COMPARISON OF LONG-TERM EFFICACY AND SAFETY RESULTS OF CACHET® AND ARTIFLEX® LENSES

Phakic intraocular lenses allow correction of moderate to high myopia with excellent levels of efficacy, safety, stability and refractive predictability. Progressive endothelial loss is a serious medium to long-term complication associated with phakic lenses implanted in the anterior chamber. The AcrySof Cachet^® lens was discontinued from the market in 2014 due to an association with severe endothelial loss. The purpose of this study was to evaluate and compare the refractive and safety parameters between Acrysof Cachet^® (Alcon) and Artiflex^® (Ophtec) anterior chamber phakic lenses, at 5 and 10 years of follow-up.

Ophthalmology Department, Hospital de Braga, Braga, Portugal

Retrospective and comparative study of patients undergoing Cachet^® and Artiflex^® lens implantion surgery for treatment of myopia at the Ophthalmology Service of Hospital de Braga. Inclusion criteria: age >20 years, stable refraction >12 months, primary procedure with no previous eye surgeries, follow-up at 5 and 10 years. Parameters evaluated: Visual acuity without (UDVA) and with correction (CDVA), subjective refraction (sphere, cylinder and spherical equivalent), efficacy and safety index, predictability curve, endothelial cell density (ECD), anterior chamber angle (ACA), spherical equivalent correction rate and postoperative complications.

Forty eyes of 24 patients undergoing Cachet^® lens implantation and 91 eyes of 50 patients with Artiflex^® lens were evaluated. The preoperative value of spherical equivalent (SE) to be treated was 9.55 ± 2.837 D in the Cachet^® group and -9.621 ± 3.127 D in the Artiflex^®group (p=0.912). At 5 years, the safety and efficacy index were similar in the two groups (p=0.612; p=0.423, respectively); At 10 years, both indexes were higher in the Cachet^® group (p=0.010; p=0.013, respectively). The SE correction rate was higher in the Cachet^® group at 5 years (p=0.016); with no significant differences at 10 years of follow-up (p=0.115). There was a significant decrease in endothelial cell density in both groups along the follow-up; without significant differences between them at 5 (p=0.607) and at 10 years (p=0.592). A total of 4 (10%) Cachet^® lens and 2 (0.02%) Artiflex^® lens explantation (p=0.049) were reported.

The Acrysof Cachet^® lens demonstrated a safety and efficacy index similar to the Artiflex^® anterior chamber phakic lens. Any patient with a phakic lens should be monitored annually to prevent complications such as severe endothelial loss and loss of corneal transparency.