Cataract surgery with ciliary sulcus fixation of intraocular lenses in patients with uveitis

• Published in: American journal of ophthalmology Vol. 128; no. 1; pp. 21 - 30
• Main Authors: HOLLAND, G. N, VAN HORN, S. D, MARGOLIS, T. P
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01-07-1999
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Capsulorhexis; Ciliary Body - surgery; Female; Follow-Up Studies; Humans; Intraocular Pressure; Iris Diseases - complications; Lens Implantation, Intraocular - methods; Lenses, Intraocular; Male; Medical sciences; Middle Aged; Phacoemulsification; Postoperative Complications - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Suture Techniques; Tissue Adhesions; Uveitis, Anterior - complications; Uveitis, Anterior - pathology; Visual Acuity; Human; Postoperative; Ciliary body; Cataract; Implantation; Uvea disease; Capsule; Eye disease; Lens disease; Association; Treatment; Surgery; Posterior; Uveitis; Complication; Technique; Intraocular lens; Synechia; Anterior segment disease
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(99)00140-3

To describe intentional placement of intraocular lens haptics in the ciliary sulcus of patients with uveitis who are at high risk for postoperative posterior synechiae and lens dislocation.
We reviewed our experience with 16 eyes of 12 patients with uveitis who underwent cataract surgery with ciliary sulcus fixation of intraocular lenses. Patients were followed for a median of 16.5 months (range, 9 to 44 months) after surgery. We evaluated eyes for surgical technique and the following preoperative and postoperative factors: best-corrected visual acuity, intraocular pressure, anterior chamber cells, and posterior synechiae. The following additional postoperative factors were sought: lens dislocation, lens edge capture, and evidence of pigment dispersion.
Posterior synechiae were present in 13 eyes before surgery; postoperative posterior synechiae developed in only three of these eyes. These adhesions resulted in lens edge capture in one eye and limited lens decentration in another. Scant pigment was present on the lens optic or in the anterior chamber, suggesting pigment dispersion, in four eyes. We found no evidence of consistently increased anterior segment inflammation or intraocular pressure after surgery when compared with preoperative levels for this group of patients. Postoperative posterior synechiae were seen more often in eyes that had can-opener anterior capsulotomy than in eyes that had continuous, curvilinear capsulorhexis (P = .036).
Ciliary sulcus fixation allows the intraocular lens to serve as a physical barrier between the iris and the lens capsule remnants. This technique may be useful for reducing the risk of postoperative posterior synechiae in patients with uveitis without increasing the risk of other postoperative problems.