Official ESCRS | European Society of Cataract & Refractive Surgeons


Visual outcomes, safety and main causes of posterior chamber phakic intraocular lens bilensectomy

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Session Details

Session Title: Combined Cataract Surgery & Practice Styles

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 14:18

Venue: Free Paper Forum: Podium 2

First Author: : V.Vargas Fragoso SPAIN

Co Author(s): :    R. Barraquer   J. D’Antin   C. Garcia   F. Duch   J. Balgos   J. Alió              

Abstract Details


To evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens (pIOL) explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOL.


Vissum Alicante and Madrid, Spain; Centro de Oftalmología Barraquer, Barcelona, Spain and Instituto Catalán de Retina (ICR) Refractive Surgery Unit, Barcelona, Spain.


This is a consecutive retrospective, multicenter study, which included 88 eyes that had bilensectomy for a posterior chamber pIOL. All the data was obtained from the IBERIA biobank. Patients with follow up less than 6 months were excluded from the study. The main outcome measures were: uncorrected and corrected visual acuity (UCVA, CDVA), refractive outcome, central endothelial cell density (ECD), safety and efficacy index. The secondary outcomes were: main cause of bilensectomy, type of pIOL explanted, time between the implantation and the bilensectomy, intraoperative and postoperative complications.


The main reason for bilensectomy was cataract (82 cases), followed by neuroadaptation failure, corneal edema, IOL dislocation, refractive surprise, and endophthalmitis. The mean time between pIOL implantation and bilensectomy was 85.2  61.59 months The pIOLs explanted were: seventy-three ICL (models V3, V4), seven IPCL and eight PRL. There was a significant improvement in UCVA and CDVA after bilensectomy (p=.000). Efficacy and safety index were 1.2 and 1.5 respectively. The ECD remained stable after surgery (p = .626). The only intraoperative complication was posterior capsule rupture (1 eye). Postoperative complications included retinal detachment (1 eye) and posterior capsule opacification.


All phakic IOLs will be explanted at some point, and cataract remains the main reason for bilensectomy. There were few postoperative complications, although one was sight threatening (retinal detachment). The ICL was the most explanted pIOL - this can be explained because it is the most widely implanted PC pIOL. The development of cataract with the latest model of ICL (V4c) is less common than with older models. In our series, just one ICL V4c was explanted due to cataract development. Bilensectomy for posterior chamber pIOL successfully improved the UCVA and CDVA without a significant loss of ECD.

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