EVALUATION OF ANTERIOR CHAMBER SULCUS SUPPORTED INTRAOCULAR

LENSBY

PROF. HAMED NASER EL- DIN TAHAHAED OF OPHTHALMOLOGY DEPT.

SAUDI GERMAN HOSPITALJEDDAH

NO FININICAL INTREST IN THIS STUDY

INTRODUCTION

• With the universal acceptance of PC lens implantation as the standard procedure of IOL implantation, IOL implantation in the absence of sufficient posterior capsule remain a difficult management problem.

Scleral fixation IOL or AC IOL is the available known solution.

INTRODUCTION

• There are 3 types of AC-IOL fixation • AC angle fixation of an AC-IOL with rigid or

semi rigid loops.• AC angle fixation of AC-IOL with flexible open

loops .• Iris fixation of an iris claw lens.• In this study we will add a new type which is AC-IOL

sulcus supported loops.

PATIENTS AND METHODS

• This study include 6 eyes of 6 patients.• 4 aphakic eyes ,have history of cataract

extraction .• Informed consent was taken.• Anterior and posterior segments examination

was done with careful attention to the corneal clarity, integrity of the hyaloid face ,anatomy of the iris and the presence or absence of capsular support.

PATIENTS AND METHODS

• The other 2 eyes:– One eye had a large defect of the capsular support

during phacoemulsification .– One eye had a large dialysis of the posterior

capsule , more than 270 degree during phacoemulsification.

PATIENTS AND METHODS

• corneal tunnel incision 3mm with AC opening was done.

• Pupillary construction• AC formation by viscoelastic substance.• 2 peripheral iridectomies was done 180

degree apart (the far one was done by cystotome, microsurgery knife or the vitrectomy prob ).

PATIENTS AND METHODS

• PC IOL multiple pieces acrylic hydrophilic was injected in AC.

• During injection of IOL, the far haptic was directed to be pass through the peripheral iridectomy to the ciliary sulcus

• The near haptic was grasped by forceps and passed through the near iridectomy to the ciliary sulcus

• Lens centration.• Hydration of corneal tunnel.

RESULTS

• Patients age ranged from 54 to 69 years. • Postoperative visual acuity was ranged from

0.5to 0.8.• compared with preoperative best corrected

VA , 2 eyes had the same VA level, 4 eyes had improvement of more than 2 lines and only one eye has one line decreased.

• There is no postoperative increase in IOP during the follow-up period.

RESULTS

• The pupil was rounded regular reactive in al eyes with deep AC as the angulated haptics push the iris back.

• No cases of pupillary block.• Mild pigment dispersion in 4 eyes which

disappear writhen 6 months,• No post operative uveitis or iritis.• IOL was centralized and stable in all eyes.

DISCUSSION

• Correction of aphakia and the absence of sufficient lens capsule support remains a difficult management problem .

• Controversy existed as to the preferred location for the implant. Although many researches believes that complication rats of anterior chamber IOL and posterior chamber IOL may be similar. Because of the ease of the surgical procedure, ACL insertion remains the technique of choice for many surgeons.

DISCUSSION

• Very often ,the inadvertent insertion of too small or to big ACL led to serous outcome.

• Long term complications associated with ACL including bullus keratopathy, glaucoma, uveitis, angle fibrosis and CME.

• Scleral fixation IOL is technically difficult procedure associated with complications like suture erosion ,vitreous hemorrhage ,endophthalmitis, greater degree of lens tilt , decneteation, astigmatism ,CME and subluxation withen 6 to 7 years .

DISCUSSION

• We suggest that this new technique can avoid many ACL and scleral supported PCL complications.

• In this new technique sulcus supported ACL ,there is no contact between lens haptic and the delicat AC angle structures or the corneal endothelium which reduce the long term risk of glaucoma or bullous keratopathy.

• Further prospective clinical trials with longer follow-up may help to evaluate the long-term visual outcome and complications