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New technique for cataract surgery after implantation of iris-fixated phakic intraocular lens

Poster Details

First Author: A.Silva PORTUGAL

Co Author(s):    J. Marques   C. Lobo   J. Murta   J. P�Ã�³voa           

Abstract Details


The purpose of this study was to present an innovative surgical technique for cataract surgery and subsequent phakic intraocular lens (pIOL) explantation and its refractive results and corneal endothelial injury.


Department of Ophthalmology, Centro Hospitalar e Universit�Ã�¡rio de Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal


Digital photographs, visual acuity, corneal topography, endothelial cell density, biometry, optical coherence tomography, corneal pachymetry and the surgical video were retrospectively analyzed. We developed an innovative approach for cataract surgery in eyes with pIOL. After a 2.75 mm incision and injection of dispersive viscoelastic to protect the endothelial cells, the temporal haptic of the iris-fixated pIOL was released and re-enclavated at 7h. An intracamerular injection of epinephrine was then performed in order to obtain a good mydriasis for phacoemulsification. Phacoemulsification was accomplished using an ultrasonic OZIL�Â�® tip (INFINITI�Â�®, Alcon, USA). A foldable acrylic IOL lens was inserted in the capsular bag. The incision was subsequently extended to 5.5 mm to allow for the explantation of the pIOL.


A total of 20 eyes from 13 patients (70% females), mean aged 47�Â�±8.9 years old (range 37-60 years old) were included in the study. All patients presented with decreased best-corrected visual acuity (BCVA), after pIOL implantation for high myopia (mean 20/40). Ophthalmologic examination revealed a nuclear and posterior subcapsular cataract. The pre-operative evaluation revealed an endothelial cell count of 2007 cells/mm2. The surgery was uneventful and no safety concerns related to the any of the procedures were observed during the postoperative period. Both anatomical and functional improvement were accomplished. In the first post-operative month, mean BCVA was 20/25 and there was no significant loss of endothelial cells.


This new approach allows for harmless and effective cataract surgery in patients with pIOL by maintaining an excellent stability of the anterior chamber. The technique is less prone to produce high surgically induced astigmatism because sutures need only to be performed at the end of the surgery. Although technically challenging, this innovative procedure proved safe and successful, resulting in a substantial improvement of VA and no significant loss of endothelial cells.

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