6. www.globetheme.com
1: Anterior Chamber IOL:
potentially long history
Chronic inflammation/
UGH
Corneal
decompensation
Endothelial cell lost
(16% at 3 years)
CMO
Late onset/ chronic
Glaucoma
ACIOL too small
Pigment dispersion and corneal
endothelial fair
ACIOL too big
Chronic iritis and CMO 6
7. 1: Anterior Chamber IOL:
Relative Contraindications
1.Pre existing cornea dystrophy/ problem
2.Young patient < 50 years old
3.Poor endothelial cell count for various reason
4.Extensive PAS/ abnormality at the angle
5.Large eyeball
7
8. 2: Iris Fixated IOL
Iris sutured IOL
(1990s/ early 2000)
810 prolene
Standard Iris Claw
EC lost: 10%
Retropupillary Iris Claw
EC lost 5%
*Gonnermann J, Amiri S, Klamann M et al. Endothelial cell loss after retropupillary iris-claw intraocular lens implantation. Klin Monatsbi Augenheikd 2014;231:784-787 (2006-2012: 62 eyes; follow up range from 13 months-78 months)
• 7.78% during the first year
9. 2: Iris Fixated IOL: iris claw
Guell JL, Velasco F, Malecaze F et al. Secondary Artisan-Veruysise aphakic lens implantation. J cataract refract Surg.2005 (31) 2266-2271
(16 eyes 36 months follow up)
Vision: 20/40 or better in 37.5%
Mean SE: 0.46 D
Endothelial cell lost:
ACIOL (16%) vs
Standard iris claw (10%)
Retropupillary iris claw (5.5%)
9
Standard Iris Claw
EC lost: 10%
Retropupillary Iris Claw
EC lost 5%
EC lost : ACD less than 3 mm vs more than 3.4 mm
10. 2: Iris Fixated IOL:
Gonnermann J et al
•Abnormal shape of pupil ( ovalisaton): 3.2%
•Disenclavation occurs in 4.8% (enclavement site becomes atrophic)
*Gonnermann J, Amiri S, Klamann M et al. Endothelial cell loss after retropupillary iris-claw intraocular lens implantation. Klin Monatsbi Augenheikd 2014;231:784-787 (2006-2012: 62 eyes; follow up range from 13 months-78 months)
#Forlini M, Soliman W, Bratu A et al. Long term follow up of retropupillary iris-claw IOL implantation: a retrospective analysis. BMC ophthalmology (2015)15:143 (2 experienced surgeon
Forlini M et al:
*Mean IOP: 16 mmHg (follow up until 5 years)
*Specific: (5%)
*Dull aching pain
*Severe Iridodenesis
*Poor vision when leaning forward
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23. www.globetheme.com 23
Case 1: Subluxated Artisan
54 year-s old
Cat op with artisan IOL implanteation 3 years ago
Presented with reduce vision
Focal iris atrophy (previous enclavemeny site)
With disenclaved iris claw lens
24. www.globetheme.com 24
Case 2: malposition of the ACIOL
Sutured SF IOLACIOL
2015
This is a 50 year old lady had complicated
cataract surgery few years back
Referred
• ongoing corneal decompensation
(superior)
• Tilted ACIOL
Vision: 6/12
Surgery:
Explantation of ACIOL (with difficulty)
- Implantation of posterior sutured IOL
Vision: 6/12
Stable
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Case 3: Iris sutured IOL(Broken haptic)
Anterior segment
Iris Sutured IOL
24 year old female/ student
Previous history of trauma 10 years ago (14 years old)
- lens aspiration and IOL implantation
Presented with history of fluctuation of vision
Post recent shuttlecock injury.
Although vision on sitting down was 6/9,
Lying down: IOL was in the anterior vitreous
Sutureless SF IOL
Vision 6/12,6/9
26. Personal sharing:
Start w easy cases
• (GA/ non vitrectomised eyes)
Avoid soft eye
• (infusion/loads of Viscoelastic)
Don’t be afraid to leave the eye Aphakic
What is best for the patient: depends on the
- availability,
- Most comfortable technique for the attending surgeon
Consider the patient’s age
Other comorbidities:
Ocular or systemic
- ? endure repeated surgery
- Primary or secondary IOL
Be prepared to deal
with unexpected challenges
Plan A/Plan B/Plan C
Yamane
• Few similar lenses
• ACIOL standby
• Scleral sutured IOL:
• few similar IOL power
If too complex:
reschedule when
The surgeon is ready
IOL Properly chosen
IOL Properly fixated
Patient well Monitored
26
SUCCESSFUL SURGERY
