Femtosecond laser-assisted cataract surgery in patients with phakic intraocular lenses and low endothelial cell counts: a case report

Abstract

BackgroundPhakic intraocular lens (PIOL) implantation has been used to correct myopia and myopic astigmatism, although corneal decompensation can occur after implantation. Femtosecond laser-assisted cataract surgery (FLACS) has gained in popularity due to its lower postoperative astigmatism and endothelial loss. Herein, we report the use of FLACS in patients who previously received PIOL implantation and have a low corneal endothelial cell count.Case presentationTwo patients with a previous iris-claw PIOL implantation were enrolled. The preoperative corrected distance visual acuity (CDVA) and diopter sphere (DS) were 20/32 and −0.25 D in patient 1 and 20/32 and −3.00 D in patient 2. Specular microscope examination revealed an endothelial cell density (ECD) of 1532/mm2 in patient 1 and 1620/mm2 in patient 2. Capsulotomy was performed smoothly using a femtosecond laser. Postoperative CDVA improved in both eyes, with a difference of DS less than 1 D from the preoperative estimation. Specular microscope examination revealed a decreased endothelial cell density (ECD) in patient 2, but no signs of corneal decompensation were detected.ConclusionsThe influence of using PIOL on capsulotomies performed via FLACS, in combination with preoperative refraction calculation, is minimal. A mild decrease in ECD may occur, but there is a low probability of severe corneal decompensation, even in patients with a low endothelial cell count.

Challenges during femtosecond laser assisted cataract surgery with posterior chamber phakic intraocular lens

“…Several authors have described the use of FLACS in eyes with anterior and posterior chamber ICLs. [345678] Anisimova et al reported bubbles similar to ours which lead to incomplete capsulotomy but did not interfere with nuclear fragmentation. [4] Similarly, Kaur et al reported incomplete nucleotomy due to bubble entrapment.…”

Femtosecond laser–assisted cataract surgery: A review

“…91 More recently, indicating its surgical potential, the FL has been used to transect IOLs which require exchange 92 and can be used without adverse effect in cataract surgery with coexisting phakic IOLs and low endothelial counts before phakic IOL removal. 93 The FL can also be used to perform a primary laser posterior capsulotomy just prior to or just after IOL insertion 94,95 and has been used to this effect in paediatric congenital cataract cases. 96…”

Successful Phakic Intraocular Lens Implantation with the Usage of Topical Ascorbic Acid in Patient with Reduced Corneal Endothelial Cell Density

“…In our patient, the level of ECD was only about 60 to 70% that of ordinary healthy individuals in the Chinese population [ 24 ]. Although the ECD was not very low compared to that of those undergoing phacoemulsification in previous reports [ 10 , 26 ], there was still a chance to develop corneal decompensation after the intraocular procedure. As a result, topical AA was still applied to our patient for one month postoperatively to ensure the normal level of ECD.…”