Our guest surgeon is very talented surgically and manages to perform a beautiful cataract surgery in a patient while operating under the phakic IOL. My management would differ and in patients with an anterior chamber iris clip phakic IOL who develop a cataract, I recommended removing the phakic IOL at the time of cataract surgery.
These phakic lenses such as the Verisyse, Artisan, Veriflex, and Wörst lens, are iris-fixated and positioned in the anterior chamber, and they been associated with progressive corneal endothelial cell loss over time. Leaving it in place during or after cataract surgery may increase the risk of long-term corneal decompensation, particularly in older patients or those with already low endothelial cell counts. Additionally, the presence of the lens can hinder surgical access, impair visualization, and complicate capsulorhexis and phacoemulsification. Removing the Verisyse lens before or at the beginning of cataract surgery allows for safer manipulation of intraocular structures and reduces intraoperative risk. Given the potential for long-term corneal compromise, explanting the Verisyse lens and proceeding with standard cataract extraction and posterior chamber IOL implantation is typically the safest and most effective approach.
