Femtosecond Laser Assisted Cataract Surgery in a Patient with Anterior Chamber Phakic IOL in situ

Introduction: Conventional phacoemulsification and intraocular lens (IOL) implantation for patients who already have a phakic IOL (PIOL) in situ can present challenges in IOL power calculation and the surgical procedure. Here we report a case of phacoemulsification with IOL implantation without removing the anterior toric PIOL. Patient and Clinical Findings: This 45-year-old male was referred to our clinic with mature cataract in the right eye, and a history of multiple corneal surgical procedures including radial keratotomy, LASIK, corneal cross-linking, and Artiflex toric PIOL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity were 20/2000. Diagnosis, Intervention, and Outcomes: Since CDVA was 20/25 after toric PIOL implantation and prior to the development of cataract, and the cornea was compromised, the toric PIOL was not removed. Using femtosecond laser assisted cataract surgery (FLACS) through the toric PIOL, capsulotomy and lens fragmentation were completed without modifying the device setting, and an IOL was inserted in the bag. At one year after surgery, right eye UDVA, CDVA, and refraction were 20/32, 20/25, and +1.25/-1.00*120ᵒ. Conclusion: In this case, FLACS was a successful technique for preserving the toric PIOL, and results were stable during the one year of postoperative follow up.