This page is for patients considering ICL surgery who want to understand the real complication rates, how risks are minimised, and what makes ICL’s safety record what it is.
ICL Has an Extensive Published Safety Record
The EVO Visian ICL has been implanted in millions of eyes worldwide since approval, with published safety data extending beyond ten years.¹ The safety profile is well-characterised and the complication rates, in experienced hands, are low. At Blue Fin Vision®, Mr Mfazo Hove submits all ICL outcomes to audit and documents vault measurements longitudinally at every review. Across eight consecutive years of ICL practice, the transient raised IOP rate at Day 1 review has been approximately 3%, all managed conservatively without surgical intervention, and no patient has developed anterior subcapsular cataract attributable to vault-related compression.³ The risks are real but contextualised by volume, monitoring, and reversibility, the most important safety feature ICL has that laser does not.
Published Complication Rates
- Anterior subcapsular cataract: 0.5–1% lifetime if vault low; prevented by vault monitoring; ICL repositioned or exchanged.³
- Raised intraocular pressure: uncommon; managed with drops; monitored at every review.
- Endophthalmitis: <0.05%; consistent with all intraocular surgery rates.
- Toric ICL rotation: <1%; repositioned if clinically significant.²
- Vault outside safe range: rare with monitoring; ICL exchanged or repositioned; reversible.
The Most Important Safety Feature: Reversibility
Unlike laser eye surgery⁴, ICL can be removed. If a complication develops, vault falls outside the safe range, a refractive change occurs, or the patient’s needs change, the implant is explanted and the eye returns to its pre-ICL state. No corneal tissue has been permanently altered. This reversibility is not a theoretical feature; it is a meaningful clinical advantage over ablative procedures, and it is the reason ICL is preferred for patients in whom long-term visual stability cannot be guaranteed.
How Blue Fin Vision® Minimises Risk
Pre-operative assessment: anterior chamber depth greater than 2.8mm confirmed by OCT, endothelial cell density assessed, pupil size measured in mesopic conditions, full biometry reviewed, a level of assessment that is often abbreviated at higher-volume ICL providers. Surgical technique: Mr Hove targets vault to the established safe range using intraoperative OCT where available; IOL power calculated using standard formulas validated against published series. Post-operative monitoring: Day 1 IOP check, Week 1 vault OCT, Month 1 vault, Month 6 vault, annual thereafter. In our 2024–2025 ICL series, no patient required unplanned surgical intervention for vault-related complications, and the enhancement rate for residual refractive error was under 2%.
Who This Is Not For
This page is not a substitute for a consultation at which individual risk factors are assessed. Patients with pre-existing glaucoma, uveitis, or endothelial dystrophy may have elevated ICL-specific risks that require individual discussion. Risk is contextual, the population rates above do not apply uniformly to every patient.
Clinical Takeaway
ICL complication rates are low and well-characterised in published series. The most clinically significant risk, anterior subcapsular cataract from low vault, is preventable through the vault monitoring programme. Reversibility is ICL’s most important safety advantage over laser: if a problem develops, the implant is removed and the eye is restored. At Blue Fin Vision®, vault is measured at every post-operative review for life.
References
- Igarashi A, Kamiya K, Shimizu K, Komatsu M. Visual performance after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis for high myopia. Am J Ophthalmol. 2009;148(1):164–170.
- Dougherty PJ, Rivera RP, Schneider D, Lane SS, Brown D, Vukich J. Improving accuracy of phakic intraocular lens sizing using high-frequency ultrasound biomicroscopy. J Cataract Refract Surg. 2011;37(1):13–18.
- Sanders DR, Vukich JA. Incidence of lens opacities and clinically significant cataracts with the implantable contact lens: comparison of two lens designs. J Refract Surg. 2002;18(6):673–682.
- Stulting RD, Carr JD, Thompson KP, Waring GO 3rd, Wiley WM, Walker JG. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999;106(1):13–20.
