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Phacoemulsification with phakic intraocular lens

Indian Journal of Ophthalmology
Medknow Publications
Publication Date
DOI: 10.4103/0301-4738.105059
  • Letters To The Editor
  • Medicine


Sir, The new-onset or the progression of lens opacity is most likely to occur after phakic intra-ocular lens (pIOL) implantation.[1] Further more endothelial decompensation with progressive cell loss is a common complication of pIOLs implantation and a major concern during the post-operative period.[2–4] The most common technique is to remove first the phakic IOLs, and then to perform the cataract surgery with posterior chamber IOL implant in the capsular bag. Moreover, even in uneventful cases, the micro-incision cataract surgery induces corneal endothelial cell loss similar to a standard phacoemulsification due to the ultrasonic energy as well as the fluidic currents in the eye.[5] In phakic eye with pIOLs implantation the surgery will generate then a further endothelial cell loss. We describe a new surgical approach to avoid further endothelial cell loss performing the cataract surgery with pIOLs in place. The technique uses the pIOLs as shields for endothelial cells during the cataract surgery. Our technique involves the injection of adhesive viscoelastic such as Healon GV (Abbott Medical Optics Inc. (AMO), Santa Ana, CA) or Viscoat (Alcon, Fort Worth, TX) between the endothelium and pIOLs and a cohesive viscoelastic such as Provisc (Alcon, Fort Worth, TX) between pIOLs and lens. [Fig. 1a] We then perform anterior continuous curvilinear capsulorhexis and all the steps of the cataract surgery behind the pIOLs [Fig. 1b–d]. The pIOLs will be removed as last step before the posterior chamber IOL implant in the capsular bag. Figure 1 The technique involves the injection of adhesive viscoelastic between the endothelium and pIOLs and a cohesive viscoelastic between pIOLs and lens. (a) Then the anterior continuous curvilinear capsulorhexis, (b) phacoemulsification, (c) and aspiration of the cortex are performed behind the pIOLs. We believe that splitting in the sleeve could be generated by the contact between the sleeve and the edge of the phakic IOLs, (d) The pIOL is removed af

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