Unsutured phakic implantation of a black intraocular lens in the sulcus to treat leukocoria

Abstract

We describe a 40-year-old woman with von Hippel-Lindau syndrome, secondary chronic exudative retinal detachment, and white cataract with consequent leukocoria. Because the cataract was contracted and calcified, a black Morcher 85F poly(methyl methacrylate) IOL was implanted in the ciliary sulcus anterior to the lens to prevent posterior capsule rupture and potential destabilization of the retinal detachment with a risk for phthisis. Excellent centration of the black IOL was achieved with good cosmetic outcome and without postoperative uveitis or glaucoma. We suggest that this is a rare indication for implantation of an IOL designed for the sulcus but in the presence of the crystalline lens. This approach makes IOL removal, if necessary at a later date, relatively straightforward.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned.

Ethical Considerations for Performing Intraocular Surgery on Eyes with No Light Perception

“…4,5 In patients for whom these minimally invasive options are intolerable or unacceptable, there is precedent in the literature for intraocular surgery in the form of black intraocular lens insertion with or without cataract extraction. [6][7][8][9] Eyes with NLP may be painful, and some ophthalmologists argue that when the pain is likely to be due to a discrete and modifiable process, intraocular surgery to address that process is appropriate. For instance, if an ophthalmologist chose to proceed with the cataract extraction described previously, and the procedure was complicated by retained lens fragments, relief of the pain may be possible after surgical retrieval of the lens fragments.…”

Análisis, por Simulación, de los Esfuerzos Cortantes en la Superficie del Iris, en Presencia de Lentes Fáquicos Intraoculares

“…Sin embargo, el 66% de los casos presentan cambios en las líneas de Snellen 3 meses después de la cirugía. Este tipo de lentes intraoculares están asociados a otras problemáticas como: formación de cataratas [2] , desarrollo de glaucoma [3] , descompensación corneal [4] , y pérdida de células endoteliales de la córnea [5] . Para analizar las problemáticas descritas, se han desarrollado diferentes investigaciones que muestran que la instalación de lentes intraoculares (LIO) genera perturbaciones de pequeña escala en el flujo del humor acuoso (HA) en la cámara anterior [6] .…”