Secondary PC IOL Implantation

Friday, January 07, 2011

Introduction

 

 

The preferred lens for aphakic rehabilitation is a posterior chamber lens. Major therapeutic advantage of a posterior chamber IOL over anterior chamber IOL is its position away from delicate anterior chamber structures especially the corneal endothelium and aqueous out flow channels. More over the posterior chamber IOL is positioned in the focal point of the eye and is close to the rotational axis of the eye. This ensures good refraction and minimal pseudophacodonesis.

 

 

Secondary PC IOL implantation in aphakics is an established procedure. The most suitable candidate for this procedure is a patient who had had uncomplicated extra capsular cataract extraction in the past. The posterior capsule is intact and pupil is mobile with no anterior or posterior synechiae. However most of the patients, going to have secondary intraocular lens implantation, are far form this ideal situation. The eyes are usually already compromised secondary to inadvertent surgical trauma in the past. The scenario may be complicated by borderline endothelial cell counts, lack of iris tissue and iridocapsular adhesions. Vitreous touch and vitreous wick along with all associated problems like CME is not an uncommon     finding.

 

IOL exchange is another indication for secondary IOL implantation. Dislocation or subluxation of the posterior chamber lenses may occur secondary to postoperative trauma to the eye or zonular dehiscence not recognized at the time of primary lens implantation. Repositioning or retrieval and fixation of the same lens transsclerally or IOL exchange, can be a procedure of choice in these situations.

 

The status of posterior capsule may vary from intact to partially deficient or totally absent. Similarly the technique has to be varied from simple implantation to synechiolysis to anterior vitrectomy combined with single or double haptic trans-scleral fixation of PC IOL.

 

This blog is focussed on developing a concensus over a systematic approach to secodary posterior chamber IOL  implantation.