Intraindividual Comparison of Visual Performance After Posterior Chamber Phakic Intraocular Lens With and Without a Central Hole Implantation for Moderate to High Myopia

PURPOSE: To compare postoperative visual performance after implantable Col lamer lenses with and without a central hole (Hole ICL and conventional ICL) are implanted to correct moderate to high myopia. DESIGN: Prospective intraindividual comparative study. PATIENTS AND METHODS: This study evaluated 58 eyes of 29 patients with spherical equivalents of -7.55 +/- 2.09 diopters (D) [mean +/- standard deviation] who underwent Hole ICL implantation in one eye and conventional ICL implantation in the other eye by randomization assignment. Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log CS function was calculated. RESULTS: For 4-mm and 6-mm pupils, the changes after Hole ICL implantation in coma-like aberrations, spherical-like aberrations, and total HOAs are similar to those after conventional ICL implantation (P > .05, Wilcoxon signed rank test). The postoperative area under the log CS function was significantly increased after Hole ICL implantation (P < .05), and was equivalent to that after conventional ICL implantation under photopic, mesopic, or mesopic with glare conditions. Subjective symptoms such as glare or halo were also essentially equivalent after Hole ICL and conventional ICL implantation. CONCLUSIONS: A newly developed Hole ICL implantation appears to be equivalent in the induction of HOAs and CS function to conventional ICL implantation for the correction of moderate to high myopia, suggesting its viability as a surgical option for the treatment of such eyes, because it does not require additional peripheral iridotomies and may also reduce the risk of cataract formation. (Am J Ophthalmol 2012;154:486-494. (C) 2012 by Elsevier Inc. All rights reserved.)