Abstract
BackgroundWe discuss the safety, since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications.MethodsThis retrospective, cross-sectional study included 69 pIOLs, explanted at a single tertiary center between July 2005 and March 2020: 34 angle-supported (G1), 28 iris-fixated (G2) and seven posterior chamber (G3) pIOLs. Case data including the reason for explantation was taken from the patient records. Intra- and postoperative complications were evaluated for an association with the pIOL.ResultsThe mean duration in the eye was 10.4 (0.2–28) years. Cataractogenesis and subsequent surgery that required pIOL explantation was the reason in 42% of all cases. In 22%, cataract in combination with endothelial damage prompted explantation, with 26, 18 and 14% for G1, G2 and G3 respectively. The second most common reasons were corneal damage alone in the angle-supported group (26%), IOL subluxation in the iris-fixated group (18%), and photopic disturbance in the posterior chamber group (29%). In 68% of all explantations, the surgical course was unremarkable, while in the remaining cases perioperative complications were associated with the lens in 45.7%.ConclusionOverall, the need for cataract surgery was the most common reason for pIOL explantation. Corneal complications were more frequent in the angle-supported pIOLs and their removal was associated with higher rates of complication compared to the other groups.
Highlights
A variety of phakic intraocular lens designs have been developed for implantation to correct refractive errors in eyes with clear crystalline lenses [1]
Corneal complications were more frequent in the angle-supported phakic intraocular lenses (pIOLs) and their removal was associated with higher rates of complication compared to the other groups
In cases where the cornea was affected, three subcategories were made depending on the type of corneal damage: Corneal decompensation was chosen if keratoplasty was required, low endothelial cell count (ECC) if the number of cells was below 1500 cells/mm2 prior to explantation
Summary
A variety of phakic intraocular lens (pIOL) designs have been developed for implantation to correct refractive errors in eyes with clear crystalline lenses [1]. Choyce developed a series of nine designs intended for iridocorneal angle implantation. These lenses were made principally for cataract patients but some he implanted for the correction of ametropia in phakic eyes [3]. The ZB5M was later improved and made with thinner optics, larger optic diameter, flatter anterior face, and improved haptic profile to reduce angle trauma: the NuVita MA20 (Bausch & Lomb, Rochester, USA). Since their introduction, of phakic intraocular lenses (pIOLs) to correct refractive errors in healthy eyes. We investigated the reasons for pIOL explantation and the associated perioperative complications
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