High-frequency ultrasound biomicroscopy of silicone posterior chamber phakic intraocular lens for hyperopia Julia ´n Garcı ´a-Feijoo ´, MD, PhD, Jose ´ L. Herna ´ndez-Matamoros, MD, Alfredo Castillo-Go ´mez, MD, PhD, Carlos La ´zaro, MD, Carmen Me ´ndez-Herna ´ndez, MD, Teresa Martı ´n, MD, J.M. Martı ´nez de la Casa, MD, Julia ´n Garcı ´a-Sa ´nchez, MD, PhD Purpose: To study the intraocular position and anatomic relationships of the PRL-III phakic refractive lens (PRL), a posterior chamber phakic intraocular lens (PCP IOL), in cases of hyperopia using ultrasound biomicroscopy (UBM). Setting: Centro Oftalmolo ´ gico Real Vision, Madrid, Spain, and Instituto de Inves- tigaciones Oftalmolo ´ gicas Ramo ´ n Castroviejo, Universidad Complutense, Madrid, Spain. Methods: Eleven phakic hyperopic eyes of 6 patients who had PRL implantation were examined 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: Eight eyes had both haptics on the zonule, 2 had 1 haptic in the sulcus and 1 on the zonule, and 1 had 1 haptic in the sulcus and the other in the ciliary body. The mean PCP IOL– crystalline lens peripheral distance in the minor axis was 239.7 m  179.4 (SD) and the mean PCP IOL– endothelium central dis- tance, 2146.98  219.6 m. Contact between the PCP IOL and crystalline lens was observed in 1 eye. Conclusions: In this study of hyperopic eyes, the PRL was located on the zonule in most cases. However, the location of the haptics in the sulcus and contact be- tween the PCP IOL and the crystalline lens that occurred in some cases suggest further study of possible long-term complications is needed. J Cataract Refract Surg 2003; 29:1940 –1946 © 2003 ASCRS and ESCRS I mplantation of a phakic posterior chamber IOL (PCP IOL) is an alternative to other refractive techniques for the correction of hyperopia. 1 Its main advantages over other corneal refractive surgery techniques for hy- peropia, such as thermokeratoplasty, 2–4 photorefractive keratectomy, and laser in situ keratomileusis, 4–7 are mainly the result of its greater predictability and stabil- ity. Unlike intraocular techniques such as clear lens ex- traction, 7–10 phakic lens implantation preserves accommodation. Although the distance between new- generation PCP IOLs and the corneal endothelium and crystalline lens is greater than with older models, cata- ract formation has been reported 11–13 and mid- and long-term endothelial complications cannot be ruled out. Thus, it is important to know the position of these lenses in the posterior chamber and their effect in al- ready compromised eyes. The posterior chamber PRL-III phakic refractive lens (PRL) is a third-generation silicone IOL. 14 –16 The development of this lens and the complications of earlier models have been described. 17,18 The most significant complication was cataract formation. The present study evaluated the anatomic relation- ships between the hyperopic PRL IOL and posterior chamber structures, determined its exact position in the Accepted for publication January 29, 2003. Reprint requests to Julia ´n Garcı ´a-Feijoo ´, MD, PhD, Paseo de San Francisco 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)00240-2