Aim To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation.

Design A retrospective, non-randomised, case series.

Participants Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (–11.66±3.3) were analysed.

Methods The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17–78 months).

Main outcome measures The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC).

Results The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3–6 years after implantation. Other serious complications included one patient with Urrets–Zavalia Syndrome (one eye).

Conclusion Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm².