AFTER PHAKIC INTRAOCULAR LENS EXPLANTATION: A SERIES OF 175 SURGERIES

To evaluate the indications for phakic intraocular lens (pIOL) explantation, pIOL survival time, visual outcomes and access endothelial cell loss (ECL) after explantation.

 

Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal.

 

Chart review was performed for all consecutive patients that underwent pIOL explantation from January 2010 to December 2019 in a single center.

 

This study included 175 eyes of 112 patients, 77% of which were female. Phakic IOL survival was 12.9 ± 4.8 [3.7 – 28.6] years and the follow-up period after explantation was 4.1 ± 3.0 [0.3 – 9.9] years. The most frequent causes for explantation were cataract formation (44.0%, n=77) and ECL (50.3%, n=88) and there was no difference in survival time accordingly to the cause for explantation (p=0.351). Ten cases (5.7%) were explanted due to uncommon reasons: severe dysphotopsia (n=3), open ocular trauma (n=2) and cataract formation after posterior segment surgery for retinal detachment (RD, n=5). No pIOL was explanted due to ocular hypertension, severe pupil ovalization, glaucoma, intraocular inflammation or non-traumatic pIOL luxation. Posterior chamber pIOL had higher pre-explantation endothelial cell density (ECD) than anterior chamber pIOL (p=0.008), but ECL remained the cause for explantation in 14% of cases with posterior chamber pIOL.  During the follow-up period after explantation, mean ECL rate was 2.27 ± 9.32 %/year in the cataract group and -2.14 ± 10.24 %/year in the ECL group, reflecting an increase in cell density in the latter. Moreover, in the ECL group, most cases (60%) showed an increase in ECD during the follow-up and these cases did not differ in age, type of pIOL, preoperative ECD or follow-up period (p>0.077) from the ones that showed a decrease in ECD during the follow-up. Eight eyes (4.6%) required a corneal transplant during the follow-up. Mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit.

 

Our study demonstrates that pIOL explantation, after an average survival time of 13 years, is a safe procedure. The main causes for explantation were cataract formation and ECL, in both anterior chamber and posterior chamber pIOL. Most patients show a sustained improvement in visual acuity and stable endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.