Intraocular refractive surgery

The phakic implant

When the correction is too high for corneal reshaping, or the anatomy of the cornea rules out the laser, an artificial lens is placed inside the eye — in front of the natural lens, which is preserved intact. The procedure is reversible.

Indication

When laser
is not enough

Corneal laser surgery relies on removing a volume of corneal tissue. This ablation has a twofold limit: the desired correction cannot exceed what the thickness and biomechanics of the cornea allow to be removed safely, and certain corneal morphologies rule out any reshaping.

In these situations, a phakic intraocular lens — placed inside the eye without touching the cornea — makes it possible to reach corrections beyond the laser’s range, with a different and complementary safety profile.

01

High correction

Myopia up to −18 D, high hyperopia (subject to suitable anatomy): the amount of corneal tissue to be removed exceeds the biomechanical safety limit. The phakic implant takes over without any corneal constraint.

02

Insufficient cornea

A cornea that is too thin, irregular or shows a suggestive topography: the laser is contraindicated in order to preserve the long-term structural integrity of the cornea.

03

Pre-existing dry eye

Surface surgery and LASIK sometimes worsen existing dry eye. The phakic implant, which does not alter the cornea, causes less postoperative dryness.

Implant 01
Offered

ICL

Visian Implantable Collamer Lens — STAAR Surgical

Phakic ICL implant — cross-section of the anterior segment Cross-section of the anterior segment of the eye: the ICL phakic implant is positioned in the sulcus, between the iris and the preserved natural lens, behind the cornea. PHAKIC IMPLANT (ICL) A lens in front of the natural lens Cornea untouched no reshaping of the tissue Anterior chamber aqueous humour Iris Haptics in the sulcus resting behind the root of the iris Phakic implant (ICL) soft lens about 50 µm thick thickness exaggerated for clarity Natural lens preserved intact, with its accommodation Central opening lets the aqueous humour flow through; no prior iridotomy needed 1 mm — drawn to scale Unlike the laser, a phakic implant changes neither the cornea nor the natural lens. It can be removed or exchanged.
Position of the phakic implant, between the iris and the natural lens

The ICL is a flexible lens made of a hybrid material — plastic and collamer (a biocompatible synthetic collagen) — that folds to be introduced into the eye through a 2-to-3 mm corneal micro-incision. Once in place, it unfolds and settles naturally between the iris (the coloured part of the eye) and the natural lens, which is kept intact with its ability to accommodate.

The ICL works in addition to the natural lens: it does not replace it, it adds its refractive power to the lens’s own to bring the point of convergence exactly onto the retina.

The procedure is performed as a day case, in a sterile operating theatre, under topical (eye-drop) anaesthesia or general anaesthesia, according to the patient’s preference. Both eyes are treated on the same day.

Correction range

up to −18.00 D myopia
up to +10.00 D hyperopia
astigmatism toric model available

Benefits

  • Cornea not altered — micro-incisions only
  • Very wide correction range
  • Less dry eye than with the laser
  • Natural lens and accommodation preserved
  • Reversible: removal or exchange possible
  • Excellent optical quality, including for high corrections

Prerequisites

  • Anterior segment deep enough to house the implant safely
  • Adequate endothelial cell density
  • No cataract or glaucoma
  • Complete anatomical assessment mandatory
Introductory video — ICL Source: Clinique Saint-Pierre Ottignies
Implant 02
Offered

IPCL

Implantable Phakic Contact Lens — Care Group Sight Solutions

The IPCL is a second-generation phakic lens, developed after STAAR’s ICL. It shares the same positioning principle in the posterior chamber, between the iris and the lens, and corrects the same refractive errors over comparable ranges.

Its design incorporates the experience accumulated with the ICL: the lens is thinner at the periphery, its centring is optimised for anterior chambers of varied geometry, and its toric design (astigmatism correction) is particularly precise. Like the ICL, the IPCL is biocompatible and can be removed or exchanged if necessary.

The choice between ICL and IPCL is determined during the preoperative assessment, based on the anatomical characteristics of the eye, the desired correction and the availability of models for the required power. Both options are discussed in consultation.

ICL vs IPCL — what differs

  • Different manufacturer → independent power calculation
  • Slightly different edge profile and geometry
  • Variable stock availability and ordering times
  • Both are placed in the posterior chamber
  • Both are reversible

Please note

Long-term follow-up data are more extensive for the ICL (on the market since the 1990s) than for the IPCL (more recent). This difference is taken into account in the preoperative discussion.

The three anatomical conditions for a phakic implant Three views. The first measures the depth of the anterior chamber, between the inner surface of the cornea and the front of the natural lens. The second shows the mosaic of cells on the inner surface of the cornea, whose density must offer a sufficient reserve. The third measures, once the implant is in place, the gap left between the implant and the natural lens. The three anatomical conditions It is not the prescription that decides whether an implant suits: it is the anatomy of the eye. THE ROOM AVAILABLE at least 2.8 mm depth of the anterior chamber The implant must sit without ever touchingthe cornea. A chamber that is too shallowrules this option out at once. THE CELL RESERVE reserve sufficient for the age density of the cells on the inner surface These cells are never replaced. Theirdensity must last a lifetime, implantincluded. THE CLEARANCE ONCE IN PLACE 250 to 750 µm gap between implant and natural lens Too close, the implant threatens the lens;too far, it pushes the iris forward. This gapis checked after implantation. These three measurements are taken before implantation and checked again afterwards. They weigh as much as the correctionitself: an eye that is perfectly correctable, but too shallow or with a low cell reserve, is not a candidate. That is where mostof the decision is made, well before the power is chosen.
Anatomical conditions for a phakic implant
The central opening in the phakic implant Three views. Without a central opening, aqueous humour produced behind the iris cannot pass the implant, so the iris had to be perforated before implantation. With the central opening, fluid crosses the implant and flow is restored with no prior procedure. Seen from the front, that opening lies at the centre of the optical zone, which can cause halos during the first weeks. The central opening in the implant Why it exists — and what it costs optically. WITHOUT A CENTRAL OPENING the iris had to be perforated beforehand Aqueous humour, produced behind theiris, must reach the front of the eye. Asolid implant blocks that route. WITH A CENTRAL OPENING flow is restored on its own The opening gives the fluid its route back.No prior iridotomy isneeded. SEEN FROM THE FRONT dilated pupil the opening lies on the optical axis It crosses the optical zone. Halos arepossible in the first weeks, then thedisturbance fades. The central opening removed a prior laser procedure and the risk of a pressure rise from a blocked route. It has also all butabolished the lens opacities that could follow implantation. In exchange, it sits on the visual axis:a few weeks of adaptation are common, especially at night. It is a trade, not a gain without a downside.
The central port of the implant
Night vision and neuroadaptation At the top, the same light source seen at night according to the type of implant: a sharp point with a monofocal, a faint halo with extended focus, concentric rings with a trifocal. Below, a curve shows that the perceived disturbance falls sharply over the first months and then settles at a low but non-zero level in a minority of patients. Night vision and neuroadaptation The same light source at night, according to the optical profile of the implant. MONOFOCAL Sharp point of light, slight veiling possible. EXTENDED FOCUS Faint halo, sometimes a streak. TRIFOCAL Concentric rings around light sources. Schematic depiction of a car headlight seen at night. HOW THE DISTURBANCE CHANGES OVER TIME first weeks 3 to 6 months beyond disturbance none residual in a minority The brain learns to ignore these stray images: the disturbance fades markedly over the months, without disappearingcompletely in everyone. If it remains disabling, the implant can be exchanged — that is a second intraocular operation.
Night vision and neuroadaptation
What can be undone and what cannot Three cross-sections compared. The corneal laser permanently removes corneal tissue, whose original profile is shown as a dotted line. The ICL implant is added behind the iris, in front of the preserved natural lens, and can be removed. Lens exchange removes the lens, replaced by an implant in the capsular bag: the step cannot be undone, even though the implant itself remains changeable. What can be undone — and what cannot Three surgical routes, three degrees of reversibility. CORNEAL LASER dotted: the original corneal profile (tissue removal exaggerated for clarity) The laser permanently removes corneal tissue. This cannot be undone; a touch-up remains possible if thickness allows. ICL IMPLANT natural lens preserved The implant is added behind the iris, in front of the lens, which stays put. It can be removed: the eye returns to its previous state. LENS EXCHANGE lens removed, capsular bag preserved The lens is removed. That cannot be undone. The implant itself can be changed — at the cost of a second intraocular operation. REMOVABLE PERMANENT ICL implant Lens exchange* Corneal laser * A lens that has been removed cannot be put back; only the implant remains changeable.
What can be undone and what cannot
A distinctive advantage

A reversible
procedure

Unlike corneal surgery, which permanently changes the shape of the cornea, the phakic implant can be removed or exchanged with a simple surgical step. This reversibility is a real advantage in several situations: a change in refraction with age, the development of a cataract requiring lens replacement, or simply the patient’s wish.

It does not mean the procedure is without consequence, nor that removal is routinely recommended — but it offers a flexibility that corneal surgery cannot provide.

Phakic implant Reversible

Removal or exchange possible with simple surgery

Corneal laser Irreversible

Corneal tissue removed permanently

Lens replacement Irreversible

Natural lens removed and replaced

The anatomy of your eye
determines the indication

The depth of the anterior segment, the endothelial cell density and the desired refraction are the key parameters. They are measured during the preoperative assessment, before any surgical decision.

Book an appointment → Compare the approaches

A cornea the laser cannot reshape

Keratoconus →

Frequently asked questions

What is a phakic implant, and how does it differ from laser?

A phakic implant is an artificial lens placed inside the eye, in front of the natural lens — which is kept intact, with its accommodation. Whereas laser corrects by removing corneal tissue, the implant does not alter the cornea: it adds its power to that of your eye. It is an approach with a different, complementary safety profile to laser.

When is laser not enough?

The implant takes over in three main situations: a correction too strong to be achieved while preserving enough cornea (up to −18 diopters of myopia); a cornea that is too thin, irregular, or whose topography contraindicates reshaping; or pre-existing dry eye that laser could worsen. It is the indication, determined by the assessment, that precedes the technique.

Is my natural lens removed?

No — and this is what distinguishes the phakic implant from lens surgery. Your natural lens stays in place and keeps its accommodation; the implant sits in front of it, between the iris and the lens, and works in addition to it.

Is it reversible?

Yes, and that is a distinctive advantage. Unlike laser, which alters the cornea permanently, the implant can be removed or exchanged through a simple surgical procedure — in the event of a change in refraction with age, a cataract to be treated later, or at your wish. This does not mean the procedure is without consequence, but it offers a flexibility that corneal surgery cannot.

Can the implant cause a cataract? And later, when the cataract comes?

Historically, the implant’s proximity to the lens could promote a cataract. Modern implants have a central hole (called Aquaport) that restores the circulation of intraocular fluid and has almost eliminated this risk for the myopic version. And should a cataract develop with age, the implant is simply removed at the time of cataract surgery, which then proceeds in the usual way.

Can it be felt or seen?

No. Placed behind the iris, the implant is invisible to the naked eye and you do not feel it.

ICL or IPCL: what is the difference?

Both are phakic implants placed in the same location, on the same principle, and correct comparable errors. The IPCL is a more recent generation, with a refined edge profile and centration; the ICL benefits from longer follow-up, having been available since the 1990s. The choice is made at the assessment, according to your eye’s anatomy, the desired correction, and model availability.

What determines eligibility, and what follow-up afterwards?

Three parameters are decisive, measured at the preoperative assessment: an anterior segment deep enough to house the implant safely, a sufficient density of corneal endothelial cells, and the absence of cataract or glaucoma. After implantation, the endothelium is monitored with regular check-ups.

Is the procedure painful? How long does it take?

It is performed on an outpatient basis, in a sterile operating room, under local anaesthesia with drops (or general anaesthesia according to your preference), through a 2-to-3-mm micro-incision. It is not painful and takes only a few minutes per eye.

Are both eyes operated on the same day?

Yes: both eyes are treated on the same day.

When will I recover my vision?

Recovery is generally quick, with vision clearing within the first few days.

Will I have dry eyes or halos at night?

As the cornea is not altered, dry eye is less frequent than after laser. The implant’s central hole, however, can cause marked halos during the first days to the first week; they then ease, and only rarely persist longer term.

What is the risk of serious complications?

Like any intraocular surgery, implantation carries specific risks — a rise in intraocular pressure, inflammation — that follow-up allows to be monitored. It can also happen that, to achieve optimal positioning, the implant must be removed and replaced with one of a different size: this is slightly more frequent than the need for a touch-up after laser. The implant’s reversibility is precisely what makes this adjustment possible.

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