Preferred practice patterns in aphakia management in adults in India: A survey

Abstract

Purpose: To assess different approaches in the management of aphakia in adults in Indian ophthalmologists via an online survey. Methods: A survey-monkey based online questionnaire was fielded to Indian ophthalmologists in accordance with the CHERRIES guidelines. We recorded participants’ demographics, practice settings, and preferred surgical options including the type of intraocular lens (IOL) preferred when encountering a case of aphakia in adults with and without adequate capsular support. Differences between anterior segment (AS) surgeons and vitreoretinal (VR) surgeons as well as differences between surgeons with more or less than 10 years of surgical experience were evaluated using analytic statistics. Results: Of the 481 surgeons who responded to the survey, 369 (77%) were AS surgeons and the remaining 112 (23%) were VR surgeons and represented all regions of India. When encountering posterior capsular rent during cataract surgery, a three-piece IOL in the ciliary sulcus was the most preferred (n = 275, 57%) when there was adequate capsular support, while a retrofixated iris-claw IOL (n = 91, 19%) was the commonest choice in eyes without adequate capsular support. With associated nucleus drop, 85% of surgeons preferred to refer the patient to a VR surgeon and left the eye aphakic. Multivariable logistic regression showed that VR surgeons were more than six times likely to prefer a scleral fixated intraocular lens (SFIOLs) [odds ratio (OR) = 6.5, 95% confidence interval (CI) = 3.4–12.5, P < 0.001] and surgeons with >10 years of experience were also twice more likely to prefer an SFIOL (OR = 2.4, 95% CI = 1.2–4.9, P = 0.02). Conclusion: The choice of IOL in absence of capsular support in adult eyes differs between AS and VR surgeons and is also influenced by the surgeon’s experience.

Corneal endothelial protection during manual small-incision cataract surgery

“…In cases without adequate capsular support, anterior segment surgeons prefer retro pupillary iris-claw IOLs in the primary cataract setting, whereas posterior segment surgeons and more experienced anterior segment surgeons preferred SFIOLs in this scenario. [ 47 ] A meta-analysis on various techniques of SFIOL involving 2624 eyes reported an overall mean EC loss of 8.95% at 16.77 ± 11.04 months. Glued SFIOLs in this series caused the lowest endothelial cell loss, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.…”

Clinical outcome in patients with 4- point scleral fixated intraocular lens: Our experience

“…Other factors include IOL availability, adequacy of capsular support, coexistent nucleus or cortex drop, white to white diameter, and primary (i.e., at the time of cataract surgery) vs. secondary surgery (after previous surgery). 2 SFIOL is preferred over iris claw IOL when normal iris pattern is lost as in cases of sphincterotomy, aniridia, dilated pupils post-surgery, iris atrophy. Advantages of SFIOL over ACIOL includes less corneal endothelial damage and secondary pupil block glaucoma.…”