Comparison Of Efficacy And Safety Following Phakic Intraocular Lens Explantation And Cataract Surgery: Scleral Vs. Corneal Incision

To evaluate visual, refractive, corneal topography and corneal endothelial cell density (ECD) outcomes in eyes that have undergone phakic intraocular lens (pIOL) explantation either through a corneal or a scleral incision, with associated phacoemulsification and pseudophakic IOL implantation.

Multi-center study conducted in two tertiary care university hospitals, in the Department of Ophthalmology of Centro Hospitalar Universitário S. João (Porto, Portugal) and Hospital de Braga (Braga, Portugal).

Retrospective cohort study of patients who underwent pIOL explantation witht associated phacoemulsification due to cataract formation or corneal endothelial damage, from 2013 to 2023 in both departments. Demographic and clinical data (age at surgery, secondary IOL implanted, preoperative and postoperative refraction, corneal topography and corneal ECD) were collected. Our primary outcomes were the variation in uncorrected (UCVA) and best corrected visual acuity (BCVA), refractive spherical equivalent (SE), corneal astigmatism and corneal ECD. The clinical outcomes were evaluated and compared according to the type of incision performed for pIOL explanatation: a corneal incision or a scleral incision. 

34 eyes from 28 patients were included. Average age was 48.59±7.72 years and follow-up duration after pIOL explantation was 67.74±43.82 months. 23 eyes (67.6%) presented cataract formation, while 11 eyes (32.4%) presented corneal endothelial damage. Globally, there was a significant improvement in BCVA (from 0.58±0.37 to 0.36±0.30 logMAR units; p=0.001) and refractive SE (from -2.07±1.65 to -1.09±1.25 D; p=0.048), with no significant differences in UCVA (p=0.158), corneal astigmatism (p=0.209) or corneal ECD (p=0.081). When comparing eyes with corneal (n=14) and scleral incision (n=20), there were no significant differences in UCVA (p=0.616), BCVA (p=0.842), SE (p=0.167), corneal astigmatism variation (p=0.708) or corneal ECD (p=0.142).

pIOL explantation with associated phacoemulsification and pseudophakic IOL implantation is a safe and effective procedure which results in significant refractive and visual gains without significant differences in corneal topographic alterations, or corneal endothelial cell loss. Both corneal and scleral incisions are safe and effective for the pIOL explantation procedure, presenting similar refractive and visual gains, without significantly distinct corneal topographic and corneal ECD variations.