Phakic Lens Explantation – Outcomes And Complications

To analyze a retrospective sample of patients who underwent phakic lens explantation. The main objectives were to compare visual, refractive, and safety outcomes based on the reason for explantation (cataract, endothelial cell loss, others), the type of surgery associated with the explantation (with or without lensectomy), and preoperative endothelial status.

Cornea and Anterior Segment Department, in Hospital de Braga, Braga, Portugal

The study included 154 eyes from 110 patients (mean age: 47.4 ± 9.1 years). Phakic lenses had been implanted for 12.38 ± 5.7 years. Patients underwent anterior or posterior chamber phakic lens explantation via corneal or scleral incision, with or without phacoemulsification and pseudophakic IOL implantation. Main indications for surgery were cataract and/or severe endothelial cell loss. Preoperative and 12-month assessments included uncorrected (UDVA), and corrected (CDVA) distance visual acuity, refractive predictability (sphere, cylinder, spherical equivalent), efficacy/safety indices, endothelial cell density (ECD, cells/mm²), complication rates, and risk factors for poor outcomes or secondary interventions.

The most explanted phakic lenses were rigid (44.2%) and foldable (29.2%) iris-fixated lenses. Main reasons were cataract (52%) and endothelial cell loss (40%). Combined explantation and lensectomy was most common (69.5%), while isolated explantation occurred in 25.8%. At 12 months, CDVA improved from 0.46±0.26 to 0.60±0.26. Patients explanted for endothelial loss had lower preoperative anterior chamber depth, shorter critical distance, and lower ECD. Keratoplasty was needed in 12/60 eyes with endothelial loss (20%) (penetrating in 3 and posterior lamellar in 8 eyes). Nine had bullous keratopathy or endothelial decompensation preoperatively. At 12 months, excluding two with bullous keratopathy, ECD remained stable.

Cataract is the most common reason for phakic lens explantation. The triple procedure (explantation, lensectomy, and pseudophakic IOL implantation) was safe and effective, with no significant endothelial cell loss or major complications requiring reintervention. No cases of cataract-related explantation led to endothelial decompensation. In patients requiring explantation due to progressive endothelial cell loss, the postoperative keratoplasty rate was significant (20%), with a higher risk in cases with preoperatively reduced ACD, shorter critical distances, or evident signs of corneal decompensation.