Address pupil distortion early in patients with phakic IOLs, surgeon advises

LISBON, Portugal — Surgeons should not wait to try and rectify pupil distortion in patients who have been implanted with phakic IOLs, according to a presenter here.

Antonio Marinho, MD, PhD, said “doing nothing” is not an option for most of these patients. He spoke at the Luso-Brazilian Joint Surgical Symposium during the European Society of Cataract and Refractive Surgeons meeting.

“If treated in a timely fashion, the distortion can be partially reversed,” said Dr. Marinho, a member of the Ocular Surgery News Latin America Edition Editorial Board. “If we use angle-support lenses and we see ovalization, we shouldn’t wait until we have to do an iridectomy.”

Dr. Marinho said options for remedial action include rotation of the IOL, explantation or replacement of the lens.

He said rotating the IOL is not logical because it creates stress on the other side of the iris. Simply explanting the lens is a viable option, but he cautioned that “the patients won’t be happy” because they will not want to wear contact lenses.

In older patients, explantation of the lens followed by clear lens extraction is a reasonable alternative, because these patients could have a beginning calcification of the lens. Performing phacoemulsification in these patients could be complicated, though, because a large incision is needed to remove the IOL, he added.

“Phacoaspiration may compensate, but extra care is in order,” he said.

In younger patients, simply replacing the lens could be the most feasible plan. He described a case in which he was able to easily explant the IOL, and implant the Ophtec/Advanced Medical Optics Artisan/Verisyse lens while avoiding the atrophic areas of the iris.

“We were able to achieve partial reversal of the distortion,” he said.