Comparing Femtosecond Laser–Assisted Cataract Surgery Before and After Phakic Intraocular Lens Removal

PURPOSE: To investigate two approaches for femtosecond laser–assisted cataract surgery (FLACS) in patients with phakic intraocular lenses (IOLs). METHODS: Anterior capsulotomy and lens fragmentation were performed with an image-guided femtosecond laser. Laser treatment was performed under sterile conditions prior to (technique 1, 5 cases) or after (technique 2, 5 cases) phakic IOL explantation. RESULTS: In technique 1, gas accumulated between the phakic IOL and the anterior capsule. In 2 (40%) of these cases, an anterior capsule tear occurred during phacoemulsification. In both cases, no anterior vitrectomy was necessary and the IOL was implanted into the capsular bag. In technique 2, no anterior capsule tears or other complications occurred. CONCLUSIONS: Laser treatment prior to phakic IOL explantation has a risk for anterior capsule tears. Potentially, the laser beam is deflected by the optic of the phakic IOL and gas between the anterior capsule and the phakic IOL induces radial forces. [ J Refract Surg. 2018;34(5):343–346.]