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Implantation criteria key to avoiding endothelial cell loss with angle-supported phakic IOL
AMSTERDAM — Three years of follow-up show the AcrySof Cachet phakic IOL is safe for the endothelium if the proper patient selection is made, according to a specialist.
The Alcon lens was recently suspended from sale due to endothelial problems reported in some cases. Antonio Marinho, MD, believes it will be reintroduced in the market once new criteria for implantation are established.
Antonio Marinho
In his series of 113 eyes of 61 patients with a mean sphere of about -7.5D, the limits for anterior chamber depth were established at 2.8mm from the endothelium.
“This is the main difference with other studies that follow the recommendations of Alcon, i.e. 3.2mm from the epithelium,” he said at the European Society of Cataract and Refractive Surgeons meeting.
A slight oversizing of the IOL compared to chart given by Alcon, so that the difference between the size of the IOL and the size of the angle is at least 1mm, is also important according to Marinho.
“A slight compression of the IOL minimizes rotation,” he said.
In his series, decrease of endothelial cells was only 4% at 3 years.
By subgroup analysis of his patients, rotation at any point of the follow-up was not found to impact the rate of endothelial cell loss. However, in the eyes where compression of the lens against the angle was less than 1mm, as recommended by Alcon to avoid oversizing, a 10% loss was found while eyes with more than 1mm compression had a smaller loss.
Eyes with anterior chamber depth above 3mm were also found to perform better in terms of endothelial cell count.
“In conclusion, in our series, the lens appears to be safe for the endothelium. Criteria for implantation are key,” he said.
Disclosure: Marinho is a consultant for Alcon.