Ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for myopia Julia ´n Garcı ´a-Feijoo ´, MD, PhD, Jose ´ L. Herna ´ndez-Matamoros, MD, Carmen Me ´ndez-Herna ´ndez, MD, Alfredo Castillo-Go ´mez, MD, PhD, Carlos La ´zaro, MD, Teresa Martı ´n, MD, Ricardo Cuin ˜a-Sardin ˜ a, MD, Julia ´n Garcı ´a-Sa ´nchez, MD, PhD Purpose: To study the intraocular position and anatomic relationships of PRL-III (phakic refractive lens) (PRL) posterior chamber phakic intraocular lens (PCP IOL) for high myopia using ultrasound biomicroscopy (UBM). Setting: Centro Oftalmolo ´ gico Real Vision, and Instituto de Investigaciones Oftal- molo ´ gicas Ramo ´ n Castroviejo, Universidad Complutense de Madrid, Madrid, Spain. Methods: Sixteen phakic myopic eyes that had had PRL implantation were ex- amined by UBM 1 month after surgery. The PRL position, PRL– crystalline lens peripheral distance, and central distance between the corneal endothelium and the PRL were measured. Results: Both haptics were on the zonule in 6 eyes, in the ciliary sulcus in 5 eyes, and impacted in the ciliary body in 1 eye. In the 4 remaining eyes, the haptics were in mixed positions. The mean PCP IOL crystalline lens peripheral distance in the minor axis was 588.1 m  232.5 (SD), and the mean PCP IOL– endothelium central distance was 2082.8  277.6 m. Conclusions: Phakic refractive lens implantation should be done carefully be- cause of the sulcus location of the haptics in many cases. This, with the iris–PRL contact, suggests caution for the long-term outcome. J Cataract Refract Surg 2003; 29:1932–1939 © 2003 ASCRS and ESCRS P osterior chamber phakic intraocular lenses (PCP IOLs) are an alternative to anterior chamber IOLs for the correction of high myopia. 1–8 They share the theoretical advantages of correction of refractive defects by phakic IOLs (excellent refractive results, fast visual recovery, preservation of accommodation, familiar sur- gical technique for anterior segment surgeons, reversibil- ity, and combination with corneal refractive procedures for extreme myopia 9 ). In addition, a greater distance from the corneal endothelium can theoretically be achieved so long-term endothelial damage would be lower than with anterior chamber IOLs. 10 –14 However, the PCP IOL position in the posterior chamber can cause new problems, especially the development of cat- aracts and pigment dispersion. 7,15,16 In the mid-1990s, Dementiev developed a third- generation PCP silicone IOL, the PRL (phakic refractive lens)-III (D. Dementiev, MD, “Comparison of Three Generations of Posterior Chamber Phakic Lenses for the Correction of High Hyperopia and Myopia,” presented at the Symposium on Cataract, IOL and Refractive Sur- gery, Boston, Massachusetts, USA, 1997), which was Accepted for publication January 29, 2003. From Instituto de Investigaciones Oftalmolo ´gicas Ramo ´n Castroviejo, Hospital Clı ´nico San Carlos, Universidad Complutense (Garcı ´a-Feijoo ´, Me ´ndez-Herna ´ndez, Castillo-Gome ´z, Martı ´n, Cuin ˜a-Sardin ˜a, Garcı ´a- Sa ´nchez), and Centro Oftalmolo ´gico Real Vision (Herna ´ndez-Matamo- ros, Castillo-Go ´mez, La ´zaro), Madrid, and Hospital Provincial de Toledo (La ´zaro), Toledo, Spain. None of the authors has a financial interest in any product mentioned. Reprint requests to Julia ´n Garcı ´a-Feijoo ´, MD, PhD, Paseo de San Fran- cisco de Sales 12 (6°A), Madrid 28003, Spain. E-mail: mherrerad@ sego.es. © 2003 ASCRS and ESCRS 0886-3350/03/$–see front matter Published by Elsevier Inc. doi:10.1016/S0886-3350(03)00239-6