Clinical Ophthalmology: small-aperture IOL paper

Prof. Chameen Samarawickrama linked on May 14 to a newly published Clinical Ophthalmology paper examining small-aperture intraocular lens implantation in cataract patients with preexisting corneal disease. The paper, published on April 27, reports outcomes from a retrospective chart review of 45 consecutive patients, covering 67 eyes, treated with the IC-8 small-aperture intraocular lens. The authors said the lens was used in a group that often presents problems for standard cataract surgery because irregular corneas can reduce the accuracy of biometry and lens power calculations. The study’s corresponding author is Samarawickrama, a University of Sydney and Westmead Hospital ophthalmologist, according to the paper. ### Which patients did the paper examine? The study included 45 consecutive patients and 67 eyes with “preexisting corneal irregularities” that underwent cataract surgery with implantation of a small-aperture IC-8 lens, the paper said. Samarawickrama and co-author Muhammad Khan are affiliated with the Translational Ocular Research and Immunology Consortium at the Westmead Institute of Medical Research, the University of Sydney, and Westmead Hospital in Sydney, according to the article. (dovepress.com) Clinical Ophthalmology said the article was received on Dec. 15, 2025, accepted on April 8, 2026, and published on April 27, 2026. The paper described the work as a retrospective chart review and said outcome measures included uncorrected distance visual acuity, spherical equivalent refraction, and refractive prediction accuracy across five IOL formulas using IOLMaster 700 and Pentacam measurements. (dovepress.com) ### What did the authors report on visual outcomes? Of the 67 eyes, 56 underwent IC-8 implantation only, while 11 later required a piggyback intraocular lens as a secondary procedure, the paper said. In the IC-8-only group, mean postoperative uncorrected distance visual acuity was 0.24 ± 0.30 logMAR, and 61.1% of eyes with available data achieved 6/9 or better, according to the results. (dovepress.com) The same group had a mean postoperative spherical equivalent refraction of minus 0.17 ± 1.27 diopters, with 54.2% of eyes within 0.50 diopters of target and 81.3% within 1.00 diopter, the paper said. In eyes that later underwent piggyback implantation, postoperative uncorrected distance visual acuity was 0.42 ± 0.39 logMAR, with 36.4% reaching 6/9 or better, according to the report. (dovepress.com) ### Why is this group difficult to treat with standard cataract surgery? The paper said diseases including keratoconus, prior penetrating keratoplasty, radial keratotomy and corneal scarring can induce aberrations or alter corneal relationships in ways that reduce the accuracy of biometry and intraocular lens power calculations. The authors wrote that corneal irregularities also make estimation of effective lens position less certain. (dovepress.com) Earlier literature cited in search results has described the small-aperture lens as an option for eyes with severe corneal irregularities and as a way to reduce the impact of irregular astigmatism through a pinhole effect. PubMed records for prior case reports and studies show the device has been examined in post-refractive surgery eyes and other complex corneal settings before this 2026 paper. (tandfonline.com) ### Did one lens formula outperform the others? Five formulas were evaluated in the study: Barrett Universal II, EVO, Kane, Hill-RBF and Pearl DGS, the paper said. The authors reported no significant differences in precision or accuracy among the formulas and biometry measurements they assessed. (pubmed.ncbi.nlm.nih.gov) That finding matters because the paper framed refractive prediction as a central issue in this patient group. Rather than naming a single preferred calculation method, the authors reported similar refractive prediction accuracy across the five formulas they tested. ### What did the authors say surgeons should do with these findings? (dovepress.com) The authors concluded that IC-8 implantation in patients with irregular corneas was “safe and effective,” with good visual and refractive outcomes in what they called a niche population. They also said clinical guidelines for use of the IC-8 should be updated to help lens selection in these patients. (dovepress.com) Clinical Ophthalmology lists the article in its cataract section under volume 20 for 2026, with DOI 10.2147/OPTH.S588341. Samarawickrama’s May 14 X post linked readers to that paper, which remains available through the journal’s full-text page. (dovepress.com)