Phakic intraocular lenses (ICL) in Paris
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PHAKIC INTRAOCULAR LENSES: PRINCIPLES
This procedure involves the placement of an intraocular lens (ICL V5 from Staar Surgical) through a straightforward and well-controlled surgical act.
The first phakic intraocular lenses were placed in the early 2000s. The material’s tolerance is well established, and the lens can remain in the eye for life, or until an age-related cataract develops, in which case the ICL can be easily removed and cataract surgery performed. In 2017, 160,000 phakic intraocular lenses were placed worldwide.
- Simple and controlled technique yielding excellent results.
- The operation is performed at the Clinique de La Muette, with both eyes operated on the same day.
- You are treated as an outpatient: you arrive at the clinic in the morning and leave in the early afternoon.
- The procedure can be performed under local anesthesia with simple eye drops, or under short general anesthesia lasting a few minutes, according to the patient’s preference.
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PREPARATION AND PROCEDURE – PHAKIC LENSES SURGERY
- The evening before and the morning of surgery, you must take a shower with Betadine, including the face and hair, and rinse thoroughly.
- Do not wear makeup on the day of surgery and thoroughly remove makeup the evening before; avoid mascara for the three days preceding the intervention.
- You must fast for 6 hours before surgery: no eating, drinking, or smoking.
- Patients who wear contact lenses must remove them at least 48 hours before surgery.
ARRIVAL AT THE CLINIC
You will be admitted to a room in the outpatient surgery department. You will need to change into a gown and leave your personal belongings in a secure area. Nurses will instill eye drops to dilate your pupils (mydriaticum).
ARRIVAL IN THE OPERATING ROOM
Orderlies will take you to the operating room, where anesthesia and surgical nurses will prepare you by administering the first anesthetic drops and disinfecting your face with Betadine.
ENTERING THE OPERATING SUITE
You will be positioned lying on your back on the operating table. You will have a warming blanket, and the anesthetist will monitor your blood pressure and insert an intravenous line for immediate administration of medications if necessary (for example, in case of hypertension or stress).
DURING THE OPERATION
If local anesthesia is chosen, a surgical drape is placed over your face, under which you receive oxygen to breathe comfortably. You will see a more or less colored light with three luminous points, like stars, which you may look at without discomfort.
The operation is painless and lasts a few minutes. You can communicate with the surgical team during the procedure if needed.
If general anesthesia is chosen, you will be asleep before the drapes are placed.
PHAKIC INTRAOCULAR LENSES SURGERY
A soft eyelid speculum keeps the eye open. The surgery consists of making a 3mm micro-incision in the cornea, through which the Staar ICL V5 phakic intraocular lenses is injected and simply positioned under the iris. 1mL of antibiotics is instilled into the eye to minimize the risk of postoperative infection, and the procedure is complete. The incision is so small that it is self-sealing and does not require sutures.
An examination of the eye is performed 2 to 4 hours after the procedure, before you leave the clinic.
END OF THE PHAKIC LENS PROCEDURE
The surgical drape is removed, and a transparent protective shield is placed over the operated eye. You are brought back to your room, where nurses will offer you a snack. You may get dressed and leave the clinic after completing the administrative formalities.
POSTOPERATIVE COURSE
RECOVERY AFTER PHAKIC INTRAOCULAR LENSES SURGERY
The operated eye may be watery for a few hours after surgery and can be sensitive on the first postoperative day.
Visual improvement is progressive in the first days after surgery.
Between the two eyes’ procedures, you may continue your personal and professional activities. The operated eye quickly regains good vision, and for the eye awaiting surgery, you may use your usual contact lens. If you do not have contact lenses, you may remove the lens from your glasses corresponding to the operated eye (or replace it with a neutral lens at the optician’s).
PRECAUTIONS AFTER PHAKIC INTRAOCULAR LENSES SURGERY
Reading and computer work are allowed from the day of surgery, although some initial discomfort is common.
Normal activities can be resumed from the next day.
Makeup is permitted one week after surgery.
Showering is possible from the day after surgery, avoiding water and rubbing the eyes.
Sports, intense physical activity, and swimming are allowed three weeks after surgery.
GLARE AND HALOS AFTER PHAKIC INTRAOCULAR LENSES SURGERY
Glare and halos are common in the first postoperative days
PHAKIC INTRAOCULAR LENSES: SAFETY
Studies show there is no corneal alteration in the postoperative period. No cases of infection have been reported.
PHAKIC INTRAOCULAR LENSES: RESULTS
Compared to corneal photoablation techniques with LASER, Sanders and Vukich demonstrated that ICL implantation was superior to standard LASIK in terms of efficacy and safety for the correction of moderate to severe myopia as well as mild myopia. This study is one of the most important on the subject, including a large number of patients and published in a leading refractive surgery journal.
The authors found with ICL:
- Fewer halos
- Better contrast sensitivity
- Better quality of vision
- Less dryness
- Greater accuracy of visual results
Hidenaga Kobashi. Long-term quality of life after posterior chamber phakic intraocular lens implantation and after wavefront-guided laser in situ keratomileusis for myopia. J Cataract Refract Surg 2014; 40:2019–2024
Frequently asked questions about phakic intraocular lenses (ICL)
What is the main factor impacting the cost of phakic intraocular lenses placement?
It is primarily the type of implant required to correct the patient’s visual defect that determines the cost of the procedure. In general, implants for astigmatism correction are more expensive than those for myopia or hyperopia.
Is phakic intraocular lenses surgery covered by health insurance?
No, there is no reimbursement. Social Security does not reimburse procedures that treat vision problems that can be corrected with glasses or contact lenses.
However, it is increasingly common for supplementary health insurance to offer optical packages that may provide partial reimbursement. Once a personalized estimate has been provided by the practitioner, patients are strongly advised to contact their insurer to determine the possible level of coverage. The procedure is never urgent, so there is time to gather the necessary information.
What are the maximum degrees of refractive error that phakic intraocular lenses can correct?
One advantage of phakic intraocular lenses is that they can correct refractive errors too high to be treated by laser procedures.
They can fully correct myopia up to 15 diopters (D) and partially beyond that. They can also treat hyperopia up to 10D. For astigmatism, the upper limit is 5D.
What is the “posterior chamber” of the eye and why are its characteristics essential?
The posterior chamber of the eye is the space located in front of the lens and behind the iris. This is where phakic intraocular lenses are inserted. However, the procedure can only be performed if the posterior chamber has a depth of at least 2.8 millimeters. Therefore, its measurement is essential during the preoperative assessment to confirm that the patient is eligible for the treatment. This is accompanied by other standard tests, including biometric measurements and corneal topography.
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This page was written by Dr. Camille Rambaud, an ophthalmologist based in Paris and a specialist in refractive surgery.
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