Presbyopia Management with Diffractive Phakic Posterior Chamber IOL

Objective: To evaluate safety and refractive efficiency after posterior chamber diffractive implantable phakic contact lens (IPCL) surgery. Material and Methods: A prospective non-randomized case-series study was performed on 54 myopic eyes of 27 patients who had undergone diffractive IPCL surgery. Corneal endothelial cell density (ECD), central corneal thickness (CCT), intra-ocular pressure (IOP), vault, uncorrected distance (UDVA), spherical equivalent (SE) and defocus curve, were all evaluated twelve months after surgery. The presence of cataracts was evaluated by slit-lamp during a postoperative follow-up. Results: Mean age was 47 ± 2.62 years-old. Mean SE decreased, from -5.95 ± 2.56 D in a pre-operative stage, to -0.25 ± 0.25 D twelve months after surgery. Achieved UDVA was 20/20 in 24.1% of all cases, 20/25 in 74.1% of them, and 20/32 in all remaining cases. No eyes suffered lost lines of vision. The binocular defocus curve was 0.06 ± 0.05 logMAR for a -3.0 D of defocus; 0.11 ± 0.04 logMAR for a -1.5 D of defocus, and 0.08 ± 0.03 logMAR for a 0 D of defocus. Twelve months after surgery, mean ECD had decreased by 1.43 %, whereas mean CCT had increased by 0.06 %, without any significant statistical difference (p = 0.28 and p = 0.93 respectively). No difference (p: 0.86) in the vault was observed at 6 months vs.12 months, as well as between IOP measurements (p = 0.22). There were no non-intra or postoperative complications, and, specifically, no cataracts developed either. Conclusions: Diffractive IPCL was implanted safely. Corneal endothelial CD, CCT, vault, and IOP remained stable twelve months after surgery. Visual acuity for distance, intermediate and near sight were achieved without spectacles.