Clinical impact of a spontaneous decentration of a phakic refractive lens

To evaluate the clinical impact and possible causes of a spontaneous decentration of a phakic refractive lens (PRL) implanted in a highly myopic eye, and analyzing the visual, refractive, and aberrometric outcome as well as the possible causes for this phenomenon.

The description of a case of bilateral high myopia corrected by implantation with the phakic intraocular lens (pIOL) PRL (Carl Zeiss Meditec, Germany) is presented and documented. Both eyes had similar anatomical configuration, and therefore, a pIOL (Model 101) with the same size was implanted without any associated intraoperative complication. Clinical outcomes were evaluated during a 3-month follow-up.

Implanted pIOLs were properly positioned in both eyes and provided an excellent visual outcome during the immediate postoperative period. However, 1 month after surgery, the patient presented a logarithm of the minimum angle of resolution uncorrected distance visual acuity of 0.15 and 0 in the OD and OS, respectively. Subjective refraction in the OD was +1.00 to 1.00 × 15°, with logarithm of the minimum angle of resolution corrected distance visual acuity of 0. Temporal displacement of the PRL was evident in the biomicroscopic examination and analyzed in detail with advanced imaging techniques finding an asymmetric vault. Regarding aberrometry, larger amounts of primary coma, and spherical aberration were present in the OS. Two months later, the situation remained stable.

Spontaneous PRL decentration is not necessarily associated with a visual quality loss and a bad selection of pIOL size. For implantation of this pIOL, a comprehensive analysis of the zonule would be necessary.