During the period January 1988 to August 1990, 48 anterior chamber intraocular lenses were implanted during primary cataract surgery. In 6 eyes an anterior chamber intraocular lens was implanted after intracapsular cataract extraction, in 42 eyes after extracapsular cataract extraction complicated by posterior capsular or zonular rupture. Of the 40 cases which had been followed for at least 6 months (mean 23 months), 5 eyes (12.5%) developed clinically significant cystoid macular oedema. All these eyes had an extracapsular cataract extraction with a posterior capsular tear and anterior vitrectomy and in addition all had some other surgical or postoperative complications. Thus, in this series of complicated cataract surgery, cystoid macular oedema was an important cause of visual impairment but cystoid macular oedema was hardly due to the presence of an anterior chamber intraocular lens.

The long-term visual outcome and complications related to the use of a semiflexible open-loop alI-PMMA anterior chamber intraocular lens were evaluated in 40 eyes in which the capsular support was lost. The mean follow up time was 2.3 years (range 6 months to 6.7 years). 55% of the eyes had exfoliation syndrome. 68% (27 of 40 eyes) obtained a visual acuity of 0.5 or better, and only in one of the remaining eyes decreased visual acuity was related to cataract surgery (cystoid macular oedema). No cases of corneal decompensation, uveitis-glaucoma-hyphaema syndrome or retinal detachment have developed, and no IOLs have been explanted. Based on these results, the use of a modern anterior chamber intraocular lens can be suggested at least in old persons, if the capsular support is lost.

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The effects of a semiflexible, one-piece, open-loop anterior-chamber intraocular lens (AC-IOL) implanted after intracapsular or extracapsular cataract extraction complicated by posterior-capsular or zonular rupture on intraocular pressure (IOP) level and the control of previous glaucoma were studied in 48 eyes with primary implantation and in 10 eyes with secondary implantation. Fifty-four percent of the eyes with primary implantation had exfoliation syndrome; anterior vitrectomy was performed in 60.4%. An immediate pressure rise (IOP ≥30 mm Hg) was observed in 29.3% of the eyes. The long-term IOP level (median follow up, 21.5 months) was ≥20 mm Hg in 83.7% and between 21 and 29 mm Hg in the remaining 16.3%. In three of the nine glaucomatous eyes, the medication had to be increased; in the remaining six, the IOP could be controlled with the previous or reduced medication or with none at all. In three out of the 49 (6.1%) nonglaucomatous eyes, glaucoma medication was started during the follow up. All of these eyes had exfoliation syndrome and two of the fellow eyes had similar IOPs and were receiving similar medication. The results indicate that the semiflexible, openloop AC-IOL has little effect on IOP and seems to be a safe alternative, even in glaucomatous eyes, if a posterior chamber lens cannot be used.