Role of intraocular lens implant in restoration of sight in usual and unusual circumstances

ABSTRACT

One may divide the history of artificial intraocular lens [IOL] into four periods the age of myth, when in the ancient folklore and fairy tales magical crystals or precious stones gave the blind an extraordinary ability to see; the age of cocept, when in the 18th century some maverick oculists conceived that cataract could be replaced by an artificial lens, but failed to practically achieve it; the age of realization, when in 1949 Ridley first successfully implanted an IOL following cataract extraction; and the age of refinement, the modern era in which IOL implantation has become a routine therapy for cataract. The greater part of credit goes to technological advances rather than to ideation in ushering in this modern period. The modern surgery uses the anterior chamber, the pupil, or the posterior chamber for the intraocular fixation of the lens implant. However, because of its superior record of safety and success, the posterior chamber IOL implantation has now become the most popular technique. This technique has also proved helpful in restoring useful sight in situations where previously it would not have been possible without resorting to very extensive and complex surgical procedures. Hence, a simple posterior chamber IOL implantation restored useful sight in a 67-year-old man with a 21-year old traumatic cataract and extensive fibrovascular adhesions of the anterior segment with only a small portion of the cornea remaining clear; a 16-years-old girl with a traumatic cataract and thick central vascularized capsulocorneal adhesions; a 64-year-old man with a subluxated traumatic cataract, vitreous prolapse in the anterior chamber, and glaucoma; and a 70-year-old man with bilateral cataracts, basal cell carcinoma that had completely destroyed the nose, and keratinization of the nasal conjunctivae from irradiation of this tumor. Finally, the possibility that the anticipated advances in laser corneal sculpting and photorefractive surgery might render the present day IOL implantation surgery obsolete in the future is most exciting. [Pakistan Journal of Ophthalmology 833-38, April, 1992]