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IPCL implanted in a patient.
Image: Salvá Ladaria L
Phakic lens offers new option for presbyopia
correction
A novel lens manufactured in India may be the ‘missing link’ for phakic patients with thin
corneas.
Ocular Surgery News Europe Edition, September 2015
healio.com | Ocular Surgery News Europe Edition, September 2015
A novel posterior chamber phakic IOL may provide correction for presbyopia, as well as myopia
and astigmatism. According to Luis Salvà Ladaria, MD, and Scott Anderson García, MD,
ophthalmologists in Palma de Mallorca, Spain, it is “the missing link” within the options for
presbyopia.
“We have, alone or in combination, several laser options, refractive lensectomy, corneal inlays
and even eye drops, but a phakic IOL had not yet been proposed,” Salvà said in an interview with
Ocular Surgery News.
The new Implantable Phakic Contact Lens (IPCL, Care Group) was designed by Indian
engineers, based on extensive experience with the Visian ICL (STAAR Surgical). With more
than 500,000 implantations performed worldwide in 20 years of commercial availability, the ICL
has marked a milestone in IOL technology, providing solid evidence of safety, reversibility, ease
of implantation, stability of results and ability to correct high ametropia.
“The IPCL emerges as a new twist to a well-established concept, with further improvements in
terms of design, material, dioptric range and the entirely new multifocal option (IPCL
Presbyopia),” Salvà said.
The lens
Made of hydrophilic acrylic material that is 100% porcine collagen free, the IPCL is designed to
have six points of contact, instead of four, with the ciliary sulcus for improved stability. It has
two positioning holes in the haptics to facilitate implantation and four holes in the optic periphery
to allow aqueous flow without causing a disturbance to vision.
“Injection is easy and reproducible with a normal injector by Medicel. With ICLs, sometimes
there are difficulties because the lens tends to turn upside down, but this lens is made of an
acrylic material that is relatively harder and easy to handle into the eye and to place in the
appropriate position,” Salvà said.
The IPCL Presbyopia has a diffractive optical zone of 3.5 mm in diameter, which allows a soft
sliding of the iris over the lens and aims at reducing halos. It is available with additions between
+1.5 D and +3.5 D, in steps of 0.5 D.
Panfocality
This new phakic lens for presbyopia introduces a new way of restoring accommodation, which
Salvà defined as “panfocality.”
“It’s not just the bifocality or trifocality offered by aphakic IOLs because the IPCL interacts with
the crystalline lens and enhances the patient’s residual accommodation,” he said.
“When we perform lensectomy and implant a multifocal IOL, we only have the help of the
artificial lens to see for near, but in this particular case, there is a combination of two lenses: a
diffractive lens, which is the IPCL, and the natural crystalline lens.”
Because it is a new concept, panfocality requires a different approach to preoperative assessment,
including the measurement of residual accommodation and binocularity status. IPCL power
calculation is done by the manufacturers in India, based on individual patient data.
“In the near future, we should have algorithms and calculators we can use independently. The
IPCL has very flexible parameters in terms of diameter, optical zones and dioptric power. You
can do mix-and-match or choose monovision. You can play with a lot of variables to achieve the
best vision for near and far,” Salvà said.
The possibility of experiencing mild visual phenomena has to be taken into account when
proposing this lens to the patient, but no more than with any other multifocal lens.
“The main advantage of this lens is the possibility to correct presbyopia reversibly, in addition to
spherical and cylindrical error correction, in a single step. And it is a way we can offer surgery
also to patients with thin corneas. In our opinion, the ideal target for this lens is the group of
patients from 40 to 55 years of age who have not yet developed cataract,” Salvà said.
In a small study, Salvà and García evaluated the safety parameters and visual results of the lens
by implanting three patients with a monofocal IPCL in one eye and a standard ICL in the other
eye. Preliminary results showed no differences in visual acuity, except in one case in which the
target refraction could not be achieved in the ICL eye because there was no commercially
available lens with the required dioptric power. There were no intraoperative complications, and
none of the patients had complaints about halos or neuroadaptation problems.
“We also have a small 3-month personal experience with the IPCL for presbyopia, which we
implanted in three bilateral cases. We used the mix-and-match approach to be able to achieve the
best in intermediate vision, as well as good and stable near vision, because seeing well at
intermediate is increasingly necessary in the everyday life of most patients,” Salvà said.
More cases, more experience and further results are needed, and refinement in the implantation
and power calculation strategies will be the key to future success, he said.
The IPCL is widely used in India and is now commercially available in Europe, where several
patients have been implanted in Spain and some other countries. – by Michela Cimberle
Disclosure: Salvà reports no relevant financial disclosures.
Perspective
Magda Rau

When we perform lensectomy and implant a multifocal IOL, the artificial lens provides
near and intermediate vision, but the IPCL allows us to maintain the support of the intact
natural lens.
In patients between 40 and 50 years, I am a little concerned about performing clear lens
exchange. It is a safe procedure but not without risks and complications. A reversible, less
invasive procedure is a welcome new option. Opti-K (NTK) did not fulfill my
expectation, and I believe now that IPCL could be the answer.
There is a need for further studies to confirm efficacy and to answer the question of safety
as far as the induction of cataract and glaucoma is concerned. There is also a need to find
a reproducible method for calculating lens power in relation to the remaining
accommodation of the crystalline lens.
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o

Magda Rau, MD
OSN Europe Edition Board Member
Disclosures: Rau reports no relevant financial disclosures.
Perspective
Pavel Stodulka

There is a new surgical option for presbyopia available with the IPCL, a presbyopic
phakic IOL. This is a breakthrough in phakic IOL technology.
I implanted the world’s first presbyopic IPCL more than a year ago. At the beginning, we
intended to implant this lens for emmetropic presbyopia. We consider this indication too
risky, and today we implant it in presbyopic myopes, which seems to be an excellent
indication.
We are following our patients, and 1-year results look fine and very encouraging.
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
Pavel Stodulka, MD, PhD
OSN Europe Edition Board Member
Disclosures: Stodulka reports no relevant financial disclosures.
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