Shield Technique: Phacoemulsification In Phakic Lens With Cataract.
Published 2023 - 41st Congress of the ESCRS
Reference: FP29.10 | Type: Free paper | DOI: 10.82333/ayee-6a22
Authors: Adriana Mutilva* 1 , Sebastian Basualdo 2 , Nicolas Garces 3 , Leroy Didionisio 4
1SOF OFTALMOLOGIA,Buenos Aires,Argentina;Centro de Ojos Ituzaingo,Buenos Aires,Argentina, 2SOF OFTALMOLOGIA,Buenos Aires,Argentina, 3Clinica Santa Lucía,San Juan,Argentina;Hospital Rawson,San Juan,Argentina, 4SOF OFTALMOLOGIA,Cordoba,Argentina;SOF OFTALMOLOGIA,Pergamino,Argentina
Purpose
To describe this shield technique that involves performing phacoemulsification with foldable lens implantation in the capsular bag before phakic lens extraction during the same surgical procedure.
Setting
This is a multicenter and retrospective study.
It was carried out in Sof Buenos Aires medical clinic, Buenos Aires city Argentina; in Sof Cordoba medical clinic, Cordoba, Argentina; the Rawson Hospital, SanJuan, Argentina, in Sof Pergamino medical clinic, Buenos Aires, Argentina. and in Centro de Ojos Ituzaingo medical center, Buenos Aires, Argentina.
All the surgeries were performed between May 2019 and November 2022 by three different surgeons.
Methods
This technique was performed in 18 eyes of 13 patients, all underwent phacoemulsification and foldable intraocular lens implantation before phakic lens explantation. The inclusion criteria were eyes with anterior chamber phakic lens with a decreased endothelial cell density or a reduced visual acuity secondary to cataract.
The best corrected visual acuity (BCVA) was measured preoperatively and one month postoperatively. The endothelial cell density (ECD) was measured preoperatively and in the third month postoperatively using a specular microscope. Non-contact optical biometry was evaluated using Lenstar LS900, Haag Streit, Switzerland. Fourth generation formulas were mostly used for the power intraocular lens calculation.
Results
The mean standard deviation age of the patients at the time of cataract surgery was 48,44 +/- 7,88 years. The mean period between anterior chamber phakic lens implantation and cataract surgery was 16 years. Six eyes had Artisan phakic lenses, eleven eyes had Morcher phakic lenses and one eye had Safety Flex Phakic 6. Five eyes were operated on because of a decreased cell density and thirteen eyes due to cataract. Scleral tunnels were performed in twelve eyes. There were no intraoperative or postoperative complications.
The preoperative BCVA was 0,4368 +/- 0,20 logMAR and the postoperative BCVA was 0,1549 +/- 0,14 logMAR (p<0,0001). The ECD was 2065.05 +/- 447,68 cells/mm2 and the postoperative ECD 1933,66 +/- 442,55 cell/mm2 (p<0,0001).
Conclusions
The anterior chamber stability through a small incision and the corneal endothelial protection using the anterior chamber phakic lens as a shield are the major advantages of this technique.
It is not recommended when the phakic lens is unstable because it can damage the corneal endothelium or the trabecular meshwork and when a fully dilated pupil is not achieved.
Nowadays, non-contact optical biometers allow more accurate intraocular lens power calculations, indeed there are newly designed models with the phakic lens option.
We believe this technique is a good option that may be considered for patients with phakic lens who have low endothelial cell density or visual impairment secondary to cataract.