Long-term evaluation of primary anterior chamber intraocular lens implantation in complicated cataract surgery

Abstract

The long-term visual outcome and complications related to the use of a semiflexible open-loop alI-PMMA anterior chamber intraocular lens were evaluated in 40 eyes in which the capsular support was lost. The mean follow up time was 2.3 years (range 6 months to 6.7 years). 55% of the eyes had exfoliation syndrome. 68% (27 of 40 eyes) obtained a visual acuity of 0.5 or better, and only in one of the remaining eyes decreased visual acuity was related to cataract surgery (cystoid macular oedema). No cases of corneal decompensation, uveitis-glaucoma-hyphaema syndrome or retinal detachment have developed, and no IOLs have been explanted. Based on these results, the use of a modern anterior chamber intraocular lens can be suggested at least in old persons, if the capsular support is lost.

In-the-bag scleral suturing of intraocular lens in eyes with severe zonular dehiscence

“…There are four options for IOL implantation in aphakic eyes with inadequate capsular support: 1 (1) An open-loop AC-IOL, 2, 3, 4 (2) a scleral-sutured PC-IOL, 5, 6, 7 (3) an iris-sutured PC-IOL, 8, 9, 10 and (4) a scleral-sutured modified capsular tension ring. 11, 12, 13, 14 AC-IOLs have been improved from a closed-loop design to an open-loop design, and the open-loop AC-IOLs have been shown to be less traumatic to corneal endothelial cells than are closed-loop AC-IOLs.…”

“…11, 12, 13, 14 AC-IOLs have been improved from a closed-loop design to an open-loop design, and the open-loop AC-IOLs have been shown to be less traumatic to corneal endothelial cells than are closed-loop AC-IOLs. 3, 4 However, studies have shown that corneal edema with open-loop AC-IOLs occurs more frequently than with scleral-sutured or iris-sutured PC-IOLs, and that glaucoma escalation occurs at an incidence of between 1.3 and 15%. 1, 2, 3 Thus, such complications to the angle may be unavoidable with the AC-IOL.…”

“…When performing cataract surgery for eyes with severe zonular dehiscence or lens subluxation, surgeons need to employ a surgical technique to fixate an intraocular lens (IOL) without adequate capsular support; 1 these techniques include implantation of an open-loop anterior chamber IOL (AC-IOL); 2, 3, 4 scleral suture fixation of a posterior chamber IOL (PC-IOL); 5, 6, 7 iris suture fixation of a PC-IOL; and 8, 9, 10 scleral fixation of a modified capsular tension ring with the IOL. 11, 12, 13, 14 However, after implantation of an AC-IOL, corneal endothelial damage or glaucoma escalation remain a concern in spite of refinement in design.…”

“…11, 12, 13, 14 However, after implantation of an AC-IOL, corneal endothelial damage or glaucoma escalation remain a concern in spite of refinement in design. 2, 3, 4 In addition, after suturing of a PC-IOL to the sclera or iris, postoperative tilt and decentration due to inadequate haptic position is of particular concern. 15, 16, 17 Previous studies have shown that marked tilt or decentration after scleral fixation occurs in approximately in 8–23% of cases.…”

Secondary IOL implantation without capsular support. A laser flare cell‐meter study

“…Some studies have however demonstrated how the onset of cystoid macular edema varies from 6.7% to 42.9% following scleral-fixated IOL implants while it is drastically reduced from 5.7% to 22.2% with 4 ISRN Ophthalmology anterior chamber IOL implants [11,19,[30][31][32][33][34][35]. Thus the laser flare meter data we collected in this study, highlight that, following secondary IOL implantation, due to the absence of capsular support, there is a subclinical inflammation that is still present three months after surgery and is statistically significant when compared with flare values of patients undergoing phacoemulsification and contemporary IOL implantation in the capsular bag.…”