Management and challenges of femtosecond laser-assisted cataract surgery in patients with cataracts secondary to reverse-implanted posterior chamber phakic intraocular lens: a case report.

Background: Posterior chamber phakic intraocular lens are widely recognized as an effective treatment for refractive errors, yet they are not without risks. One notable complication that can emerge years after reverse implantation is cataract formation. In these intricate scenarios, femtosecond laser-assisted cataract surgery presents itself as a remarkably precise and safer approach for the extraction of cataracts, especially when the ICL is in a reverse position.

Case presentation: This report details the extraordinary case of a 33-year-old woman who, ten years after undergoing posterior chamber phakic intraocular lens implantation, experienced a decline in visual acuity in her left eye. She chose to undergo femtosecond laser-assisted cataract surgery in conjunction with posterior chamber phakic intraocular lens removal to address an anterior subcapsular cataract. The procedure encountered unique challenges, including biometric inaccuracies caused by the pre-existing posterior chamber phakic intraocular lens and difficulties in laser targeting. Manual adjustments were necessitated during the laser application. A trifocal intraocular lens was successfully inserted. At her three-month follow-up, the patient exhibited a remarkable improvement, achieving an uncorrected visual acuity of 20/20 in the treated eye. She expressed high satisfaction with the outcome, acknowledging only minor occurrences of halo effects.

Conclusions: This report confirms the feasibility of FLACS in treating cataracts in patients with reversely implanted posterior chamber phakic intraocular lens. Compared to typical cataract cases, the surgical procedure did not present significant additional challenges. However, meticulous preoperative measurements, laser scanning, and intraoperative alignment remain essential. With thorough preoperative preparation and precise posterior intraocular lens power calculation, the surgical outcomes can fully meet.