Angle-supported anterior chamber phakic intraocular lens explantation - Causes and outcome

Purpose: To investigate the reasons for explantation of angle-supported phakic intraocular lenses (IOLs) as well as the outcome and safety of the explantation procedure. Design: Consecutive retrospective series. Participants: One hundred eyes of 66 patients who underwent phakic angle-supported IOL explantation. Intervention: Surgical explantation of anterior chamber angle-supported phakic IOLs. Main Outcome Measures: Visual acuity, refraction, and endothelial cell density. Results: The main causes of explantation were cataract development (64 cases {[}64\%]), progressive endothelial cell loss (24 cases {[}24\%]), and pupil ovalization (10 cases {[}10\%]). According to the reason for phakic IOL explantation and the condition of the eye at time of explantation, 92 cases underwent bilensectomy (phakic IOL explantation followed by phacoemulsification of the crystalline lens), 2 cases underwent phakic IOL exchange, 4 cases underwent concomitant phakic IOL explantation and penetrating keratoplasty, and 2 cases underwent simple explantation of a phakic IOL. The mean time between phakic anterior chamber IOL implantation and explantation due to cataract was 10.04 +/- 3.66 years (range, 2-14). The mean time between implantation and secondary intervention due to progressive endothelial cell loss was 8.97 +/- 2.21 years (range, 2-14), and most of these cases were related to a specific model of angle-supported phakic IOL. Conclusion: Nuclear cataract was the most frequent reason for angle-supported phakic IOL explantation. Bilensectomy was effective and maintained the refractive benefits obtained with phakic IOL implantation. Few cases developed severe endothelial cell loss, most of them related to certain types of phakic IOLs.