Good results seen with phaco with IOL implantation after phakic IOL explantation
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Key takeaways:
- Bilensectomy outcomes are generally good.
- Cataract development was the main cause of phakic IOL explantation.
A large multicenter retrospective study showed that bilensectomy — phacoemulsification with lens implantation following the explant of a phakic IOL — has good results with a low rate of complications.
The causes of explantation and their prevalence with different types of phakic implants were also investigated.
“Phakic IOLs nowadays are safe because we know how to select patients better, because some lenses have been withdrawn from the market, and because surgical techniques and indications have been refined. We also have imaging modalities like OCT to guide us in our selection,” study author Jorge L. Alió, MD, PhD, told Healio/OSN. “However, complications may still happen.”
The study included 234 eyes of 185 consecutive patients who underwent bilensectomy between 2005 and 2021. Of the phakic IOLs previously implanted, 59 were iris fixated (three Artiflex and 56 Artisan, both Ophtec), 101 were posterior chamber (eight IPCL from Care Group, 11 PRL from Ciba, and 82 ICL model V3 and V4 from STAAR Surgical) and 74 were angle supported (36 Kelman from Tekia, 27 Baikoff from Domilens, nine ZSAL-4 from Morcher, and two Phakic 6 from Ophthalmic Innovations International).
The main reason for bilensectomy was cataract development, accounting for 96 cases in the posterior chamber group, 37 cases in the iris-fixated group and 67 cases in the angle-supported group. Development occurred significantly earlier in eyes implanted with the old models of posterior chamber phakic IOLs before the central AquaPORT hole (STAAR Surgical) was introduced.
The second most common cause was endothelial cell density (ECD) loss, occurring in 25 eyes in the iris-fixated group, 10 eyes in the angle-supported group and one eye in the posterior chamber group. Pupil ovalization was a specific cause for explanation in the angle-fixated group, occurring in six eyes.
Overall, all groups experienced a significant improvement of uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) after bilensectomy. Particularly good were the outcomes in the posterior chamber phakic IOL group, with only 1% of eyes with two or more lines of CDVA loss as compared with 5% in the iris-fixated group and 8% in the angle-supported group. The posterior chamber group also reported the highest ECD count and the best UDVA after bilensectomy. The largest loss of endothelial cells after bilensectomy was reported in the iris-fixated group, particularly in hyperopic cases.
There were few intraoperative complications, but surgery was more challenging in the angle-supported group because of synechiae between the phakic IOL and the angle. Because angle-supported and iris-fixated phakic IOLs were mostly non-foldable, larger incisions were needed, leading to greater postoperative cylinder.
“Our paper should be very helpful for young surgeons who may not have had the chance to see some of the phakic IOLs, such as the angle-supported lenses,” Alió said. “We recommend reading the paper but also watching the videos we have enclosed because we show the best surgical techniques for explanting the different types of phakic IOLs.”
For more information:
Jorge L. Alió, MD, PhD, of Vissum in Alicante, Spain, can be reached at jlalio@vissum.com.
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