Sutured posterior chamber intraocular lenses: indications and procedure

Abstract

Intraocular lens (IOL) implantation is the standard of care for treating aphakia when spectacle or contact lens correction is not viable. There is considerable controversy about the relative efficacy and safety of the different IOL implantation approaches, as well as their indications. Since the development of the modern, open-loop anterior chamber IOL (ACIOL) and the re-emergence of the iris-fixated claw IOL, ACIOL implantation for aphakia has regained popularity. However, the posterior chamber IOL (PCIOL)--namely, the capsular-supported PCIOL and, in the absence of capsular support, the iris-sutured or transsclerally sutured PCIOL--offers numerous advantages for certain patients. By virtue of their anatomic location in the eye, capsular-supported or sutured PCIOLs are appropriate for patients with glaucoma, diabetes, cornea guttata or low endothelial cell count, peripheral anterior synechiae, or known or suspected cystoid macular edema. They may also be appropriate when the patient with aphakia is young and has a relatively long life expectancy. The sutured PCIOL procedure--specifically, the transsclerally sutured PCIOL procedure--is far from benign, however, and surgical expertise is an important consideration. Recent surgical and technological advances, including the technique of burying the suture knot in sclera, use of an ab externo suturing approach in the normotonic eye, and the use of intraoperative endoscopy, have improved the accuracy of the transsclerally sutured PCIOL technique. Additional advances, including diagnostic ultrasound biomicroscopy and small-incision surgery with foldable, transsclerally sutured IOLs, may further improve patient management and clinical outcomes.

Implantation of scleral fixated sutured posterior chamber lenses: a retrospective analysis of 119 cases

“…This complication has also been highlighted in other studies [14,15,[17][18][19][20]. In most cases (81%), the IOP rise was transient and lasted no longer than 3 months.…”

“…In 19% of all cases we observed some small vitreous haemorrhages following the operation; these resolved without additional interventions in all cases as found by other groups [20,21]. In one case we had a postoperative endophthalmitis, where a sclera flap had failed to cover the sutures.…”

Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty

“…secondary lens implantation or correction with contact lenses or spectacles, is required, due to the hazard of potential complications. The best method for secondary lens implantation to offer the lowest complication rate and best possible rehabilitation of vision has been discussed for several years [4,8,19]. Our study showed a mean improvement in visual acuity of 3 lines in group 1, which was statistically significant.…”

“…In addition to early complications, such as vitreous bleeding, initial intraocular pressure fluctuations and iris capture, the main risk is the postoperative development of retinal detachment. Vitrectomy, which is often performed in a combined procedure, might play a role [8]. Nevertheless, vitrectomy is necessary, since otherwise vitreous traction might lead to retinal edema.…”

Secondary IOL implantation without capsular support. A laser flare cell‐meter study

“…In fact we believe that this is due to some disadvantages of sclera-fixated IOLs, such as the greater technical complexity, increased operating time, and surgical manipulations in the region of the ciliary body which may cause a greater risk of damaging vascular uveal tissue with consequent cyclitic reactions, hyphema, and vitreous and suprachoroidal hemorrhages [36][37][38][39][40].…”