Safety and efficacy of a small-aperture capsular bag-fixated intraocular lens in eyes with severe corneal irregularities

J Cataract Refract Surg. 2020 Feb;46(2):188-192. doi: 10.1097/j.jcrs.0000000000000045.


Purpose: To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity.

Setting: University Hospital, LMU Munich, Germany.

Design: Prospective nonrandomized interventional case series.

Methods: Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (<1800 cells/mm), and central corneal opacity. Conventional phacoemulsification with implantation of the small-aperture IOL was performed. The primary efficacy endpoint was corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary endpoints were life quality assessment using the Visual Function Questionnaire-25 and determination of the refractive defocus curve.

Results: Seventeen eyes of 17 patients were enrolled. In all 17 patients, CDVA improved from 0.37 ± 0.09 to 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) 3 months postoperatively (P < .0001). Similarly, postoperative UDVA, UIVA, and UNVA improved significantly in 100%, 88%, and 88%, respectively. The defocus curve showed best results at 0.17 logMAR with a defocus of -0.5 diopter. In addition, overall life quality analyses reported less difficulty with activities under reduced optical phenomena conditions.

Conclusions: The small-aperture IOL was a useful option in eyes with severe corneal irregularities, had a high safety index and a high satisfaction rate, and can lead to better visual quality in these cases. Further studies are needed to improve power calculation of this IOL.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Astigmatism / physiopathology
  • Axial Length, Eye
  • Contrast Sensitivity
  • Corneal Wavefront Aberration / complications*
  • Corneal Wavefront Aberration / physiopathology
  • Female
  • Humans
  • Keratoconus / complications*
  • Keratoconus / physiopathology
  • Lens Capsule, Crystalline / surgery*
  • Lens Implantation, Intraocular / methods*
  • Lenses, Intraocular*
  • Male
  • Middle Aged
  • Phacoemulsification / methods*
  • Prospective Studies
  • Prosthesis Design
  • Pseudophakia / physiopathology
  • Refraction, Ocular
  • Visual Acuity / physiology