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Paediatric high myopia

Outcomes show favourable profile for phakic posterior chamber lens

Cheryl Guttman Krader

Posted: Thursday, March 1, 2018

Phakic posterior chamber lens implantation (Visian ICL, STAAR Surgical) is a good option for treating children with unilateral high myopia and moderate amblyopia who failed conventional therapy with glasses or contact lenses. This is according to data from 20 years of follow-up study presented at the 2017 WSPOS Paediatric Subspecialty Day meeting in Lisbon, Portugal.

In addition to having good safety, refractive, and functional outcomes that lead to quality-of-life improvement, the Visian ICL has advantages compared with the alternatives of laser vision correction and implantation of an anterior chamber phakic IOL.

“PRK and LASIK can provide good refractive results, but these require patient cooperation, modify the cornea and can lead to haze. The anterior chamber phakic IOL has not been associated with significant complications during 36 months of follow-up, but it can cause endothelial cell loss and the long-term safety is unknown,” said Laurence C Lesueur MD, Centre d’Ophtalmologie, Toulouse, France.

Implantation of the posterior chamber Visian ICL is performed through a small incision and maintains integrity of the cornea. It is a reversible technique that has shown good refractive predictability and stability, and it has not been associated with significant endothelial cell loss, lens opacification, or increased IOP, she noted.

Dr Lesueur and Jean L Arne MD first implanted a Visian ICL in a child in 1997. An updated review of their experience analysed data from 20 eyes of patients (mean age 8.8 years) implanted with versions V2, V3, V4b, and V4c of the lens.

Mean refraction was -12.3D preoperatively and -0.4D at last follow-up (mean 9.4 years). Mean BCVA improved from 0.12 to 0.35. No eyes lost more than one line of BCVA, 66% had a BCVA gain of at least one line, and a single eye lost one line of BCVA after a traumatic retinal detachment.

Presence of strabismus was reduced from 53% to 30%, as four children underwent surgery for strabismus with high angle deviation (>40D) after ICL surgery. The percentage of children with binocular vision improved from 12% to 43%.

There were no late significant inflammatory reactions. One eye implanted with the V2 ICL developed moderate anterior capsule opacification.

“Secondary opacification of the crystalline lens is the main risk with this phakic IOL, but cataract surgery with capsular bag implantation of a pseudophakic IOL could restore good functional vision,” Dr Lesueur said.

Laurence C. Lesueur: lesueur.lc@gmail.com