Cataract Surgery And Phakic Iol Explantation In High Myopes: A Case Series Of Tailored Surgical Approaches
Published 2025 - 43rd Congress of the ESCRS
Reference: PO324 | Type: Free paper | DOI: 10.82333/44h8-qj29
Authors: Dilan Colak 1 , Burcu Yakut* 2 , Songul Kilic 2 , Ugur Tunc 3 , Aylin Kilic 4
1Ophthalmology,University of Health Sciences, Beyoglu Eye Research and Training Hospital,Istanbul,Türkiye, 2Ophthalmology,University of Health Sciences, Haseki Training and Research Hospital,Istanbul,Türkiye, 3Ophthalmology,Faculty of Medicine, Istanbul Medipol University,Istanbul,Türkiye, 4Ophthalmology,Faculty of Medicine, Biruni University,Istanbul,Türkiye
Purpose
Multifactorial cataract development is the most common reason to explant a phakic IOL (pIOL). We review challenges and techniques related to simultaneous cataract and pIOL explantation surgery.
Setting
Ophthalmology Department, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal
Methods
A descriptive retrospective analysis of a case series of cataract surgeries with simultaneous pIOL explantation. The sample included 26 eyes from 19 patients. We collected data on patient demographics, pIOL characteristics, surgical techniques, visual and refractive outcomes. Surgical techniques and special considerations were ilustrated in video segments.
Results
All eyes were high myopes (average AL = 30.8 mm). The series included posterior chamber (PC) pIOLs and both foldable and rigid designs of angle-supported and iris-fixated anterior chamber (AC) pIOLs. Average age at pIOL implantation was 39 years and at cataract surgery was 54 years. The mean endothelial cell density (ECD) was significantly lower in the AC pIOL group (1940 vs 2469 /mm3, p=0,034). Rigid pIOLs were explanted either through scleral tunnel (n=9) or through enlargement of the corneal incision after phacoemulsification (n=5). Monofocal IOLs were implanted in all cases. The median final spherical equivalent was -1.5D, and the average corrected visual acuity was 0.31 logMAR, with 54% achieving 0.1 logMAR or better.
Conclusions
Despite increased complexity of cataract surgery with pIOLs in eyes with high myopia, knowledge of different pIOL characteristics and tailored surgical techniques resulted in good visual and refractive outcomes. Rigid PMMA lenses require larger incisions for explant. Phacoemulsification through small incisions before explantation is made helps maintain anterior chamber stability during surgery. The scleral tunnel technique minimizes induced astigmatism when larger incisions are needed. AC pIOLs may reduce ECD, necessitating extra surgical care to prevent endothelial decompensation. High myopia justifies early cataract development and myopic degeneration limits visual outcomes as well as IOL choice in this series.