Visual outcomes and complications of intraocular lens placement in the absence of capsular support in a Philippine Tertiary Hospital

Background@#Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia.@*Objective@#This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support.@*Methods@#We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted.@*Results@#Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. @*Conclusion@#There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.

Long-Term Endothelial Cell Changes after Angle-Supported Anterior Chamber Lens Implantation in Phakic Eyes

PURPOSE: To evaluate long-term endothelial cell changes in phakic eyes that underwent implantation of an angle-supported anterior chamber lens to correct myopia. METHODS: A retrospective analysis was performed in 110 eyes of 55 patients who underwent implantation of angle-supported anterior chamber lenses with a follow-up period longer than 5 years. Comparisons were made between preoperative and postoperative endothelial cell density, coefficient of variation, and percentage of hexagonal cells. RESULTS: Mean preoperative corneal endothelial cell density was 2951 +/- 336 cells/mm2 and the percentage of cell loss was 3.8% at year 1, 12.6% at year 3, 13.4% at year 5, 22.5% at year 7, and 22.2% at year 9. Explantation was required in 13 eyes (11.8%) due to the decrease of endothelial cell count to 936 +/- 458 cells/mm2 over 9 years of follow-up. CONCLUSIONS: Continuous endothelial cell loss was observed after implantation of angle-supported anterior chamber lens in the long-term follow-up. A constant decline in the endothelial cell density necessitates periodic ophthalmologic evaluation including specular microscopy.

A Case of Ahmed Glaucoma Valve Implantation without Removal of the Anterior Chamber Lens

PURPOSE: To report the results of performing an Ahmed glaucoma valve implantation without removing the anterior chamber lens to treat secondary glaucoma. CASE SUMMARY: A 72-year-old male visited the hospital for imminent visual field loss in the left eye. At the time of the visit, he had a mild headache, and the intraocular pressure of the left eye was 38 mm Hg. The left eye had received anterior chamber lens insertion with iridectomy and the posterior capsule was ruptured. The vitreous protruded at the two o'clock site and adhered to the backside of the anterior chamber lens tilting it toward the temporal cornea. At the time of the visit, the maximum corrected vision of the left eye was 0.32. The patient was diagnosed with secondary glaucoma caused by the anterior chamber lens. Because the patient did not want to have the anterior chamber lens removed and the supporting area of the anterior chamber lens blocked the trabeculectomy and peripheral iridectomy sites, the authors performed an Ahmed glaucoma valve implantation instead. The outcome of Ahmed glaucoma valve implantation was evaluated through a preoperative and postoperative vision test and periodical corneal endothelial cell analysis. During the six months of postoperative follow-up, the vision was improved, intraocular pressure was stabilized, and corneal endothelial cells were maintained. CONCLUSIONS: When a patient requires glaucoma surgery for secondary glaucoma caused by an anterior chamber lens, an Ahmed implantation without lens removal may be an option which may carefully be considered. However, because of the possibility of subsequent complications, a longer follow-up period is necessary.

Visual Improvement in High Myopic Amblyopic Adult Eyes following Phakic Anterior Chamber Intraocular Lens Implantation

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic anterior chamber intraocular lenses in amblyopic adult eyes with very high myopia. METHODS: We evaluated 12 eyes in nine patients with very high myopic amblyopia who received angle-supported phakic intraocular lenses (Phakic 6H(R)) and followed them for more than six months. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications were evaluated. A satisfaction score was rated by patients using a 5-point (1~5) numeric scale. RESULTS: The mean age of patients was 37.3+/-9.4 years, ranging from 29 to 59 years old. The preoperative mean refraction (spherical equivalent, SE) was -20.10+/-5.41 diopters (D). The postoperative mean refraction (SE) was -1.75+/-0.76 D at six months. The postoperative BCVA improved an average 3.92+/-1.24 lines over preoperative values, and mean endothelial cell loss was 8.9% at six months. Development of cataracts, glaucoma, and pupil abnormalities were not demonstrated in any case during the study. The patients were all very satisfied, as the average satisfaction score was 4.3. CONCLUSIONS: This study indicates that angle-supported phakic anterior chamber intraocular lens implantation may be an effective surgical alternative for the correction of amblyopic adult eyes with very high myopia. However, long-term evaluation is necessary to assess possible complications and long-term safety.

Corneal Complication after 3M(R) Style 78E Anterior Chamber Intraocular Lenses Implantations

Anterior chamber intraocular lenges(IOLs) are important roles in visual rehabilitation in patients with vitreous loss during cataract surgery and secondary IOLs implantations. We examined three patients among 21 cases had implanted 3M(R) style 78E ACLs, which was closed loop, semiflexible and they experienced decreased vision due to bullous Keratopathy. ACLs were removed immediately, and then scanning electron microscopy(SEM) was performed. This study shows that fibrous tissues and inflammatory cells were precipitated around loop-optic junction. So, we expect this ACLs must be avoid especially secondary ACL implantations.

Corneal Complication after 3M(R) Style 78E Anterior Chamber Intraocular Lenses Implantations

Anterior chamber intraocular lenges(IOLs) are important roles in visual rehabilitation in patients with vitreous loss during cataract surgery and secondary IOLs implantations. We examined three patients among 21 cases had implanted 3M(R) style 78E ACLs, which was closed loop, semiflexible and they experienced decreased vision due to bullous Keratopathy. ACLs were removed immediately, and then scanning electron microscopy(SEM) was performed. This study shows that fibrous tissues and inflammatory cells were precipitated around loop-optic junction. So, we expect this ACLs must be avoid especially secondary ACL implantations.

Clinical Evaluation of Posterior Chamber Intraocular lens Implantation in thee Eye Without Poosterior Capsular Support

The use of a secondary intraocular lens is the best method for the management of spectacle-and contact lenses-intolerant aphakic eye. Because of the high incidence and the great variety of complications associated with anterior chamber lenses, a sulcus-fixed posterior chamber lens is more desirable than an anterior chamber lens. Therefore we have performed newly developed surgical techniques using 25-gauge needle for implanting a posterior chamber lens in the eye without posterior capsular support by securing haptic of the posterior chamber lens to the sclera at the ciliary sulcus with 9~0 prolene suture. These techniques have been sucessfully performed and have produced considerable visual improvement in thirteen aphakic eyes, two patients who had dislocated lens, and two pseudophakic patients who had sun-set syndrome. Eighty-eight percent of the 17 eyes had a postoperative visual acuity of 20/30 or better. The complications in three eyes were transient hyphema, transient vitreitis and exudate in lens surface, and pupillary capture. We have not yet experienced in our series any serious complication, such as lens dislocation, cystoid macular edema, retinal detachment, 2ndary glaucoma, endophthalmitis, and corneal decompensation, but long term follow up and more experience are necessary to establish the safety.