ESCRS - FPT07.02 - Bilensectomy Outcomes In A Large Series Of Cases With Previous Angle-Supported, Iris Fixated And Posterior Chamber Phakic Intraocular Lens.

Bilensectomy Outcomes In A Large Series Of Cases With Previous Angle-Supported, Iris Fixated And Posterior Chamber Phakic Intraocular Lens.

Published 2022 - 40th Congress of the ESCRS

Reference: FPT07.02 | Type: Free paper | DOI: 10.82333/xgw5-d214

Authors: Veronica Vargas* 1 , Jorge Alio 2 , Rafael Barraquer 3 , Antonio Marinho 4 , Francisco Duch 5 , Jorge Alió del Barrio 2 , Saad Al Amri 6 , Mario Canto 7

1VISSUM,Alicante,Spain;IMOL,Monterrey,Mexico, 2VISSUM,Alicante,Spain;Universidad Miguel Hernández,Alicante,Spain, 3Centro de oftalmología Barraquer,Barcelona,Spain, 4Hospital Luz Arrábida,Porto,Portugal, 5Instituto Catalán de Retina,Barcelona,Spain, 6VISSUM,Alicante,Spain;Prince Sultan Medical Military City,Riyadah,Saudi Arabia, 7VISSUM,Alicante,Spain

Purpose

To report the main causes leading to bilensectomy, its visual and refractive outcomes in a large series of cases implanted with angle supported (AS), iris fixated (IF) and posterior chamber (PC) phakic intraocular lens (pIOL), as well as the intra and postoperative complications in these different groups.

Setting

This multicenter study included the following centers: Vissum Miranza Alicante & the University Miguel Hernandez; Centro de Oftalmología Barraquer, Barcelona, Spain; Instituto Catalán de Retina, Barcelona, Spain and Hospital Luz Arrábida, Porto, Portugal.

Methods

This is a retrospective study which included 234 eyes that underwent bilensectomy from the year 2005 to 2021. The primary outcome measures were: Uncorrected visual acuity (UDVA) and corrected visual acuity (CDVA), efficacy (mean UDVA after bilensectomy / mean CDVA after bilensectomy), and safety (percentage of eyes in which the postoperative CDVA was worse than the preoperative CDVA). The secondary outcomes were: bilensectomy etiology, time between pIOL implantation and bilensectomy (in years (yr.)), as well as intra/postoperative complications. Of the 234 eyes, 101 had a PC pIOL (ICL V4,IPCL, PRL models)59 eyes had an IF pIOL (Artisan and Artiflex models), and 74 eyes had an AS pIOL (Baikoff, Kelman, ZSAL4, and Phakic6 models)

Results

The main reason for bilensectomy was cataract in all groups, followed by ECD loss in the IF and AS groups.

The mean time between pIOL implantation and bilensectomy was 7 yr. in the PC group, 11 yr. in the IF group and 12 yr. in the AS group.

There was a statistically significant improvement in UCVA and CDVA after bilensectomy in all groups (p: .001).

UCVA improved from 0.27, 0.23 and 0.24 to 0.60, 0.43 and 0.46 in the PC, IF and AS group respectively.

CDVA improved from 0.27, 0.23 and 0.24 to 0.60, 0.43 and 0.46 in the PC, IF and AS group respectively.

Efficacy index was 0.77, 0.66 and 0.69 for PC, IF and AS pIOLs, respectively.

Safety for PC pIOLs was 3%, 12% for IF and 15% for AS pIOLs.

Complications: PCR, Hyphema, wound leak and high IOP.

Conclusions

Bilensectomy following PC pIOLs showed to be the safest and with a higher efficacy Index than IF and AS pIOLs, nevertheless, the time between pIOL implantation and bilensectomy was shorter in the PC pIOL group. Most of the bilensectomy cases in the PC pIOL group were secondary to cataract formation. In the IF and AS group we had an important number of cases with ECD loss, which is a serious sight-threatening condition. The group implanted with an IF pIOL presented a higher ECD loss rate.  Regarding the surgical technique, those surgeries involving an AS pIOL were more challenging due to the adhesions between the pIOL and the angle structures. Intra and postoperative complications were few and successfully managed.