Visual Acuity Outcomes And Endothelial Cell Loss Following Combined Phakic Intraocular Lens Explantation And Cataract Surgery

To evaluate the visual acuity outcomes and the endothelial cell loss after a combined phakic intraocular lens (pIOL) explantation and cataract surgery with an implantation of a posterior chamber intraocular lens (IOL).

International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany

An interventional case series of 25 eyes of 14 patients, who underwent a combined pIOL-explantation and cataract surgery. The corrected distance visual acuity (CDVA) and the corneal endothelial cell density (ECD) were measured before and after the surgery. The Wilcoxon Signed-Rank Test was used to compare the postoperative outcomes with the retrospectively collected preoperative data and p < 0.05 was considered to be statistically significant. The results are expressed as a mean ± standard deviation.

The combined surgery was performed at the age of 55.4±6.8 years, 13.5±5.6 years following the pIOL implantation. Preoperatively, CDVA was 0.41±0.30 logMAR and ECD was 2038±526 cells/mm2 (n=22). After the pIOL explantation (9 angle-supported pIOLs, 15 iris-claw pIOLs and 1 implantable collamer lens), a monofocal IOL was implanted. Postoperatively, CDVA improved to 0.16±0.23 logMAR (p <0.001) and ECD was 1672±613 cells/mm2 (n=24). ECD decreased by an average of 20.8±18.0 % (p <0.001, n=21), with 7 eyes (33 %) losing more than 30 % in ECD. Endothelial decompensation occurred in 1 eye (4 %). No other eyes lost one or more lines of CDVA.

The combined pIOL-explantation and cataract surgery improved CDVA but, in some cases, significantly decreased ECD. A high preoperative ECD may mitigate the impact of the intraoperative endothelial cell loss, avoiding postoperative endothelial decompensation.