Iris-fixated phakic intraocular lens explantation

Abstract

Background/aims: To evaluate the visual outcomes and indication for surgery in a series of patients who underwent explantation of a phakic intraocular lens (PIOL). Methods: A retrospective case series of patients who underwent PIOL explantation in our institution was performed. The indication for explantation and visual and refractive outcomes were examined. The method of explantation is described. Results: Twenty-two eyes of 16 patients underwent PIOL explantation with a mean time to explantation of 7 ± 3 years (range 3–11.4). The mean age at explantation was 50.3 ± 9.3 years. Sixteen Artisan PIOLs and six Artiflex PIOLs were explanted. The indications for explanation were cataract development (17/22), endothelial cell loss (4/22) and synechiae formation (1/22). All patients with cataract underwent a combined procedure with explantation and phacoemulsification and the placement of a posterior chamber IOL. Mean corrected vision after explantation was 0.22 ± 0.10 logMAR (range 0.1–0.3 logMAR). One patient with endothelial cell loss required a Descemet’s Stripping Endothelial Keratoplasty (DSEK). Conclusion: Removal of PIOLs was necessitated most frequently by cataract followed by endothelial cell loss. Both explantation alone and explantation with concurrent phacoemulsification are safe procedures with good visual outcomes and will become more frequent in the future as more patients with PIOLs reach cataractous age.

Phakic intraocular lens explantation: series of 175 surgeries

“…The overall pIOL survival time (13 years) matched with that of the studies by Sucu et al and Jonker et al (13 to 14 years) but differed significantly from that of other studies (5 to 8 years). 7,9–13 This difference may be because the latter ones had inclusion periods starting from 1998 to 2006 (vs 2010 in ours and 2015 in the study by Sucu el al.). 9 Moreover, the differences observed between studies may be explained by the evolution of pIOL models, stricter implantation criteria and technological improvements to evaluate patients both before implantation and along the follow-up.…”

“…7–9 However, only small size reports have addressed the results of explantation surgery. 10–13 To the authors' knowledge, our report adds the largest single-center sample (175 eyes) and the longest mean follow-up period after explantation (4.1 years).…”

“…Overall, the main causes of explantation were cataract formation (44.0%) and ECL (50.3%), similar to the results reported in previous studies, where the rate of cataract as the reason for explantation varied from 35% to 71%. [7][8][9][10][11][12][13] Numerous mechanisms explain the premature development of cataract in this population: myopia which is by itself strongly associated with cataract development, surgical trauma, chronic inflammation and breakdown of the blood-aqueous barrier, crystalline lens touch during accommodation or eye rubbing, and changes in aqueous humor circulation. [14][15][16] Previous studies report ECL as the cause for pIOL explantation in 20% to 67%.…”

Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results

“…They cited a higher preoperative age as a risk factor for cataract formation [ 11 ]. Duignan et al [ 37 ] summarized that removal of IF pIOLs was necessitated most frequently by cataracts (followed by endothelial cells loss). He stressed that explantation with concurrent phacoemulsification is a safe procedure with good visual outcomes.…”

Bilensectomy

“…Duignan et al . [ 10 ] evaluated the visual outcomes of 17 eyes that underwent bilensectomy secondary to cataract development. The mean CDVA improved from 0.5 ± 0.3 to 0.2 ± 0.1 logMAR after surgery.…”