Visual rehabilitation of aphakia – The Indian perspective.

ABSTRACT

Aim of study To evaluate efficacy of surgical intervention in patients having aphakia by secondary IOL implant and to study their complications.Design: A time bound study for management of aphakia in the department of ophthalmology , SAIMS Indore from Feb. 2004 to Feb. 2012. Method: After clinical evaluation on individual basis, we carried out a secondary procedure on thirty two eyes of thirty one patients from age group twenty-six months to seventy four years. Placement of implant in posterior compartment was given first priority in cases of aphakia reporting on out patient basis. In cases where cataract surgery was eventful or could not be completed we preferred doing in the bag placement.If this was not feasible then placement of haptic in ciliary sulcus was the next preferred choice.In the event of pre-existing PAS or insuffecient iris ,we chose to do scleral fixation. In absence of these with inadequate capsular support, anterior chamber placement of lens was done . Power of intraocular lens was calculated by SRK formula. In all cases, except one ab externo, a scleral tunnel was made or previous tunnel used for implantation, depending on duration elapsed between cataract surgery and secondary implantation. Best corrected visual acuity for distance and near was determined at the end of six weeks. In traumatic cases A-Scan biometry was done after six weeks using aphakic mode. Undercorrection of implant power in paediatric patients was done according to age. Result: On the basis of visual acuity recorded patients were categorized into three groups. Twenty four (80%) patients achieved BCVA of 6 /18 or better, four(13.3%) patients gained vision between 6/24 to 6 /60 while two (6.6%) had visual acuity between 3/60 to 5/60. Mean spherical refractive correction was - 0.616 , mean value of cylinder was -0.742 ,which is considerred the most optimal and desired outcome after IOL implantation. Conclusion: Though secondary intervention was done in eyes where ocular tissues had undergone prior surgical handling , inclusive of patients with poor visual prognosis, still 80% could achieve BCVA 6/18 or better. This shows that secondary implantation is an effective means of rehabilitating aphakic patients. Traumatic cases should better be dealt with by a sequential approach.