Implantable Collamer Lens Surgery

What are the risks involved in ICL (Implantable Collamer Lens) surgery?

By January 30, 2020 No Comments

Author: Dr Val Phua MBBS, MMed (Ophth), FRCOphth, FAMS
Photo by: Loic Leray

ICL surgery is not risk free. As with all surgical procedures, it is important to understand the risks, benefits and alternatives available and make an informed decision before proceeding.

ICL surgery is more invasive than the various forms of laser vision correction. One of the most feared complication is infection (endophthalmitis). This occurs when bacteria makes its way into the eye causing severe inflammation and damaging structures in the eye. This can result in severe visual loss and even blindness if left untreated. Fortunately, with modern day precautions taken to ensure sterility throughout the procedure, this risk is low. Just to give you an idea about the precautions taken, this includes proper selection of patients to ensure there is no active infection of the eye and any diseases like uncontrolled diabetes is properly managed before surgery is done. The operating theatre environment is properly cleaned and equipment used in the surgery is thoroughly sterilised. The eye is cleaned before the surgery with iodine solution which kills off bacteria and after surgery, antibiotic eye drops are given to prevent infection. In the rare case of an infection occurring, it should be promptly treated with antibiotic injections into the eye as well as strong antibiotic eye drops.

Another devastating complication is retinal detachment. This occurs when the retina (likened to the film in a camera) falls away from the wall of the eye. As you can imagine, light will no longer is captured properly resulting in poor vision. This should be promptly treated to restore as much sight as possible before irreversible damage to the retina occurs. This risk is higher in those with significant myopia.

The implanted lens sits behind the iris (the brown part of the eye in most Asians) and in front of the natural lens of the eye. Due to its location, there is a risk of cataract formation where the natural lens of the eye turns cloudy. This is commonly due to a poorly sized implanted lens as well as surgical technique. Fortunately, even if a cataract were to form, the implanted lens and the cataract can be removed and an artificial lens put in place, all in the same sitting and correcting any refractive error in the eye at the same time.

In the older models of these implantable lenses, high eye pressures could develop due to blockage of the fluid flowing from behind the iris to the front. However, with newer modified lens designs, the risk of this blockage is minimal because intrinsic to the lens design is a small hole to allow a clear passage of fluid flow.

In some models of implantable lenses, the lenses sit in front of the iris instead of behind. This brings it into close proximity to the corneal endothelial cells. This layer of cells is important in maintaining cornea clarity. If these cells are damaged and falls below a certain threshold, the cornea may turn cloudy and may require a corneal transplant to clear it up again. With designs of implantable lenses that sit behind the iris, this risk of damaging these cells are much lower.

While detailed tests and assessments are done to determine the exact power and type of lens that would correct the refractive error in your eye, it is not possible to guarantee a 100% spot on target each and every time. As such, the targeted degree may be slightly off and require adjustments in some cases.

Some patients also experience glare and halos after surgery. This is common in the early recovery period and tends to get less with time. In the rare case that these symptoms are debilitating, the implanted lens can be removed with resolution of the symptoms.

ICL surgery is an overall safe alternative to laser vision correction but it does come with its own set of risks. Each patient should understand what is involved before proceeding with the surgery. Book a consultation to see if you are a suitable candidate for this surgery.