Secondary IOL Implantation without Capsular Support: A Laser Flare Cell Meter Study

Mauro Cellini,Ernesto Strobbe,Emilio C. Campos,Pier Giorgio Toschi

doi:10.5402/2011/653246

Abstract

Phacoemulsification and the contemporary implantation of intraocular lens (IOL) within the capsular bag represent the standard of care in cataract surgery, but sometimes a primary IOL implant is not possible due to intraoperative complications or preexisting conditions so that a secondary implantation of IOL within the anterior or posterior chamber is necessary. The aim of our study was to assess the degree of inflammation due to a secondary implant of claw lenses, angle-supported IOLs, and scleral-fixated IOLs by means of an objective, repeatable, and noninvasive device, the laser flare cell meter, which evaluates aqueous flare and cells within the anterior chamber in vivo and to show the contribution of the single IOLs to the genesis of inflammation.

Highlights

Modern cataract surgery involves phacoemulsification of the opacified crystalline lens and the implant of an intraocular lens (IOL) in the capsular bag
Phacoemulsification and the contemporary implantation of intraocular lens (IOL) within the capsular bag represent the standard of care in cataract surgery, but sometimes a primary IOL implant is not possible due to intraoperative complications or preexisting conditions so that a secondary implantation of IOL within the anterior or posterior chamber is necessary
In some conditions this is not possible due to the type of cataract or to systemic and congenital disorders characterized by weakness of zonules/capsule or to intraoperative complications. In these cases it is necessary to perform a secondary implant which may be a scleral-fixated posterior chamber IOL (SPCIOLs), an angle-supported anterior chamber IOL (AACIOLs), or an iris-fixated anterior chamber IOL (IACIOLs) [1]. The use of these types of IOLs and the stimulation of the irideal tissue and the ciliary bodies may cause the onset of an inflammatory reaction that can manifest itself as uveitis, but in most cases remains subclinical [2, 3]

Summary

Introduction

Modern cataract surgery involves phacoemulsification of the opacified crystalline lens and the implant of an intraocular lens (IOL) in the capsular bag In some conditions this is not possible due to the type of cataract (e.g., traumatic cataracts with lens subluxation, cataracts in pseudoexfoliative syndrome with zonular/capsular dehiscence) or to systemic and congenital disorders characterized by weakness of zonules/capsule (e.g., familial or idiopathic ectopia lentis, Marfan Syndrome, etc.) or to intraoperative complications (e.g., large breaks of the posterior capsule, accidental aspiration of the capsular bag, etc.). The need for fluorescein injection, the duration of the test, and the possible adverse effects related to the dye limit the clinical applications of this technique [7]

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