La chirurgie des amétropie n'est pas toujours possible avec les laser modernes. On se tourne alors vers les implants qui peuvent corriger de fortes amétropies avec ou sans astigmatismes ou des patients avec des cornées a risques.

1. Cataract Surgery
Dr B Farpour
Geneva 2017
www.visionlaser.ch
Phakic Intra Ocular Lenses (IOLs)
Geneva refractive public education lectures
Courtesy of AAO
presentation support

2. Phakic IOLs
• Light rays enter the eye through
the clear cornea, pupil and lens.
• These light rays are focused
directly onto the retina, the light-
sensitive tissue lining the back of
the eye.
• The retina converts light rays into
impulses, sent through the optic
nerve to your brain, where they
are recognized as images.
• 70% of the eye's focusing power
comes from the cornea and 30%
from the lens.
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How the eye works
Eye anatomy

3. Phakic IOLs 3
How the eye works

4. Phakic IOLs
Refractive errors
• Inability to see clearly is often caused by refractive error.
• Four types of refractive error:
 Myopia (nearsightedness)
 Hyperopia (farsightedness)
 Astigmatism
 Presbyopia
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5. Phakic IOLs
• In myopia (nearsightedness),
there is too much optical
power in the eye.
 The distance between the
cornea and the retina may be
too long or the power of the
cornea and the lens may be
too strong.
• Light rays focus in front of the
retina instead of on it.
• Close objects will look clear,
but distant objects will appear
blurred.
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Refractive errors: myopia
Myopia, or nearsightedness

6. Phakic IOLs
• In hyperopia (farsightedness),
there is too little optical power.
 The distance between the
cornea and the retina may be
too short.
• Light rays are focused behind
the retina instead of on it.
• In adults (but not children),
distant objects will look clear,
but close objects will appear
blurred.
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Refractive errors: hyperopia
Hyperopia, or farsightedness

7. Phakic IOLs
• In astigmatism, the cornea is
curved unevenly — shaped
more like a football than a
basketball.
• Light passing through the
uneven cornea is focused in
two or more locations.
• Distant and close objects may
appear blurry.
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Refractive errors: astigmatism
Astigmatism occurs when light passes
through an uneven cornea.

8. Phakic IOLs
• Presbyopia is a normal
condition in which your eyes
gradually lose the ability to
focus on things up close.
• When we are young, the lens
in our eyes is flexible and is
able to change focus easily
between near and far objects,
like an autofocus on a camera.
• At around age 40, this
flexibility naturally begins to
gradually decrease, making it
more difficult to see objects up
close.
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Refractive errors: presbyopia

9. Phakic IOLs
• Refractive surgery is a group of outpatient surgical procedures used to
alter how your eye focuses light rays on the retina, thereby improving
vision and reducing dependence on glasses and contact lenses.
• In most cases, refractive surgery affects the shape of your cornea to
redirect how light is focused onto the retina. Popular procedures include
LASIK, LASEK and PRK.
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What is refractive surgery?
Refractive
surgery
procedure on
the cornea

10. Phakic IOLs
What is refractive surgery?
• Most refractive surgery is performed on the cornea and affects only
the front of your eye, while the rest of your eye will change naturally
as you age.
• In some cases, refractive surgery procedures don’t reshape the
cornea; instead, the eye’s natural lens is either replaced or
enhanced by an implantable lens that helps correct vision.
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11. Phakic IOLs
• The word “phakic” describes the state of
the eye that still has its natural
(crystalline) lens intact.
• A phakic IOL, sometimes known as an
implantable contact lens (or ICL), is
used to treat high degrees of
nearsightedness (myopia).
 Studies are ongoing to evaluate the
treatment of farsightedness (hyperopia)
and astigmatism with the phakic IOL as
well.
• The eye’s natural lens is not removed,
so patients can retain their pre-existing
ability to focus.
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What is a phakic intraocular lens (IOL)?
Two types of phakic IOLs

12. Phakic IOLs
How is the phakic IOL procedure performed?
• The procedure is performed in a surgical suite.
• A light sedation is usually offered for anxiety.
• The entire procedure usually takes 10 to 20 minutes.
• Anesthetic eyedrops are instilled prior to surgery.
• A laser peripheral iridotomy (LPI) is performed prior to surgery to
ensure normal fluid flow inside the eye following phakic IOL
insertion.
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13. Phakic IOLs
How is the phakic IOL procedure performed?
• The procedure is performed using one of two methods:
1. The phakic IOL can be placed on top of the iris.
2. The phakic IOL can be placed beneath the iris and above the eye’s
natural lens.
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14. Phakic IOLs
• One or more small incisions
are made at the junction of the
sclera (white part of the eye)
and the cornea.
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Phakic IOL procedure: method one

15. Phakic IOLs
• The phakic IOL is inserted onto the iris (the colored part of the eye)
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Phakic IOL procedure: method one
The customized IOL is inserted through
the incision
The IOL is gently placed into its
proper position

16. Phakic IOLs
Phakic IOL procedure: method one
• The incision is repositioned with fine sutures.
 Sutures are finer than a human hair.
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The IOL firmly in place

17. Phakic IOLs
Phakic IOL procedure: method two
• One or more small incisions are made at the junction of the sclera
(white part of the eye) and the cornea.
• The phakic IOL is inserted beneath the iris (the colored part of the
eye).
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18. Phakic IOLs
• The phakic IOL is injected into the eye beneath the iris using an
injector
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Phakic IOL procedure: method two

19. Phakic IOLs 19
Phakic IOL procedure: method two
Phakic IOL rests beneath the iris and
above the natural lens of the eye.

20. Phakic IOLs 20
Method one vs. method two
Phakic IOL in the eye (behind the iris)Phakic IOL in the eye (in front of the iris)

21. Phakic IOLs
• Once the lens is properly
positioned inside the eye, it
provides the necessary
correction to redirect light rays
precisely onto the retina.
• Steroid and antibiotic eyedrops
will need to be applied for
about one week following the
surgery as your vision
continues to improve.
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What happens after the phakic
IOL procedure?

22. Phakic IOLs 22
How is the phakic IOL procedure performed?

23. Phakic IOLs
Considerations for the phakic IOL procedure
• Phakic IOLs may be recommended for patients with corneas too
thin to safely perform corneal refractive surgery (e.g., LASIK, PRK).
• Phakic IOLs may be recommended for patients with high degrees of
refractive error or significantly dry eyes.
• Phakic IOLs may result in less visual distortion (aberrations), such
as glare and halos, than corneal refractive surgery for a given
refractive error.
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24. Phakic IOLs
Considerations against the phakic IOL procedure
• In some cases, there is not enough room in the eye to
accommodate the lens.
 Your ophthalmologist (Eye M.D.) will take careful measurements to
ensure adequate space in the eye to allow safe placement of the phakic
IOL.
• Once the lens is inside the eye, repositioning or removal of the IOL
may be required if the lens is at risk of damaging any intraocular
structure.
• Presence of cataract
• History of retinal detachment or other serious retinal disease
• History of ocular inflammation
• History of glaucoma
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25. Phakic IOLs
Risks and possible side effects of phakic IOL surgery
• Overcorrection or undercorrection (with a possible need for
retreatment)
• Infection or inflammation.
• Haze and halo effect at night
• Excessive tearing
• Increased intraocular pressure (IOP), called glaucoma
• Retinal detachment
• Cataract formation and corneal swelling
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26. Phakic IOLs
Is phakic IOL surgery right for you?
• Advanced surgical procedures, including phakic IOL, are creating
more opportunities for people who want to be less dependent on
glasses or contacts.
• Refractive surgery may not totally eliminate your need for corrective
lenses. Glasses or contacts may still be needed for activities such
as fine or detailed work, reading and perhaps night driving.
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27. Phakic IOLs
Is phakic IOL surgery right for you?
• A large part of the success of any refractive surgery depends on
your understanding of the procedure and your expectations.
• Since refractive surgery is an elective procedure, you have the
opportunity and responsibility to become fully informed about its
risks and benefits.
• Your ophthalmologist will explain the specific technique, its benefits,
as well as possible risks and side effects associated with your
particular case.
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28. Phakic IOLs
• With the help of your ophthalmologist, it’s ultimately your
responsibility to weigh the risks and side effects of a procedure with
the benefits it has to offer.
• If you decide refractive surgery is right for you, you may join millions
of people who have reduced their dependence on glasses or
contacts.
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Discuss options and questions with your ophthalmologist