Anterior chamber intraocular lens - An effective alternative in traumatic and surgical aphakia in the era of scleral-fixated intraocular lens

• Published in: Indian journal of ophthalmology Vol. 69; no. 6; pp. 1404 - 1408
• Main Authors: Mahapatra, Santosh, Mannem, Navya
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-06-2021; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: ac iol; Acuity; Aged; Anterior Chamber; Aphakia; Aphakia - surgery; Care and treatment; Cataracts; Complications; Dehiscence; Edema; Eye; Female; Hemorrhage; Humans; Injuries; Intraocular lenses; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Methods; Middle Aged; Original; Patient outcomes; Postoperative Complications - epidemiology; ppv; Retrospective Studies; Sclera - surgery; sf iol; Surgery; surgical aphakia; traumatic aphakia; Uveitis; Vitrectomy; India; AC IOL; SF IOL; surgical aphakia; traumatic aphakia; PPV
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_2192_20

Purpose: To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods: In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results: Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion: Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.