Endothelial loss with AcrySof® Cachet® angle-supported phakic lens

Galvis, V.; Tello, A.; Carreño, N.I.; Berrospi, R.D.; Niño, C.A.; Cuadros, M.O.

doi:10.1016/j.oftale.2016.11.012

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In addition, several manufacturers released in the first decade of the present century similar types of lenses (Phakic 6 H2, Vivarte, GBR, NewLife, I-Care, ZSAL-4 and AcrySof® Cachet®). However, at present and without exception all angle support phakic lenses have been withdrawn from the market due to mid- and long-term complications mainly related to endothelial loss (including AcrySof® Cachet® by Alcon®, withdrawn September 2014). In a letter addressed to ophthalmologists, Alcon® explained that the decision was taken because 2.7% of lenses in a group of 1323 cases had to be explanted due to endothelial loss.<a class="elsevierStyleCrossRef" href="#bib0025">2</a>There is very few literature on explants of said lens. Pechméja et al. reported the case of a patient who required explantation due to severe endothelial loss. Endothelial count was found to be 680cells/mm2 prior to explant.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> Alió et al. also mentioned that the AcrySof® Cachet® lens had to be withdrawn from one eye. It would be important to determine endothelial cells density of that case before and after the explant. In addition, said authors mentioned that one eye exhibited cell density below 1500cells/mm2 (this case explains the extremely low inferior range of cell density after 5 years of 808cells/mm2). Was that the above-mentioned explanation case or a different eye? If it was another patient, what approach was taken? It would be interesting to know how many of the 25 eyes that were followed up for 5 years exhibited densities between 1500 and 2000cells/mm2.In addition, even though the authors indicate that the biggest endothelial loss took place within the first 6 months after surgery, it is surprising that the inferior range of that range diminished significantly after 2 years follow-up, which suggests a late continuous loss, at least in one eye.The fact that multiple attempts to develop a safe angle support phakic lens have failed, together with the existence of severe corneal complications that jeopardize vision, quite clearly suggests that this type of approach should not be pursued in the future. On the other hand, it is very important to call the patients who received implants of said lenses for a corneal endothelial cell count in order to assess the need for an early explant before the appearance of irreversible corneal edema and the need for a corneal transplant." 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Sala" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2016.05.009" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2017" "volumen" => "92" "paginaInicial" => "4" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27453580" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Corrective Action Alcon AcrySof® CACHET® Phakic Lens Product Discontinuation. Available from: <a href="http://www.bfarm.de/SharedDocs/Kundeninfos/EN/11/2014/06204_14_Kundeninfo_en.pdf?__blob=publicationFile%26v=3">http://www.bfarm.de/SharedDocs/Kundeninfos/EN/11/2014/06204_14_Kundeninfo_en.pdf?__blob=publicationFile&v=3</a> [accessed 27.11.16]." ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe endothelial cell loss with anterior chamber phakic intraocular lenses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Pechméja" 1 => "J. Guinguet" 2 => "J. Colin" 3 => "P.S. Binder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2012.04.022" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1288" "paginaFinal" => "1292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22727299" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300403/v2_201708291316/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000009/v2_201708291316/S2173579417300403/v2_201708291316/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300403?idApp=UINPBA00004N"]

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