The editors include expanded information on previous designs that have been updated : 1) The iris fixated (lobster claw of Jan Worst) Ophtec Artisan (Abbot Medical Optics, Verisyse in US) IOL, which now comes in foldable and toric designs; and 2) Foldable posterior chamber, ciliary sulcus fixated styles of the intraocular collamer lens (ICL) from Staar and the phakic refractive lens (PRL now available through Zeiss).

The editors and contributors put phakic IOLs in perspective by comparing them to excimer laser vision correction surgery—laser in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), which can be viewed from three directions: First, the use of both types of techniques in an individual eye-bioptics. In this approach, the initial major reduction of the ametropia by intraocular lens implantation is followed by refinement of the refractive outcome by corneal laser surgery, a combination that plays to the strength of both techniques. Second, the proper selection of patients for one or the other technique, generally reserving larger ametropias for the intraocular lens and smaller amounts for laser corneal surgery; however, these boundaries are becoming less clear, with PIOLs of improved quality being used for myopia down to approximately 6D and excimer lasers with aspheric ablation algorithms being used up to 11–12D. Third, surgeons may elect to incorporate either PIOLs or laser vision correction in their individual practice. The surgeon who has invested in an excimer laser and who keep up with the frequent changes in LASIK and PRK technology can treat the vast majority of myopes; by contrast, a surgeon who works primarily with lens surgery can do both cataract and phakic IOl cases in the same surgical session, in the same operating room, with the same staff and may elect not to become involved in the more complex and expensive laser technology.

Phakic IOL development has challenges ahead—incorporating multifocal design for presbyopes (which will obviate the irreversible steps of clear lens exchange) and/or introducing adjustable optics to adapt to an eye's changing conditions (without resorting to the irreversible laser corneal surgery).

This second edition tells us where we are now and allows us to look to the future—a future in which spectacles and contact lenses may indeed be historical relics.

Improvements in lens design, manufacture, and surgical techniques led to a resurgence of interest in the 1980s. New lens styles emerged. Worst and Fechner developed an iris claw lens; Joly and Baikoff, an angle-supported anterior chamber lens; and Fyodorov, a posterior chamber silicone lens. All of these lenses have undergone subsequent modifications in design, and many others have entered the market since then. An enormous amount of information have become available on phakic IOLs over the last 15 years, but it is scattered in the international literature, courses, and meetings. There is no one source where all this information is available.

In Refractive Surgery with Phakic IOLs, the editors, along with an outstanding group of contributors, present a comprehensive review of phakic IOLs for the practising ophthalmologists and refractive surgeons. Our primary goal in creating this clinical reference is to provide, in one single reference book and for a second time a thorough overview of the current state of the wide and evolving world of phakic IOLs. Moreover, we hope to provide the reader with well-referenced and up-to-date information on the latest developments in phakic IOLs.

We have divided the textbook into two major sections focusing on basic principles and implantation indications of phakic IOLs. In the first section, we present information on the limits of corneal refractive procedures, the role of phakic IOLs in refractive surgery, their classification, proper patient selection, and an extensive chapter concerning new diagnostic tools. In the second section, we describe the main phakic IOL styles for the correction of myopia, hyperopia, astigmatism, and presbyopia. For each chapter, we review the historical background of the phakic lens, patient selection, operative technique, post-operative care, and intra-operative and post-operative complications with their management. We also include information on power calculation of phakic IOLs, and combined refractive surgery procedures with phakic IOLs. We have made our best attempt to provide an extensive review of the literature, as well as practical information and clinical pearls based on the contributors’ personal experience. We hope this information facilitates surgeons’ day-to-day practice with phakic IOL implantation.

The emergence of phakic IOLs as a mainstay of refractive surgery will become increasingly evident as the reader progresses through the chapters in Refractive Surgery with Phakic IOLs. The efforts of past pioneers in phakic IOLs, coupled with new materials and emerging diagnostic tools, lead one to conclude that refractive surgery with phakic IOLs has an important present and a very exciting future.

We are honoured to present, to the practising ophthalmologists and refractive surgeons, our textbook on the past, present, and future of Refractive surgery with phakic IOLs.