Comparative Study of Three Phakic Intraocular Lenses in Correction of Myopia

To compare visual outcomes and surgical complications of three phakic intraocular lenses (pIOLs); Artisan, Artiflex and the Implantable Collamer Lens (ICL) for correction of moderate to high myopia.

In this historical cohort study, 112 myopic eyes that were operated between 2005 and 2010 and implanted with one of these three pIOLs were evaluated (Artisan 40 eyes, Artiflex 36 eyes and ICL 36 eyes). Mean follow up period was 30±11 months. Intraoperative complications were evaluated. All patients were recalled and a complete ophthalmologic examination including refraction, best corrected visual acuity(BCVA) and intraocular pressure was performed. Pachymetry, endothelial cell count as well as postoprerative higher order aberrations were evaluated and compared with corresponding preoperative values.

No significant intraoperative complications were reported. BCVA improvement, more than one line on the Snellen chart occurred in 25%, 19.4% and 38.9% of eyes in Artisan, Artiflex and ICL groups, respectively (P=0.158). Preoperative spherical equivalent (SE) in Artisan, Artiflex and ICL groups was -11.6±3.7,-9.59±1.97 and -12.3±4.8 diopters, respectively. Reduction changes in SE was not statistically significant among the 3 groups (P=0.237). Mean reduction of astigmatism was 0.31±0.72, 0.45±0.62 and 0.0±0.57 in Artisan, Artiflex and ICL groups, respectively (P=0.07). Postoperatively, 60% of Artisan, 91.7% of Artiflex and 77.8% of ICL eyes were within one diopter of emmetropia, but the change was statistically significant between Artisan and Artiflex groups (P=0.017). Percentage of endothelial cell loss was 10±9%, 9±6% and 9±10% in Artisan, Artiflex and ICL groups, respectively (P=0.694). Pachymetry changes was minimal and the difference among groups was not statistically significant (P=0.754). Higher order aberrations (P=0.039), vertical trefoil (P=0.032) and spherical aberration (P=0.001) were higher in Artisan than ICL. Total aberrations (P=0.028) and sphericalaberration (P=0.001) was higher in Artisan than Artiflex.

Visual outcomes such as BCVA improvement, reduction in SE and astigmatism were comparable among Artisan, Artiflex and ICL groups. There was no significant intra and postoperative complications in the 3 groups. Due to the increased higher order aberrations and problems in quality of vision in myopic eyes after implantation of Artisan lens, ICL and Artiflex may be better choices.