Case Reports

Visian implantable collamer lens (ICL) behavior in Descemet’s membrane endothelial keratoplasty (DMEK) surgery

Case Report Details

First Author: J.Alio Del Barrio SPAIN

Co Author(s):    F. D'Oria   J. Alió                 

Abstract Details

Purpose:

Endothelial damage is one of the leading causes for anterior chamber phakic IOL (AC-pIOL) explantation. In young patients, where the pIOL is explanted alone without lensectomy (in the absence of lens disease due to the risk of retinal detachment), an important anisometropia is left unless an exchange with a posterior chamber (PC) pIOL is performed. However, in the event of corneal decompensation, there is no published evidence about the potential influence of a collamer-based PC-pIOL (ICL) on endothelial keratoplasty surgery.

Setting:

Vissum Corporación and Universidad Miguel Hernández, Alicante, Spain.

Report of Case:

34-years old patient with unilateral visual loss and severe endothelial damage from a bilateral angle supported AC-pIOL implantation (Kelman Duet), followed by bilateral LASIK for residual astigmatism, 13 years before for a myopia of -10D. Contralateral cornea was healthy. Due to patient’s age and healthy lens with preserved accommodation, and in order to avoid postoperative limiting anisometropia, it was managed by the exchange of the AC-pIOL by a posterior chamber pIOL (Visian ICL, Staar, USA) followed 5 months later by a 8.5mm routine descemet membrane endothelial keratoplasty (DMEK) due to a post-exchange persistent bullous keratopathy. Full corneal clearance was obtained within 24h from DMEK surgery, and UDVA improved from counter-fingers at 1m to 15/25 at 1 week and 20/30 at 6 months postop (CDVA of 20/20 with a refraction of +1.75 -1.5 x 35º). Crystalline lens remained healthy without opacities, the ICL presented in place without any sign of opacification, and resultant vault was 25 µm (from 80µm pre-DMEK), with LASIK flap interface fluid resolution. Final ECD was 1630 cells/mm2 at 6 months. No DMEK perioperative complications or graft detachment was observed.

Conclusion/Take Home Message:

The ICL presence didn’t have any negative influence on graft adhesion, but the compressive effect on the PC-pIOL from the AC gas fill during the early postop seemed to justify the observed mild vault reduction. On the other hand, this transient early compression of the ICL towards the crystalline lens due to the AC gas fill, didn’t generate any lens or pIOL opacity in our case. The presence of the ICL between the lens and the AC might have a protective effect, preventing the crystalline lens from any intraoperative iatrogenic damage or contact with the gas/air bubble, thus reducing the risk of secondary cataract formation. On this regard, the presence of a collamer lens in the sulcus during DMEK could also prevent from pseudophakic IOL opacification and visual loss, mainly if a hydrophilic IOL is present. In conclusion, collamer based PC-IOLs seem to not affect DMEK outcomes, and might have a protective effect to the crystalline lens or pseudophakic hydrophilic IOLs, avoiding their risk for postoperative opacification. These potential advantages can’t be extrapolated to other available PC-pIOLs with materials different than collamer. Further studies with larger samples are necessary in order to confirm these outcomes.

Financial Disclosure:

None