Explantation Of Iris-Fixated Phakic Intraocular Lens (Piol) And Cataract Surgery: The Scaffold Technique
Published 2024 - 42nd Congress of the ESCRS
Reference: FP13.03 | Type: Free paper | DOI: 10.82333/z9jr-ad87
Authors: Inês Gonçalves Figueiredo* 1 , Miguel Raimundo 2 , Conceição Lobo 2 , João Póvoa 3 , Joaquim Murta 2
1Ophthalmology,Unidade Local de Saúde de Coimbra,Coimbra,Portugal, 2Ophthalmology,Unidade Local de Saúde de Coimbra,Coimbra,Portugal;Faculty of Medicine, University of Coimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra,Coimbra,Portugal, 3Ophthalmology,Unidade Local de Saúde de Coimbra,Coimbra,Portugal;Clinical Academic Center of Coimbra,Coimbra,Portugal
Purpose
To present a novel technique for pIOLs explantation, cataract phacoemulsification and intraocular lens insertion in patients with iris-fixated pIOLs and cataract and report on the endothelial safety and visual outcomes achieved with the technique.
Setting
Single-centre academic university hospital.
Methods
Single-centre retrospective review of a scaffold bilensectomy technique for previously implanted pIOLs and visually significant cataract from January 2015 to February 2024. The procedure involved creating two side ports and a 2.75-millimetre (mm) main incision, using dispersive viscoelastic for endothelial protection. One of the pIOL haptics was released and immediately fixated inferiorly to allow for additional space for cataract surgery. Phacoemulsification was then performed beneath the pIOL, with insertion of a pseudophakic IOL in the bag. Finally both haptics of the pIOL were released, and the main port enlarged to 6 mm for pIOL removal. The main incision was sutured with three 10/0 nylon single interrupted sutures.
Results
Sixteen eyes of 12 patients were included. Mean axial length was 30.54 ± 3.29 mm. Sixteen Artisan pIOLs were explanted. Mean age at bilensectomy was 49.62 ± 9.12 years. Mean ECD before surgery was 1916 ± 685 cells/mm2. One month post-operatively, mean ECD had decreased to 1790 ± 545 cells/mm2, with a mean surgery induced ECD decrease of 203 ± 259 cells/mm2 corresponding to a 6.58% loss. Mean corrected distance visual acuity was 0.09 ± 0.12 logMAR at one month post-operatively with a mean spherical equivalent of -0.50 ± 0.83 dioptres. No relevant intraoperative or postoperative complications were observed.
Conclusions
The scaffold pIOL explantation and cataract surgery technique allows for phacoemulsification through a single incision, with a stable chamber throughout the procedure, with enlargement of the incision for pIOL removal only after in-the-bag IOL insertion. This case series supports good visual and safety outcomes while employing this technique.