Phakic IOL and cataract: comparing two techniques of combined triple procedure – phakic intraocular lens explantation, cataract surgery, and intraocular lens implantation

Session Details

Session Title: Presented Poster Session: IOL Opacification

Venue: Poster Village: Pod 1

First Author: : J.Coelho PORTUGAL

Co Author(s): :    T. Queiros   M. Brochado   M. Lume   T. Monteiro   F. Vaz   P. Meneres        

Abstract Details

Purpose:

To evaluate and compare the efficacy and safety of two techniques of phakic intraocular lens explantation via scleral incision and via corneal incision followed by cataract surgery through clear cornea phacoemulsification and monofocal intraocular lens (IOL) implantation.

Setting:

Ophthalmology departments of Centro Hospitalar Universitario do Porto, Porto; and Hospital de Braga, Braga - Portugal

Methods:

Retrospective study conducted between January 2012 and January 2017 in patients with previous phakic IOL implantation and cataract. Uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), refractive sphere and cylinder, keratometry (k) and corneal endothelial cells count (CECC) were analysed. Patients were evaluated at preoperatively and 6 months after surgery. Scleral incision was performed 2,00 mm posterior to the limbus for phakic IOL explantation and a clear 2,4 mm corneal incision for phacoemulsification; in the explantation via cornea incision group a 5,2mm clear corneal incision was performed and partially sutured, phacoemulsification was performed through the partially sutured incision.

Results:

Twenty eyes in the sceral incision group and 41 in the corneal incision group were analysed. No differences between groups were seen in age, mean axial lenght and IOL power implanted. There was significant improvement of BCVA in both groups (0,34±0,27 to 0,49±0,20;p=0,014 and 0,49±0,26 to 0,79±0,22;p<0,001 respectively) and UDVA in the corneal incision group. All eyes improved lines of BCVA except two cases of preoperative low CECC. In the explantation via cornea group a CECC loss of -10,9% (p<0,001) was noticed. Alpins vectorial analysis showed no differences in surgical induced astigmatism between techniques.

Conclusions:

The two techniques analysed of the combined triple procedure of phakic intraocular lens explantation, cataract surgery and intraocular lens implantation are both safe and effective procedures. Surgical approach via a scleral incision for phakic IOL manipulation and explantation in patients with lower than normal endothelium cell counts seems to be preferred with non-significant endothelial cell loss allowing also a more stable anterior chamber during phacoemulsification. The techniques are similar in the surgical induced astigmatic after Alpins vectorial analysis.

Financial Disclosure:

None