Implantation of the ZSAL-4 IOL in the anterior chamber of phakic eyes was effective and predictable in correcting severe myopia. However, the ZSAL-4 did not prevent pupil ovalization, IOL rotation, or low-grade postoperative uveitis. Improvements in haptic design following our mechanical model could decrease these haptic-related complications.

Our study shows chronic subclinical inflammation between 1 and 2 years after implantation of both IOL types.

Endothelial cell loss during the first year was similar in eyes with Worst-Fechner and Baikoff ZB5M lenses; however, at 2 years after surgery, endothelial cell loss was higher in eyes with Worst-Fechner lenses than it was in eyes with Baikoff ZB5M lenses.