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Cataract surgery after phakic IOL removal offers predictable, safe results
J Cataract Refract Surg. 2009;35(1):121-126.
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Cataract surgery after explantation of an anterior chamber phakic IOL yielded predictable refractive outcomes and minimal endothelial cell loss.
Previous studies have shown implantation of an iris-fixated PMMA anterior chamber phakic IOL to be safe and effective for myopia, hyperopia and astigmatism.
"However, when applied in phakic eyes, cataract not related to the phakic IOL may develop," the study authors said.
The study included 36 eyes of 27 patients implanted with the Artisan phakic IOL (Ophtec) who later underwent cataract surgery. The mean interval between phakic IOL implantation and cataract surgery was 5 ± 3.4 years.
After removal of the phakic IOL and cataract surgery, mean spherical equivalent was –0.28 D. Spherical equivalent was within 1 D of targeted correction in 72.2% of patients and within 2 D in 86.1% of patients. Also, 30 eyes had best corrected visual acuity of 20/40 or better. Mean endothelial cell loss was 3.5%.
"The level of predictability was acceptable in this group of patients with high myopia using standard SRK/T [IOL power] calculations based on standard preoperative measurements with interferometry or A-scan ultrasound," the study authors said.
Anyone who has implanted the Artisan/Verisyse iris-fixated phakic IOL (the first model to be U.S. Food and Drug Administration-approved) wonders how this will affect subsequent cataract surgery.
This first large clinical series reassuringly shows that there was no increased rate of complications (and no increased endothelial cell loss) in 36 eyes from the practices of two surgeons. Surgically induced astigmatism and IOL power calculations were acceptable but certainly not as good as in eyes that did not require simultaneous explantation of a rigid PMMA phakic IOL.
Despite the added challenges of IOL calculation in long eyes, one wonders whether measuring and later using pre-phakic IOL axial length measurements might improve the power predictability. Surgically induced astigmatism should also be less with explantation of foldable phakic IOLs through smaller, unsutured incisions. Finally, although for most of their series they used a single shared incision for simultaneous phakic IOL explantation and phaco, the authors now recommend making separate incisions.
– David F. Chang, MD
OSN Cataract Surgery Board Member