Phakic IOLs have been very helpful in treating younger patients with high degrees of myopia beyond the capabilities of corneal refractive surgery. These phakic IOLs work very well for many years, but at some point there are some patients who develop cataracts. This requires removal of the Visian ICL and then cataract surgery with implantation of an IOL in the capsular bag. For the IOL power estimation keep in mind that the phakic IOL is clear and optical methods of biometry can go right through it. In some cases if the central lens opacities are too great, using an A-scan ultrasound may be required and it also will go through the phakic IOL without significant alteration of the sound waves. To remove this phakic IOL there is a simple pearl: rotate the Visian ICL about 90 degrees so that it is perpendicular to the main incision. This makes grabbing it with the forceps easier because of improved access to the phakic IOL edge. This video shows both eyes of the same patient.
