Concurrent phakic intraocular lens explantation and phacoemulsification with IOL implantation: A retrospective analysis of efficacy and safety

PURPOSE: To evaluate the efficacy and safety of cataract surgery in patients who underwent posterior chamber phakic intraocular lens (PCpIOL) explantation combined with phacoemulsification and intraocular lens (IOL) implantation, with a minimum follow-up period of 2 years postoperatively. Methods: Retrospective study done at a tertiary eye care hospital in South India. STUDY POPULATION: Electronic medical records of 57 eyes of patients who underwent PCpIOL explantation combined with phacoemulsification and IOL implantation due to cataract development between 2009 and 2022 were analyzed for visual outcomes, IOL power predictability, and intraoperative or postoperative complications. INTERVENTION: Phacoemulsification was performed in 54 eyes, and femtosecond laser-assisted cataract surgery (FLACS) was performed in three eyes. MAIN OUTCOME MEASURE: Efficacy and safety of cataract surgery in these patients. RESULTS: Anterior subcapsular cataract development remains the most common cause for pIOL explantation. The phakic IOL models explanted in our study were implantable collamer lens (ICL) V4b, implantable phakic contact lens (IPCL) V1, and IPCL V2. Good improvement in corrected distance visual acuity (CDVA) was observed post-phacoemulsification, with 80.6% achieving CDVA of 0.3 logMAR or better. A total of 86.1% of the eyes were within +/-1.00 D of the target refraction (spherical equivalent). No intraoperative or early postoperative complications were noted. Posterior capsular opacification developed in 11 eyes, and retinal detachment (RD) in one eye. CONCLUSION: Phacoemulsification post-PCpIOL explantation yields good visual outcomes, a high safety profile, and stable refraction, without increased complications. The Barrett Suite formula reliably predicts IOL power calculation. A detailed preoperative fundus examination, with emphasis on the peripheral retina, is vital prior to PCpIOL implantation and phacoemulsification.