Transcript Phaco and Phakic IOL - ASCRS/ASOA 2010

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 - UNIFESP
The authors have no financial interests in any of products mentioned in this
presentation
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; 115:1002–1012.
Colin J. Bilensectomy: the implications of removing phakic intraocular lenses at the time of cataract extraction. J Cataract
Refract Surg 2000;26:2–3. 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 2000;26:1303–11.
Purpose
To report the indications,
technique, results and complications
of phacoemulsification (phaco) in
highly myopic eyes with anterior
chamber phakic intraocular lenses
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 (n=1)
– Cataract (n=8)
• 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
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
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
Results
LogMar Best Corrected Visual Acuity
Pre and post AC IOL explantation and phaco
Before explantation
0,7
LogMar BCVA
0,6
After explantation
and phaco
0,5
0,4
0,3
0,2
0,1
0
-0,1
1
2
3
4
5
6
7
8
9
Average
Eye number
BCVA improved in all eyes
AC IOL explantation and phaco in Eye 2 was performed due endothelial cell loss
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
Results
Gain of line after AC IOL explantation + Phaco
6
5
4
Gain of line
3
2
1
0
Eye 1
Eye 2
Eye 3
Eye 4
Eye 5
Eye 6
Eye 7
Eye 8
No loss of BCVA was observed
Eye 9
Results
Endothelial cell density (ECD) before and after AC
IOL explantation and phaco
Average ECD
BEFORE
AFTER
2181,78 ± 637,47
1880,14 ± 623,25
T-test p=0.057
No significant endothelial cell loss was noted
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