Removal of age-related cataract and iris claw phakic intraocular lens.

we have implanted more than 300 Worst iris-claw myopia phakic intraocular lenses (IOL). We report on a patient with a Worst iris-claw lens who developed a senile cataract, necessitating removal of the IOL, extraction of the cataract, and implantation of a new IOL in the posterior chamber. A 60-year-old white male requested refractive surgery in March 1991. The manifest preoperative refraction was right eye:-11.00-1.00 x 170° (20/40) and left eye:-8.00-1.25 x 10° (20/30). The rest of the ophthalmic examination was unremarkable except for fundoscopy, which demonstrated myopic choroidal atrophy with myopia crescent and pavingstone degenerations. After being fully informed of the risks, complications, and alternatives of the procedure, and following informed consent, an Ophtec Worst myopia iris-claw lens (Ophtec, style 206001W, power-12.00 D, Ophtec, Groningen, The Netherlands) was implanted in the right eye, as described previously. 1 One month after surgery, the manifest refraction was-0.75-1.25 x 170° (20/30). Four years after surgery, the patient complained of progressive loss of visual acuity in the right eye. Examination disclosed an uncorrected visual acuity of 20/400, and a refraction of-2.50-0.75 x 160° (20/80). Slit-lamp biomicroscopy showed a dense nuclear sclerotic cataract. Based on initial biometric data and current corneal keratometry—using the SRK formula—posterior chamber IOL power was calculated at +9.00 D. Using a non-contact specular microscope (Topcon SL7F, Topcon Corp., Tokyo, Japan), we photographed and videotaped (Imagenet Topcon Corporation, 1988) 2 central corneal areas, which disclosed an endothelial cell density of 2160 cells/mm 2 ; the percentage of hexagonality was 58% and the coefficient of cell variation was 0.35. These normal values allowed us to proceed with the extracapsular extraction. Under pharmacologic mydriasis and local anesthesia , a 6-mm long tunneled scleral incision was made at the 12 o'clock meridian. Two puncture incisions were placed at the 3 and 9 o'clock meridians. After deepening the anterior chamber with a high viscosity viscoelastic agent, a forceps was inserted into it through the scleral incision, and one of the haptics was fixated. A Rycroft 30-gauge cannula was inserted through the corresponding horizontal paracentesis to liberate the iris fold from the slit in the haptic. This was repeated for the other haptic. The lens was oriented in the 6 and 12 o'clock direction and was explanted without complication. Two lateral " X " sutures were then placed in the scleral incision with partial closure of the latter to secure a 3.2-mm long wound. Through this incision …