Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation

Abstract

Purpose:To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes.Methods:Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL.Results:Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL.Conclusion:Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.

Scleral-fixated intraocular lens implants—evolution of surgical techniques and future developments

“…aniridia), and may therefore be indicated in eyes with compromised corneal endothelium [10]. In addition, a history of uveitis may preclude the use of a secondary lens that increases the risk of iris chaffing such as an anterior chamber or iris-fixated lens and there are reports of good visual outcomes following the use of SFIOL implants in patients with pre-existing uveitis [11][12][13]. Over the years, several techniques have been adopted for the fixation of IOLs to the sclera, including both sutured and sutureless approaches.…”

Intraocular lens implantation in the absence of capsular support: scleral fixation

“…This makes a scleral-fixated (SF) posterior chamber IOL the ideal choice in the presence of previous iris trauma, iris defects such as in acquired or congenital aniridia, glaucomatous eyes with or without the presence of a drainage device and eyes with a compromised corneal endothelium. Where there is history of iritis and/or CMO, the placement of an angle-supported or irisfixated AC-IOL, with varying degrees of associated iris chaffing and blood-ocular barrier breakdown, may lead to a significantly worse prognosis compared to a SF-IOL [4][5][6]. The implantation of a posterior chamber (PC) IOL in the sulcus is a lot more advantageous compared to an iris-fixated or anterior-chamber (AC) IOL in regard to both safety and optical quality.…”

Commentary: Management of coexistent cataract and uveitis – Techniques and challenges

“…Authors of aforementioned article[7] have presented their excellent work in the form of case series on sulcus fixated and glued IOL. In addition, they have correlated the efficacy further with postoperative inflammation.…”