Phakic iol surgery in Iran

overview

Phakic intraocular lenses (IOLs), also known as implantable contact lenses (ICLs), are implantable contact lenses that are surgically inserted into the eye where they provide excellent quality of vision with predictable and stable results. The Visian ICL is the latest phakic intraocular lens to receive approval from the FDA for a wide range of myopic (nearsightedness) correction needs. This technology is adapted from the proven lens technology used for cataract surgery, and works by placing the Visian ICL in front of the natural lens inside the eye. The Visian ICL is made of an advanced material that is extremely biocompatible and provides superior optical performance.

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Who are the real candidate:

Young patients who are unsuitable for laser vision correction are often offered PIOL implantation. This is because PIOLs can correct a wider range of spectacle prescriptions than laser vision correction, and may be a safer option if you have pre-existing cornea or eye surface problems.

The procedure:

PIOL implantation is performed using eye-drop anaesthetic supplemented by an injection in the back of your hand to relax you if required. Anaesthetic may also be washed around the back of the eye to prevent excessive eye movement. A spring clip holding the eyelids apart allows you to blink safely during surgery. In all forms of eye surgery, problems can occur during the operation or afterwards in the healing period. Problems can result in permanent, serious loss of vision (vision worse than the driving standard in the affected eye that cannot be corrected with glasses or contact lenses). More commonly, problems can be corrected with changes in medication or additional surgery. Typically, these additional operations feel like the original surgery and have a similar recovery period. Different types of PIOL have different associated risks. Your surgeon will ensure that you are given clear advice relevant to the lens type that is recommended. Loss of vision Permanent, serious loss of vision is very uncommon after ICL implantation.

Causes include damage to the nerve at the back of the eye caused by a sudden rise in fluid pressure within the eye after surgery, and damage to the retina caused by infection or retinal detachment. Sudden pressure rises are much less common with the newer v4c ICL used for treating myopic patients. The v4c ICL allows natural fluid flow through the pupil and does not require a bypass drainage hole in the iris. If pressure rises do still occur, it is normally because of incomplete removal of supporting gel – a problem that can be fixed relatively easily with further washout. All patients with high levels of short sight have a higher risk of retinal detachment. This risk is not increased by ICL implantation, which does not involve surgery to the back compartment of the eye. Infection rates after ICL implantation are very low (approximately 1 in 6000).

Complete loss of vision can occur after any operation involving the inside of the eye; but this is rare after ICL implantation. Although fluid pressure rises and infection can occur after Artisan/Verysise PIOL implantation, the risk of problems leading to visual loss generally relates to later complications, particularly corneal clouding. These problems can often be spotted at an early stage and may be partially or completely intercepted by PIOL removal. Annual review with your eye surgeon for life is normally recommended after Artisan/Verysise PIOL implantation, whereas a standard optometric eye health check once a year is sufficient after ICL implantation for which the main long-term risk is cataract formation. Your surgeon will be looking through a microscope to perform the surgery. You will be lying down under a surgical tent with fresh air coming in underneath. A sticky plastic drape covers the skin around the eye and sticks the eyelashes out of the way. Strong pupil dilating drugs are given as drops or a using a pellet placed under the lower eyelid to prepare the eye for surgery. Essential steps in surgery are:

Entry points – formation of small self-sealing entry points in the front of the eye at the junction of the white of the eye and the cornea
PIOL insertion – injection of the PIOL and unfolding into position using a supporting gel to fill the front of the eye. Sometimes a small bypass drainage hole is formed in the iris at this point, but this additional stage is no longer required for newer (v4c and later) ICLs in myopic patients.
Wash out and refilling – washout of the supporting gel and refilling with fluid and antibiotics. Sutured closure of the eye is often required for Artisan/ Verysise PIOLs

During the surgical procedure?

During an office visit one week before surgery, your ophthalmologist will use a laser to create a small opening between the lens and the front chamber of your eye. This allows fluid to pass between the two areas, thereby avoiding the buildup of intraocular pressure following the surgery.

The implantation procedure itself takes about 15 minutes and is performed on an outpatient basis, though you will have to make arrangements for someone to drive you to and from the procedure.

Most patients experience very little discomfort during the ICL implantation. You will undergo treatment while under a light topical or local anesthetic, perhaps with the addition of a mild sedative. Following surgery, you may use prescription eye drops or oral medication. The day after surgery, you will return to your surgeon for a follow-up visit. You also will have follow-up visits one month and six months following the procedure.

Although the ICL requires no special maintenance, you are encouraged to visit your eye doctor annually for check-ups following the procedure.

Advantages of Phakic Intraocular Lenses

PIOLs are highly effective at treating both high glasses prescriptions and astigmatism. For most patients, vision after PIOL surgery is similar to vision in contact lenses before surgery without the discomfort and limitations on activity.

Able to correct high degrees of nearsightedness that cannot be corrected with other surgical procedures
May be performed in patients who are not candidates for LASIK due to corneal irregularity or thinness
Less likely to cause or contribute to dry eyes
May be surgically removed

Complications:

You may experience infection, bleeding, or severe inflammation (pain, redness, and decreased vision). These are rare complications that can sometimes lead to permanent loss of vision or loss of the eye. Long-term data are not available. Phakic lenses are a new technology and have only recently been approved by the FDA.

Risks

You may lose vision. ...
You may develop debilitating visual symptoms. ...
You may need additional eye surgery to reposition, replace or remove the phakiclens implant. ...
You may be under treated or over treated. ...
You may develop increased intraocular pressure. ...
Your cornea may become cloudy. ...
You may develop a cataract.

10 common question about phakic iol surgery

1Is ICL surgery painful?

You may experience minor discomfort after the procedure. Your doctor may prescribe pain medication to make you more comfortable during the first few days after the surgery.

2What is ICL surgery for the eye?

ICL. The ICL is an implantable lens that works with the natural lens of your eye to improve your vision. During the procedure, the lens is inserted between your iris and your natural lens thru a tiny incision that usually does not require any stitches.

Is ICL surgery permanent? The results of ICL surgery are considered permanent. ... This condition can be treated by cataract surgery. During the surgery, the natural lens, as well as the Collamer lens, will be removed and new intraocular lens will be inserted.

4Is ICL better than Lasik?

No serious complications occurred in either series. CONCLUSIONS: The ICL was safer and more effective than LASIK and seems to be a viable alternative to corneal refractive excimer surgery in the treatment of low myopia.

5What is smile eye surgery?

SMILE is an acronym that stands for “Small Incision Lenticule Extraction” and is the latest advancement in laser vision correction. ... The SMILE procedure is the most cutting-edge laser eye surgery for the correction of myopia (near-sightedness) providing LASIK-like outcomes in a less invasive surgery.

6Is ICL reversible?

Yes, ICL surgery is reversible even though it can do away with your need to wear corrective contact lenses or glasses. ... Although it is rarely necessary, the implantable contact lenses are removable.

7Which is better Lasik or PRK eye surgery?

Though PRK recovery takes a bit longer than recovery from LASIK eye surgery, PRK is still commonly performed and offers advantages over LASIK for some patients. ... The main difference between PRK and LASIK is the first step of the procedures.

8Can I do ICL after Lasik?

Given that the ICL makes available freedom from glasses with a much better quality of life, and even to those in whom LASIK may be contraindicated, it remains a safe and cost-effective option.

9Is Lasik permanent?

In most cases the improved vision LASIK surgery provides is permanent. But in a limited number of cases — usually due to changes that can occur in the lens inside the eye, with or without LASIK surgery — some nearsightedness, farsightedness and/or astigmatism can return over time, causing blurry vision.

10What is the best eye surgery?

LASIK is the best known and most commonly performed. Many articles, including this one, will use the term "LASIK" to refer to all types of laser eye surgery.

Phakic iol surgery in Iran