Phakic Intraocular and Implantable Collamer Lenses

Refractive error, or ametropia, can be corrected surgically through a corneal or intraocular approach. Intraocular corneal sparing surgical approaches include refractive lens exchange or implantation of a phakic intraocular lens (PIOL). Bioptics is the combined approach of corneal laser refractive surgery with intraocular procedures to correct ametropia [1]. PIOLs can be used for the correction of myopia [2], hyperopia [3], and astigmatism [4]. In comparison to corneal laser refractive surgery, PIOLs allow the correction of higher degrees of myopic refractive error [5] and this is without the associated risk of retinal detachment [6], which may occur in high myopes of a younger age, undergoing refractive lens exchange [7]. Available PIOL options are broadly classified according to their positioning: anterior chamber PIOLs, which can be angle-supported or iris-fixated, or posterior chamber sulcus-supported PIOL (Fig. 9.1). Important considerations include anterior chamber depth, endothelial cell count and PIOL sizing [8]. This chapter will discuss types of PIOL, indications, contraindications, preoperative evaluation, sizing of the ICL, surgical technique, outcomes, complications, and future directions.