A Study of Anatomical and Visual Outcome in Primary Scleral Fixated Intraocular Lens Implantation.

Aims: To study the indications, safety, efficacy, post-operative outcome and complications in patients with primary scleral fixated IOL implantation. Materials and Methods: Forty patients, who underwent primary scleral fixated IOL implantation over a period of 2-years were analyzed for demographic data, indications, post-operative outcome, and complications of the procedure. Results: The study group ranged from 16-30 years. The male:female ration was 1.86:1. Subluxated cataract was the most common indication. All (100%) of our patients showed improvement in vision postoperatively. Complications were early complications like corneal odema, hyphema, iritis, and late complications including cystoid macular edema, secondary glaucoma, and astigmatism No vision-threatening complications including retinal detachment and endophthalmitis were observed. Conclusion: SF-IOLs give good anatomical and visual outcome in patients of cataract with inadequate capsular support.

Clinical Result of Iris Claw Lens and Trans-scleral Fixation Technique of Posterior Chamber Lens

Recently, with the development of ophthalmic surgical technique, many of aphakic patients want secondary implantation of intraocular lens. In aphakic eye without posterior capsule, implantation of posterior chamber lens can be performed by sulcus fixation of lens with prolene suture. But sulcus fixation technique has some complications as iP~rmanent fistula, rotation or tilting of the optics, hyphema, endophthalmitis and so on. In this study, 24 aphakic eyes, 22 patients implanted withl itis claw lens were compared with 13 aphakic eyes, 13 patients implanted with sulcus fixated posterior chamber IOLs. In 24 eyes implanted with iris claw lens, 18 eyes (75%) had a postoperative visual acuity of 20/40 or better and cystoid macular edema, intraocular lens dislocation were observed on each 2 eyes (8.3%) and iridodialysis on 1 eye (4.1 %). In 13 eyes implanted with sulcus fixed PCLs, 12 eyes (92%) had a postoperative visual acuity of 20/40 or better, and cystoid macular edema, vitreous hemorrhage, acute iridocyclitis and glaucoma were observed in each 1 case (7.7%). In aphakic eyes without posterior capsular support, iris claw lens will be a alternative method of intraocular lens implantation.

Implantation of Posterior Chamber Lens in the Absenee of Posterior Capsular Support

In the implantation of intraocular lens, anterior chamber lenses are usually avoided in glaucoma patients. And because of its close anatomic proximity to the cornea, iris and outflow structures, anterior chamber lense may give rise to more complications as compared with posterior chamber lenses. Thus, the dramatic trend toward clear decrease in the number of anterior chamber lens implantations continues. But despite these complications, the anterior chamber lenses are most often implanted secondarily in the aphakic patients, who, after having had intracapsular cataract extraction or a complicated extracapsular cataract extraction, have lost posterior capsular support. To avoid the many potential complications associated with anterior chamber lenses, attention has shifted toward posterior chamber lens insertion in these cases and particularly in glaucoma patients. From January 1989 to June 1989, we performed newly developed surgical techniques for the implantation of posterior chamber lenses in 7 eyes, including 5 eyes with glaucoma, without posterior capsular support, This was done by securing both haptics of the posterior chamber lens to the sclera at the ciliary sulcus with 10-0 nylon suture. The patients have been followed from 3 to 8 months, all have achieved visual acuity of 20/30 or better without any serious complications, and the postoperative intraocular pressure was well controlled in all 5 eyes with glaucoma.

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.