articles Long-term results of implantation of phakic posterior chamber intraocular lenses Birgit Lackner, MD, Stefan Pieh, MD, Gerald Schmidinger, MD, Christian Simader, MD, Carmen Franz, MD, Irene Dejaco-Ruhswurm, MD, Christian Skorpik, MD Purpose: To study the incidence and progression of lens opacification after im- plantation of phakic posterior chamber intraocular lenses for myopia and its corre- lation with vaulting and endothelial cell density (ECD). Setting: Department of Ophthalmology, University of Vienna Medical School, Vi- enna, Austria. Methods: An implantable contact lens (ICL V4, Staar Surgical Inc.) was inserted in 76 myopic eyes. Patients were prospectively followed preoperatively and at 1, 3, 6, 12, 24, and 36 months. The uncorrected visual acuity and best corrected vi- sual acuity (BCVA) were determined. Vaulting was measured optically with a Jae- ger II pachymeter, and the crystalline lens was examined at the slitlamp for the presence and characteristics of opacification. Endothelial cell morphometry was performed by specular microscopy, and the ECD was calculated. Eyes in which lens opacification developed were followed for at least 12 months to determine the degree and course of visual impairment. Results: Lens opacification occurred in 11 eyes (14.5%). Opacification was cor- related with intraoperative trauma to the crystalline lens, age older than 50 years, and decreased ECD values throughout the observation period. Vaulting of the ICL did not correlate with the risk for lens opacification. After onset of lens opacifica- tion, 6 eyes (55%) had a stable BCVA within 0.5 lines and 5 eyes had progres- sive opacification, losing between 3.5 lines and 0.5 lines (mean 1.8 lines  1.1 [SD]). Three eyes (3.9%) in the progressive group had a 1- to 2-line loss of BCVA over preoperative values and subsequently had cataract surgery. Conclusions: Risk factors for lens opacification after implantation of the model V4 ICL included intraoperative trauma to the crystalline lens and older age. De- creased ECD in eyes with opacification suggests ongoing inflammation as a cause. Patients younger than 45 years may have a significantly lower incidence of opacification. J Cataract Refract Surg 2004; 30:2269–2276  2004 ASCRS and ESCRS to high myopia. 1,2 With PPC IOLs, refractive correc- T he concept of phakic posterior chamber intraocular tions up to -21 diopters (D) are possible, accommoda- lens (PPC IOL) implantation suggests advantages tion is preserved, and implantation is safe and over previous surgical methods used to correct moderate potentially reversible. In 1993, the introduction of the Staar Surgical Inc. PPC IOL, the implantable contact lens (ICL), was followed by considerable expectations. Accepted for publication July 8, 2004. Initial investigations reported excellent efficiency, pre- Reprint requests to Birgit Lackner, MD, University of Vienna, Depart- dictability, and perioperative safety of this lens. 3 How- ment of Ophthalmology, Wa ¨hringer Gu ¨rtel 18-20, A–1090 Vienna, Austria. E-mail: birgit.lackner@akh-wien.ac.at. ever, with longer observation, it became obvious that  2004 ASCRS and ESCRS 0886-3350/04/$–see front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2004.07.018