Mastering the Presbyopic Surgery Lenses and Phakic IOLs Ashok Garg, Emanuel Rosen, JT Lin, Frank Jozef Goes
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1Lens History, Prelimm Considerations and IOL Power Calculations
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History of Phakic IOLsCHAPTER 1

António Marinho,
Ramiro Salgado
(Portugal)
4
 
EARLY DEVELOPMENTS
The first phakic Iols were designed in the sixties in Spain (Barraquer), Italy (Strampelli) and England (Choyce). The idea of introducing a lens in a phakic eye to correct high myopia was a consequence of 2 factors. First, there was a wave of enthusiasm after the implantations of pseudophakic IOLs by Harold Ridley in 1949, proving that the eye could tolerate an intraocular lens and second, the work of Jose I. Barraquer showing the correction of high ametropias with corneal remodelling, laying the foundations of modern refractive surgery.
However this early experience with phakic IOLs was short lived. These early designs were rigid angle-supported phakic IOLs, associated with many complications such as: uveitis, glaucoma, hyphaema, extreme pupil distortion and endothelial decompensation.
The concept was totally abandoned during almost 20 years, and the refractive surgery of high ametropias stayed with corneal surgery (different modalities of keratomileusis) with low predictability and requiring complicated machinery and technical skills.
 
ORIGIN OF MODERN PHAKIC IOLs
In 1986/87 three different investigators looked again to the issue of phakic IOLs and designed 3 different models of IOLs, that are forefathers of our present phakic IOLs.
Georges Baikoff (France) presented the ZB lens,1, 2 that was an angle-supported phakic IOL, following the Kelman design of a pseudophakic IOL. Although this IOL still caused endothelial problems due to proximity of corneal endothelium3, 4 the next model ZB5M overcome this problem and must be considered the origin of actual models of angle supported phakic IOL.
At the same time, in the Netherlands, Jan Worst develops the first iris-supported phakic IOL. This model was biconcave (the present models are planoconcave) and was derived from the “Lobster Claw” pseudophakic IOL developed in Pakistan in 1978 by Jan Worst and Singh. The first implantation of the biconcave phakic IOL was done by Paul Fechner in Germany in 1986.5
The present Artisan, Toric Artisan and Artiflex, the most implanted type of phakic IOLs today, come from this model.
Meanwhile, in Russia, Fyodorov presented a silicone posterior chamber phakic IOL.6Although this implant was associated with complications, such as: uveitis, cataract and corneal endothelial cell loss,7 it paved the way for future developments, like the Adatomed IOL (still associated with high rate of cataracts) and to the modern posterior chamber phakic IOLs (ICL and PRL).
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REFERENCES
  1. Baikoff G, Arne JL, Bokobza Y, et al. Angle-fixated anterior chamber phakic intraocular lens for myopia of −7 to −19 diopters. J Refract Surg, 1998; 14 (3): 282–93
  1. Baikoff G, Joly P. Correction chirurgicale de la forte myopie par les implants phakes de chambre antérieure. Concepts et resultants. Bull Soc Belge Ophtalmol, 1989;233:109–25
  1. Mimouni F, Colin J, Koffi V, Bonnet P. Damage to the corneal endothelium from anterior chamber intraocular lenses in phakic myopic eyes. Refract Corneal Surg, 1991; 7 (4): 277–81
  1. Saragoussi JL, Cotinat J, Renard G, et al. Damage to the corneal endothelium by minus power anterior chamber intraocular lenses. Refract Corneal Surg, 1991; 7 (4): 282–85
  1. Fechner PU, Strobel J, Wichmann W. Correction of myopia by implantation of a concave Worst iris-claw lens into phakic eyes. Refract Corneal Surg, 1991; 7 (4): 286–89
  1. Fyodorov SN, Zuev VK, Aznabayev BM. Intraocular correction of high myopia with negative posterior chamber lens. Ophthalmosurgery, 1991; 3: 57–8
  1. Fyodorov SN, Zuev VK, Tumanyan NR, Suheil AJ. Clinical and functional follow-up of minus IOL implantation in high grade myopia. Ophthalmo-surgery, 1993; 2: 12–7