Femtosecond laser-assisted cataract surgery in vitrectomized eye with posterior chamber phakic intraocular lens

Management and challenges of femtosecond laser-assisted cataract surgery in patients with cataracts secondary to reverse-implanted posterior chamber phakic intraocular lens: a case report

BACKGROUND

Posterior chamber phakic intraocular lens are widely recognized as an effective treatment for refractive errors, yet they are not without risks. One notable complication that can emerge years after reverse implantation is cataract formation. In these intricate scenarios, femtosecond laser-assisted cataract surgery presents itself as a remarkably precise and safer approach for the extraction of cataracts, especially when the ICL is in a reverse position.

CASE PRESENTATION

This report details the extraordinary case of a 33-year-old woman who, ten years after undergoing posterior chamber phakic intraocular lens implantation, experienced a decline in visual acuity in her left eye. She chose to undergo femtosecond laser-assisted cataract surgery in conjunction with posterior chamber phakic intraocular lens removal to address an anterior subcapsular cataract. The procedure encountered unique challenges, including biometric inaccuracies caused by the pre-existing posterior chamber phakic intraocular lens and difficulties in laser targeting. Manual adjustments were necessitated during the laser application. A trifocal intraocular lens was successfully inserted. At her three-month follow-up, the patient exhibited a remarkable improvement, achieving an uncorrected visual acuity of 20/20 in the treated eye. She expressed high satisfaction with the outcome, acknowledging only minor occurrences of halo effects.

CONCLUSIONS

This report confirms the feasibility of FLACS in treating cataracts in patients with reversely implanted posterior chamber phakic intraocular lens. Compared to typical cataract cases, the surgical procedure did not present significant additional challenges. However, meticulous preoperative measurements, laser scanning, and intraoperative alignment remain essential. With thorough preoperative preparation and precise posterior intraocular lens power calculation, the surgical outcomes can fully meet.

Cataract Following Pars Plana Vitrectomy: A Review

Introduction: The indications for pars plana vitrectomy (PPV) have increased over the years. The vitreous is no longer considered an inert ocular structure and it is well known that its removal has anatomical and physiological consequences. The vitreous is no longer considered an inert ocular structure. The vitreous plays a key role as an intraocular physiologic oxygen regulator. In order to maintain its transparency, the crystalline lens needs protection from an excessive oxygen exposure. PPV leads to progression of nuclear sclerosis in most eyes.Methods: A systematic review of the literature was conducted using Embase and Medline databases. Articles studying the physiology, pathogenesis and surgical treatment of cataract after PPV were included in this review.Results: The pathogenesis of cataract formation after PPV remains unclear. Predisposing factors include advanced patient age, preexisting nuclear sclerosis, light toxicity, intraoperative oxidation of lens proteins, use of silicone oil or intravitreal gas, mechanical trauma and the duration of exposure to an irrigating solution.Conclusion: Cataract surgery in vitrectomized eyes presents with more technical difficulties, is more challenging and often has a higher risk of intraoperative and postoperative complications than in non vitrectomized eyes. There is no standardized technique or management in these cases; therefore, it requires more precautions during surgery.

Challenges during femtosecond laser assisted cataract surgery with posterior chamber phakic intraocular lens

Femtosecond laser-assisted cataract surgery was performed in a patient with high myopia, who had undergone posterior chamber phakic intraocular lens surgery (Implantable Collamer Lens, ICL). During docking the machine erroneously focused the laser on the anterior surface of ICL and laser for lens fragmentation was also defocused, which were correctly positioned before laser delivery. During laser application for capsulotomy, air bubbles were entrapped under the ICL prohibiting lens fragmentation. One must be careful during focusing the laser in eyes with ICL. Additionally, gas bubbles under the ICL may lead to difficulties in completion of nuclear disassembly.