Phakic intraocular lens explantation: series of 175 surgeries

Purpose: To evaluate the indications for pIOL explantation, pIOL survival time, and visual outcomes and access endothelial cell loss (ECL) after explantation. Setting: Ophthalmology Department, Centro Hospitalar Universitario do Porto, Portugal. Design: Retrospective longitudinal study. Methods: A chart review was performed for all consecutive patients who underwent pIOL explantation from January 2010 to December 2019 in a single center. Results: This study included 175 eyes of 112 patients (77% women). The mean pIOL survival was 12.9 +/- 4.8 (3.7 to 28.6) years, and the mean follow-up period after explantation was 4.1 +/- 3.0 (0.3 to 9.9) years. The most frequent causes for explantation were cataract formation (44.0%, n = 77) and ECL (50.3%, n = 88). During the follow-up period after explantation, the mean ECL rate was 2.27 +/- 9.32%/year in the cataract group and -2.14 +/- 10.24%/year in the ECL group, reflecting a positive change in cell density in the latter. 8 eyes (4.6%) required a corneal transplant during the follow-up. The mean corrected distance visual acuity was 0.17 +/- 0.24 logMAR at the last visit. Conclusions: This study demonstrated that pIOL explantation, after a mean survival time of 13 years, was a safe procedure. The main causes for explantation were cataract formation and ECL. Most patients showed a sustained improvement in visual acuity and endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.