This case study presents the results and advantages of phacoemulsification, which Dr Dieter W Klass and his team applied after previous implantation of an iris-fixated phakic IOL (pIOL) (Artisan, Ophtec) for the correction of high myopia without explantation of the pIOL. The location of the procedure was the Outpatient Surgery Augenzentrum Friedberg/Augsburg in Germany.
The iris-fixated (PMMA) anterior chamber IOL is for the correction of ametropia in aphakic and phakic eyes. Twenty years ago, Dr Klass implanted these IOLs in highly myopic eyes as a refractive surgery with the aim of enabling patients to be nearly independent of spectacles.1,2
Some of these patients developed a cataract after ten to twelve years. At first, the team had to choose between different options to treat the cataract:
· Removal of the Artisan IOL through a mostly large incision of 6 to 7 mm dependant on the size of the IOL;3
· Removal of the cataract with phacoemulsification through a second incision of 2.2 mm with implantation of a posterior chamber IOL on the same day;
· Removal of the cataract with phacoemulsification through a second incision of 2.2 mm after waiting several weeks in order to obtain new data estimating the correct power of the IOL with special focus on residual astigmatism;
· Phacoemulsification behind the Artisan IOL without explantation of the pIOL and in-the-bag implantation of a posterior chamber IOL with the advantage of only one small incision.