TY - JOUR
T1 - Removal of dislocated intraocular lenses using Pars plana vitrectomy with placement of an open-loop, flexible anterior chamber lens
AU - Mittra, Robert A.
AU - Connor, Thomas B.
AU - Han, Dennis P.
AU - Koenig, Steven B.
AU - Mieler, William F.
AU - Pulido, Jose S.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1998/6/1
Y1 - 1998/6/1
N2 - Objective: There are many alternatives available to the vitreoretinal surgeon in the management of posteriorly dislocated intraocular lenses (IOL). The lens may be repositioned in the ciliary sulcus if there is adequate capsular support, but if this support is absent, it must either be sutured in place (to the sclera or iris) or exchanged for an anterior chamber (AC) IOL. Scleral-sutured IOLs can be associated with hemorrhage, cystoid macular edema, retinal detachment, and endophthalmitis (through the suture tract), and use sutures that must last for the lifetime of the patient. Anterior chamber IOLs (ACIOLs) are easier to implant but require a limbal incision for insertion. The authors sought to determine the safety and efficacy of combining removal of posteriorly dislocated IOLs with ACIOL placement. Design: A retrospective chart review, in which all cases of dislocated IOLs managed at the authors' institution over the last 5 years were reviewed. Patient characteristics, pre-existing ocular conditions, preoperative visual acuity (VA), intraocular pressure (lOP), type of lens dislocated, operation performed, postoperative VA and lOP, and length of follow-up were recorded. Results: A total of nine cases were identified. Seven of these underwent primary posterior chamber (PC) IOL removal with ACIOL implantation. One had an ACIOL placed after a sulcus-sutured PCIOL dislocated, and one had enough capsular support for placement of a PCIOL after removal of a plate haptic silicone lens. Of the seven primary ACIOL cases, the best-corrected VA improved in five cases, was unchanged in one (remained 20/20), and declined in another. The final postoperative VA (mean follow-up, 12 months) was 20/30 or better in five patients, and was limited by age-related macular degeneration and epiretinal membrane in the other two. A hyphema occurred in two patients and cleared in both without visual compromise. There was no evidence of corneal compromise or exacerbation of glaucoma in any of the patients. Conclusions: Given that the results and complication rates in this small series appear to be similar to those reported for sulcus-suture techniques, implantation of an ACIOL after removal of a posteriorly dislocated IOL appears to be a viable alternative to suture fixation in the absence of capsular support.
AB - Objective: There are many alternatives available to the vitreoretinal surgeon in the management of posteriorly dislocated intraocular lenses (IOL). The lens may be repositioned in the ciliary sulcus if there is adequate capsular support, but if this support is absent, it must either be sutured in place (to the sclera or iris) or exchanged for an anterior chamber (AC) IOL. Scleral-sutured IOLs can be associated with hemorrhage, cystoid macular edema, retinal detachment, and endophthalmitis (through the suture tract), and use sutures that must last for the lifetime of the patient. Anterior chamber IOLs (ACIOLs) are easier to implant but require a limbal incision for insertion. The authors sought to determine the safety and efficacy of combining removal of posteriorly dislocated IOLs with ACIOL placement. Design: A retrospective chart review, in which all cases of dislocated IOLs managed at the authors' institution over the last 5 years were reviewed. Patient characteristics, pre-existing ocular conditions, preoperative visual acuity (VA), intraocular pressure (lOP), type of lens dislocated, operation performed, postoperative VA and lOP, and length of follow-up were recorded. Results: A total of nine cases were identified. Seven of these underwent primary posterior chamber (PC) IOL removal with ACIOL implantation. One had an ACIOL placed after a sulcus-sutured PCIOL dislocated, and one had enough capsular support for placement of a PCIOL after removal of a plate haptic silicone lens. Of the seven primary ACIOL cases, the best-corrected VA improved in five cases, was unchanged in one (remained 20/20), and declined in another. The final postoperative VA (mean follow-up, 12 months) was 20/30 or better in five patients, and was limited by age-related macular degeneration and epiretinal membrane in the other two. A hyphema occurred in two patients and cleared in both without visual compromise. There was no evidence of corneal compromise or exacerbation of glaucoma in any of the patients. Conclusions: Given that the results and complication rates in this small series appear to be similar to those reported for sulcus-suture techniques, implantation of an ACIOL after removal of a posteriorly dislocated IOL appears to be a viable alternative to suture fixation in the absence of capsular support.
UR - http://www.scopus.com/inward/record.url?scp=0031862769&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0031862769&partnerID=8YFLogxK
U2 - 10.1016/S0161-6420(98)96001-8
DO - 10.1016/S0161-6420(98)96001-8
M3 - Article
C2 - 9627650
AN - SCOPUS:0031862769
SN - 0161-6420
VL - 105
SP - 1011
EP - 1014
JO - Ophthalmology
JF - Ophthalmology
IS - 6
ER -