1569: phaco under a phakic IOL

We have featured videos in the past of performing cataract surgery in patients who already have a phakic IOL in the eye. For the posterior chamber phakic IOLs, I remove them prior to perform the cataract surgery. This is easy because these are very thin and flexible like the Visian ICL and Visian EVO ICL and they can be removed through a small phaco incision of between 2 and 3 mm in width. For patients with a larger or inflexible iris-clip anterior chamber designs such as the Verisyse or Artisan or Wörst phakic IOLs, a larger incision is required.

In some cases, the patient has a large degree of corneal astigmatism so we can place the incisions for phakic IOL removal and the phaco incision on the same meridian.

(A) This patient has a cataract and an anterior chamber phakic IOL. (B) The phakic IOL is held with forceps and the iris is freed from the claws. (C) A nasal limbal incision is made with a diamond keratome. (D) The phakic IOL is then removed from the eye.
(A) The nasal incision is then sutured securely with 10-0 nylon. (B) The cataract is removed using phacoemsulfication. (C) The new IOL is placed within the capsular bag. (D) All incisions are checked with fluorescein dye to ensure sealing.

In the video presented today, we have two guest surgeons and each of them performs the same technique: doing the phaco underneath the phakic IOL and then removing it towards the end of the surgery. The advantage here is that only a single incision is made and the surgeons can use the 2.5 or 2.75 mm incision to perform the cataract surgery which gives stable fluidics. Remember that these are very myopic eyes and chamber instability from mismatched fluidics can lead to a posterior capsule rupture and retinal complications. Then the incision is enlarged so that the phakic IOL can be removed and then IOL can be implanted. If you are wondering about the IOL calculations in these eyes, you should review this post and video.

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