.
Arrange for someone to accompany you after the operation.
Purchase the post-operative treatments a few days before the procedure so that you can start them as soon as you return home.
Be sure to attend your anesthesia consultation.
The day before the operation, remove your makeup carefully.
On the day of the procedure, wash your face with soap and water. Do not wear makeup, not even foundation on your cheeks!
Do not tie your hair up or make a low ponytail.
During phakic implant placement – Procedure
Phakic lens implantation is usually performed at the clinic, where the ophthalmologist performs their usual surgeries. The procedure typically lasts about 10-15 minutes. Here's what you can expect:
Your eye will be anesthetized with drops, the operation will be painless.
If necessary, the anesthesiologist will administer sedation to help you relax.
The operation takes place with the patient lying on their back.
Your ophthalmologist will place a blepharostat (eyelid speculum) to keep your eyes open.
A 2.8mm incision is made at the outer corner of your eye.
The phakic implant is injected folded using a specific injector.
It is then slipped behind the iris to stabilize itself.
An antibiotic is instilled into the eye (Cefuroxime) to reduce the risk of infection.
The incision is self-sealing, meaning it does not require stitching.
The same procedure will be performed the following week on the other eye.
Post-operative and recovery after phakic implants
Recovery after phakic implant surgery is relatively quick. Here's what will happen after the operation:
Arrange for someone to accompany you home, as the anesthesia products may cause fatigue or nausea.
A post-operative check-up is scheduled for the day after the operation and before the second eye.
Do not return to work immediately, but 2 to 3 days after the operation.
Avoid exercise for the first 7 days.
In the first few days, you may feel a sensation of discomfort or a foreign body on the operated eye; this is a minor irritation.
Start treatment a few hours after the operation.
Pre-prescribed painkillers will help you cope with the discomfort.
Hypotonic treatments (Diamox) may make you tired and cause some tingling.
Your vision will improve the very next day. It will take approximately one week to stabilize.
What are the advantages of phakic implants?
Phakic implant surgery simply involves integrating the corrective lenses you wear with glasses or contact lenses directly into your eyes. While the technique may seem more invasive, it offers numerous advantages:
Unlike with laser, there is no risk of corneal ectasia or dry eye.
No halos of light, whereas they are almost systematic in cases of high myopia and laser surgery.
The treatment possibilities are more extensive than with laser (myopia up to -28 diopters)
What are the risks of ICL implants, also known as myopic implants?
Like any surgical procedure, ICL implantation carries certain risks. However, these are different from those of laser refractive surgery.
Over- or under-correction – Residual myopia, hyperopia, or astigmatism remains. This can be corrected with glasses, contact lenses, implant replacement, or laser surgery.
Irritation and photophobia – These symptoms are benign and subside quickly after the procedure.
Ocular hypertension and glaucoma – An implant that is too large can be responsible for an angle-closure crisis and acute glaucoma.
Endophthalmitis – Very serious, this is an infection inside the eye requiring hospitalization.
Retinal detachment – This is a theoretical risk, but myopic eyes have a fragile retina and a risk of detachment inherent to their myopia.
Cataracts – Implantation of a phakic lens accelerates the onset of cataracts. The lens will be removed approximately 15 years after the surgery and the cataract has been treated.
Irreversible visual impairment is rare in refractive surgery. However, it is slightly more frequent when phakic implants are placed.
Frequently Asked Questions
Can phakic implants be removed?
Yes! Phakic implants are intended to remain in the eye permanently; however, in case of poor tolerance, they can be removed.
What is the difference between a phakic implant and a cataract?
Phakic intraocular lenses are implanted in the eye without removing the natural lens. In contrast, cataract implants are implanted in the eye after the removal of the cloudy natural lens (cataract), during phacoemulsification (cataract surgery).
How do ICL phakic lenses work?
Phakic implants function like soft contact lenses that are put in and taken out morning and night. They are essentially diopters that refocus the light beam onto the retina.
In the case of myopia, the beam is diffractive, the image is pushed back because the eye is too strong.
In the case of hyperopia, the beam is refractive, the image projection is advanced because the eye is too weak.
In the case of astigmatism, the beam is “re-axed” because the beam is distorted along an axis of vision.
In cases of presbyopia, multiple focal zones are created in distance, intermediate and near vision in order to compensate for the loss of accommodation.