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Bilensectomy following angle-supported, iris-fixated and posterior chamber phakic intraocular lens implantation

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First Author: V.Vargas Fragoso SPAIN

Co Author(s):    J. Alió   I. Barraquer   A. Marinho   F. Duch   J. Alió del Barrio        

Abstract Details

Purpose:

To evaluate the visual outcomes, efficacy, and causes of bilensectomy ( explantation of a phakic IOL followed by cataract surgery) for angle supported (AS), iris fixated (IF) and posterior chamber (PC) phakic IOLs.

Setting:

Vissum Instituto Oftalmológico de Alicante, Spain; Centro de Oftalmología Barraquer, Barcelona, Spain; Hospital da Luz Arrábida Porto, Portugal; Instituto Catalán de Retina, unidad de Cirugía Refractiva, Barcelona, Spain.

Methods:

This multicenter consecutive retrospective study included 188 eyes of 128 patients, 87 eyes underwent PC pIOL bilensectomy, 58 eyes underwent AS pIOL bilensectomy and 43 eyes underwent iris-claw pIOL bilensectomy, with a follow-up time of 6 months. Uncorrected, best-corrected visual acuity (UCVA, CDVA), refractive outcomes, efficacy (mean UDVA postop/ mean CDVA postop), endothelial cell density (ECD), causes of bilensectomy and postoperative complications were analyzed.

Results:

There was a statistically significant improvement in UCVA and CDVA in all eyes (p=.001). The sphere and spherical equivalent improved significantly; the cylinder did not have a significant change after surgery. The efficacy index was 0.7 or the iris-fixated pIOL group and 0.8 for the PC and AS pIOL group. Cataract development was the main reason for bilensectomy followed by ECD loss in all groups. The ECD remained stable after PC pIOL bilensectomy; there was a significant loss of ECD after iris fixated pIOL bilensectomy (p=.003). Two eyes developed a retinal detachment after bilensectomy.

Conclusions:

Bilensectomy successfully improved UCVA and CDVA with an acceptable refractive outcome. We suggest an ECD of at least 1500 cells/mm2 in order to perform a safe bilensectomy, a close follow up is mandatory for patients with an iris-fixated pIOL due to the significant ECD loss they had after bilensectomy. All patients implanted with a pIOL will eventually undergo bilensectomy due to the natural development of an age-related cataract or ECD loss, so more information about this procedure is warranted.

Financial Disclosure:

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