Alcon have voluntarily withdrawn their anterior chamber Cachet lens from the market due to concerns about abnormally high endothelial cell loss. Although this only occurred in a small number of patients, it was sufficient to trigger its discontinuance. They are not recommending explantation of patients with existing lenses but are recommending close monitoring with regular endothelial cell counts.
This leaves a gapping hole in the management of patients who are seeking refractive surgery but who are high myopes, too young for refractive lens exchange and out of range for Lasik or PRK. These are largely the 20-45 year group. There are few options available to this group at present. The Artisan lens is one option but a fiddly option at that. This group is often very active and are at risk of the lens becoming detached from the iris. The lens has a clip arrangement on the haptic which allows it to be attached onto the iris. The surgery is also challenging for the surgeon and as such there aren’t many implanting it.
An alternative approach is a phakic IOL(ICL) implanted under the iris and in from of the lens. The Visian ICL is one such example. This lens, like the Artisan is also challenging to implant and has it own set of problems. Furthermore, in order to become accredited in implanting these lenses, one needs to do a number at the same sitting. The reality is, that patients with this kind of refractive error do not come along everyday, let alone 3 or 4 in one sitting. Thus, there are few surgeons in Melbourne who can implant these lenses.
With regards to safety, these lenses have been shown to increase the risk of cataract formation significantly. Indeed I have seen a patient who was in her early twenties who required me to bilaterally explant her ICL’s and perform cataract surgery for this very reason. If was in this category I don’t think that I would choose this option.
So where does that leave us? In a difficult spot, thats where.
Alcon is looking more closely at this situation and the lens may be reintroduced in the future (perhaps modified in some way)