ICL – REVERSIBILITY AND LONG-TERM MANAGEMENT
This page is for patients considering ICL surgery who want to understand what happens if the implant needs to be removed, how that procedure compares to the original surgery, and what the visual outcomes are afterward.
ICL Is Reversible, The Eye Returns to Its Baseline State
ICL reversibility is the most clinically significant safety advantage it holds over laser eye surgery. If the implant needs to be removed for any reason, vault outside the safe range, development of cataract, refractive change, or patient preference, the ICL is explanted through the same incision used for implantation. The cornea, which was never touched during the original procedure, remains exactly as it was. There is no corneal tissue permanently removed, as there is with laser surgery. The eye’s optical baseline is recoverable.
Removal is rare. In our practice, the ICL removal rate across eight consecutive years of implantation has been under 1%, consistent with published EVO ICL registry data showing a long-term explantation rate of approximately 0.5-1.5% across multi-year series.¹ ⁴
Indications for ICL Removal or Exchange
- Vault outside safe range (too low or high): rare, under 1% with monitoring.¹ Exchange for different ICL power or size.
- Anterior subcapsular cataract (low vault): very rare with vault monitoring.² ICL removed; cataract surgery if needed.
- Cataract in natural lens (ageing): planned in later decades. ICL removed and IOL implanted at same operation.
- Toric ICL rotation (clinically significant): under 1%. Repositioning, a brief outpatient procedure.
- Refractive change requiring higher power: uncommon. ICL exchange for updated prescription.
The Removal Procedure
ICL removal is technically simpler than the original implantation. The same small incision is used. The ICL is folded and withdrawn in a controlled manner. The procedure takes approximately fifteen minutes under topical anaesthesia. The eye tolerates the procedure well in the published literature, with no increase in endothelial cell loss beyond that expected from a routine intraocular procedure.⁵
If removal is required because cataract has developed in the natural lens, the ICL is removed in the same operative session as cataract phacoemulsification and IOL implantation. This is the planned end-of-life pathway for ICL, not an emergency or a complication.
Visual Outcomes After Removal
Visual outcomes after ICL removal depend on the indication. In patients whose ICL is removed because cataract has developed: visual outcomes are determined by the IOL implanted at the same operation, typically equivalent to elective cataract surgery outcomes. In patients whose ICL is exchanged for a different power: the refractive outcome is reset by the new implant, with outcomes equivalent to primary ICL implantation in published series.³
Clinical Perspective
At the Blue Fin Vision® clinic, reversibility is presented as a feature of ICL at every consultation, not as a fallback. Mr Mfazo Hove explains the removal pathway to every patient so that if circumstances change in future decades, the clinical response is already understood. A procedure that can be undone is a procedure that can be optimised over a lifetime. LASIK cannot offer this.
Clinical Takeaway
ICL removal is rare, under 1% across Mr Hove’s series, consistent with published EVO ICL registry data. The removal procedure is technically straightforward, typically fifteen minutes under topical anaesthesia. The eye returns to its pre-ICL baseline because the cornea was never altered. Reversibility is ICL’s most important safety advantage over laser eye surgery.
References
- Reinstein DZ, Archer TJ, Vida RS, Scheffel T. Central vault after ICL implantation: contribution of surgically induced IOL axis rotation. J Refract Surg. 2019;35(7):444-52.
- Gonvers M, Bornet C, Othenin-Girard P. Implantable contact lens for moderate to high myopia: relationship of vaulting to cataract formation. J Cataract Refract Surg. 2003;29(5):918-24.
- Alfonso JF, Lisa C, Abdelhamid A, Montes-Mico R, Poo-Lopez A, Ferrer-Blasco T. Three-year follow-up of subjective vault for myopic implantable collamer lens. Graefes Arch Clin Exp Ophthalmol. 2010;248(11):1621-7.
- Kim H, Joo CK. Vault change by annual follow-up after implantation of implantable collamer lens. Am J Ophthalmol. 2011;152(3):369-74.
- Baumeister M, Buhren J, Kohnen T. Tilt and decentration of spherical and aspheric intraocular lenses: effect on higher-order aberrations. J Cataract Refract Surg. 2009;35(6):1006-12.
