PURPOSE: To review the peer-reviewed literature reporting postoperative complications of the most recent models of Visian Implantable Collamer posterior chamber intraocular lenses (ICL, STAAR Surgical Co). METHODS: A literature search of the PubMed database was performed to identify all articles related to ICL complications. Articles were obtained and reviewed to identify those that reported complications using the latest ICL designs. RESULTS: Cataract was the major postoperative complication reported: 136 (5.2%) in 2592 eyes. Of those, 43.4% (n=59) were reported within 1 year, 15.4% (n=21) between 1 and 3 years, and 35.3% (n=48) ≥3 years after ICL implantation. Twenty-one (15.4%) cataracts were reported as surgically induced, 46 (33.8%) eyes had poor vault (<200 μm), and cataract surgery was carried out in 27.9% (n=38) of eyes. Early acute intraocular pressure increase was also reported to be relatively frequent, whereas acute pupillary block was less frequent and mostly resolved with additional iridotomies. A total of 42 ICLs were explanted due to cataract and IOP. Reported endothelial cell loss varied from 9.9% at 2 years to 3.7% 4 years postoperatively. This loss was reported to be more pronounced within the first 1 to 2 years, with stability or lower progression after that time. CONCLUSIONS: The majority of reported complications after ICL implantation are cataract formation. The improvements in lens geometry and more accurate nomograms applied to the selection of the lens to be implanted, in addition to the surgeon’s learning curve, might be factors in the decreased occurrence of postoperative complications reported currently.

To evaluate the efficacy, predictability, safety, and stability of a new-model posterior chamber Implantable Collamer Lens phakic intraocular lens (pIOL) (V4c Visian) to correct myopia. Private practice, Oviedo, Spain. Case series. This study enrolled patients who had implantation of a new pIOL design with a central hole for more natural aqueous flow, eliminating the need for neodymium:YAG iridotomy or peripheral iridectomy. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refractive error, intraocular pressure (IOP), endothelial cell count, central vault, and adverse events were evaluated 6 months postoperatively. The study enrolled 138 eyes (70 patients). The mean spherical equivalent decreased from -8.73 diopters (D) ± 2.54 (SD) preoperatively to -0.03 ± 0.19 D 6 months postoperatively; 98.5% of eyes were within ±0.50 D and 100% of eyes were within ±1.00 D. The mean UDVA and CDVA were 20/20 or better in 92.1% and 95.0% of eyes, respectively, at 6 months. The safety and efficacy indices were 1.01 and 1.00, respectively. Postoperatively, the IOP remained stable over time. No significant rises in IOP (including pupillary block) and no secondary cataract were found. After 6 months, the mean vault was 482.7 ± 210.5 μm (range 90 to 970 μm) and the mean endothelial cell loss was 8.5%. Implantation of the pIOL was effective, predictable, safe, and stable for the correction of moderate to high myopic errors. This design, which avoids iridotomy or iridectomy, provided good IOP outcomes. No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To compare the in vitro optical quality at different focal points of two new bifocal intraocular lenses (IOLs) and one new trifocal IOL. METHODS: The AcrySof ReSTOR SV25T0 (+2.5 diopter [D] add) and the AcrySof ReSTOR SN6AD1 (+3.0 D add) with two main foci (Alcon Laboratories, Fort Worth, TX) and the AT LISA tri 839MP with three main foci (Carl Zeiss Meditec, Dublin, CA) were evaluated. The optical quality of the IOLs was measured with the PMTF optical bench (LAMBDA-X, Nivelles, Belgium). The optical quality of the IOLs was quantified by the modulation transfer function (MTF) at five different focal points (0.0, −1.5, −2.0, −2.5, and −3.0 D) and for 3.0- and 4.5-mm apertures. The through-focus MTF of the IOLs was also recorded. RESULTS: For the 0.0 D focal point, the AcrySof ReSTOR (+2.5 D add) obtained the highest MTF values for all apertures. For the −2.5 D focal point, the AcrySof ReSTOR (+3.0 D add) showed the highest MTF values for 3.0 mm. For the −3.0 D focal point at 3.0- and 4.5-mm aperture, the best values were obtained with the AcrySof ReSTOR (+3.0 D add) and the AT LISA, respectively. For the −1.5 D focal point, the trifocal IOL provided better values. For the −2.0 D focal point, all IOLs provided comparable results. The through-focus MTF curves showed three and two peaks for the trifocal and bifocal IOLs, respectively. CONCLUSIONS: The trifocal IOL provides a better optical quality at the −1.5 D focal point. However, the optical quality of the trifocal IOL significantly decreases compared to the bifocal IOLs at far distance and −2.5 D focal points. [ J Refract Surg. 2013;29(11):749–754.]