Phacoemulsification in eyes with previous anterior chamber phakic IOL surgery

1

• Phacoemulsification in eyes with previous
  anterior chamber phakic IOL surgery

Walton Nosé, MD, PhD1,2 Adriana dos Santos
Forseto, MD1 Mariana Ávila, MD 1,2
São Paulo, Brazil 1. Eye Clinic Day Hospital
2. Federal University of São Paulo -
UNIFESPThe authors have no financial interests
in any of products mentioned in this presentation
2

• Introduction

• Phakic anterior chamber intraocular lenses (AC
  IOLs) have been considered for the correction of
  refractive errors, especially for treating high
  myopia and hyperopia.
• Several reports have confirmed the efficacy and
  predictability of the phakic AC IOL in correcting
  high ametropia. However, concerns remain
  regarding long-term safety.
• Despite various reports on outcomes and
  complications related to these lenses, the
  reasons leading to their explantation and the
  outcome afterwards have been infrequently
  reported.

Guell JL, Morral M, Gris O, Gaytan J, Sisquella
M, Manero F. Five-year follow-up of 399 phakic
Artisan-Verisyse implantation for myopia,
hyperopia, and/or astigmatism. Ophthalmology
2008 11510021012. Colin J. Bilensectomy the
implications of removing phakic intraocular
lenses at the time of cataract extraction. J
Cataract Refract Surg 20002623. 16. Alio JL,
de la Hoz F, Ruiz-Moreno JM, Salem TF. Cataract
surgery in highly myopic eyes corrected by phakic
anterior chamber angle-supported lenses. J
Cataract Refract Surg 200026130311.
3

• Purpose

To report the indications, technique, results
and complications of phacoemulsification (phaco)
in highly myopic eyes with anterior chamber
phakic intraocular lenses
4
Methods

• Nine highly myopic eyes of 7 patients with
  previous implantation of a phakic AC IOL (11 to
  19 years earlier)
• Angle supported IOL (Nuvita) 8 eyes
• Iris Fixated IOL (Artisan) 1 eye
  
• Indications for phakic IOL explantation and phaco
  were
• Progressive endothelial cell loss (n1)
• Cataract (n8)
• Surgical technique
• Topical anesthesia
• A 5.5mm limbal incision was performed to allow
  the removal of the AC IOL
• The wound was partially sutured in order to
  proceed with phaco through a 2.2mm incision
• After irrigation and aspiration, a foldable IOL
  was inserted in the bag

5

• Methods

• The central distance of the AC IOL to the cornea
  endothelium and the crystalline lens were
  analyzed with a Scheimpflug camera (EAS 1000,
  NIDEK) or optical coherence tomography (Visante
  OCT, Carl Zeiss, Meditec, Inc.) prior to AC IOL
  explantation
• Complications, uncorrected visual acuity (UCVA),
  refraction, changes in best corrected visual
  acuity (BCVA) and endothelial cell density (ECD)
  were analyzed

6

• Results

• The patient ages ranged from 45 to 67 years (mean
  50.3 ? 9.15 years) at the time of AC IOL
  explantation and phaco

The central distance of the AC IOL to the cornea
endothelium ranged from 1.72 to 2.12mm and to the
crystalline lens from 0.31 to 1.09mm
7
Results
LogMar Best Corrected Visual Acuity Pre and post
AC IOL explantation and phaco
BCVA improved in all eyes AC IOL explantation
and phaco in Eye 2 was performed due endothelial
cell loss
8

• Results

• Mean follow-up was 1 year (range, 3 to 12 months)
• No intraoperative or postoperative complications
  were observed
• Uncorrected visual acuity (logMar) after AC IOL
  explantation and phaco ranged from 0.00 to 0.88
• Postop spherical equivalent ranged from zero to
  2.00D (mean -0.73D 0.97D)

myopia (-2.00) was programmed in 1 eye for near
vision
9

• Results

No loss of BCVA was observed
10

• Results

Endothelial cell density (ECD) before and after
AC IOL explantation and phaco
BEFORE AFTER
Average ECD 2181,78 637,47 1880,14 623,25
T-test
p0.057
No significant endothelial cell loss was noted
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• Conclusions

• Phacoemulsification in eyes with AC phakic IOL
  was found to be safe and similar to that in no
  previously operated eyes except for the incision
  length and the possibility of astigmatic
  induction
• Nuclear cataract was the most frequent reason
  for AC IOL explantation