PURPOSE: To evaluate the clinical outcomes of combined phakic intraocular lens (phakic IOL) explantation, phacoemulsification, posterior chamber intraocular lens (PCIOL) implantation, and Descemet stripping automated endothelial keratoplasty (DSAEK) performed for phakic IOL-related endothelial decompensation.
DESIGN: Retrospective, interventional case series.
METHODS: SETTING: Private hospital. study POPULATION: Ten eyes of 7 patients who developed endothelial decompensation after phakic IOL implantation and were treated with a combined procedure of phakic IOL explantation, phacoemulsification, PCIOL implantation, and DSAEK. MAIN OUTCOME MEASURES: Best spectacle-corrected visual acuity (BSCVA), manifest refractive error, endothelial cell count, and intraoperative and postoperative complications.
RESULTS: Mean postoperative follow-up was 25.2 ± 28.6 months (range 3-84 months). BSCVA at last visit was 7/10 or better in 6 eyes, 4/10 in 1 eye, and 2/10 or worse in 3 eyes, of which all had myopic maculopathy or deep amblyopia. Mean postoperative spherical equivalent was -3.4 ± 1.2 diopters. Mean endothelial cell loss in comparison to preoperative donor endothelial cell density was 21.3% ± 7.7%. Minor PCIOL decentration was seen in 1 patient, and IOL exchange was required in another patient owing to high postoperative refractive error. One graft rejection leading to graft failure was seen and was excluded from endothelial cell loss calculation. Conclusion An operation combining phakic IOL removal, DSAEK, cataract removal, and PCIOL implantation can offer fast visual rehabilitation with good visual results and graft survival.