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Combined triple procedure: phakic intraocular lens explantation, cataract surgery and intraocular lens implantation

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Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Monday 09/10/2017 | 14:30-16:00

Paper Time: 15:00

Venue: Meeting Center Room I

First Author: : T.Queirós PORTUGAL

Co Author(s): :    T. Monteiro   N. Franqueira   F. Faria Correia   F. Vaz           

Abstract Details


To evaluate the efficacy and safety of combined phakic intraocular lens explantation via scleral incision, cataract surgery via clear cornea phacoemulsification and monofocal intraocular lens (IOL) implantation: visual acuity, refraction, topographic astigmatism vectorial analysis and endothelial cell count.


Department of Ophthalmology, Hospital de Braga, Portugal


A retrospective study was conducted between January 2012 and January 2016 at the Ophthalmology department of Hospital de Braga in patients with cataract and previous phakic IOL implantation. The following parameters were analyzed: uncorrected distance visual acuity (UDVA), best corrected visual acuity (BCVA), refractive sphere and cylinder, keratometry (k) and corneal endothelial cells count (CECC). Patients were evaluated at preoperatively and 6 months after surgery. A scleral incision was performed 2,00 mm posterior to the limbus for phakic IOL explantation and a clear 2,4 mm corneal incision for phacoemulsification; the IOL implanted was calculated for a -1,50 D spherical target.


25 eyes of 18 patients with a mean age of 45,87±5,22 were analyzed. Mean axial length was 31,17±4,3 mm and the mean IOL power implanted was +1,66±2,83 D. There was a significant improvement in both UDVA (from 0,18±0,17 to 0,29±0,16; p<0,05) and CDVA (from 0,30±0,23 to 0,51±0,19; p=0,001) at 6 months follow-up. All eyes improved lines of BCVA, except two cases with preoperative corneal decompensation that were later submitted to a DSAEK procedure. Vectorial analysis showed no induction of corneal astigmatism and we found a non significant endothelial cell loss of -1,62%.


The combined triple procedure of phakic intraocular lens explantation, cataract surgery and intraocular lens implantation is a safe and effective procedure. Surgical approach via a scleral incision for phakic IOL manipulation and explantation in patients with lower than normal endothelium cell counts proved to be safe, with no corneal astigmatic induction and minimal endothelial cell loss; also allowing a more stable anterior chamber during the subsequent phacoemulsification via a clear corneal incision in eyes with high axial lengths.

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