Sutured Posterior Chamber IOL Fixation in the Absence of Capsular Support, First Described in 1954

Abstract

By implanting the first IOL in 1949 Ridley's intention was to replace the opaque crystalline lens with a "lenticulus" exactly the size and the shape of the natural lens in the same physiological location in the posterior chamber. Still not resolved at that time was the fixation of the "pseudophakos" following intracapsular cataract extraction and the centration on the posterior capsule or, respectively, on residues of the anterior capsule following extracapsular cataract surgery. We describe the first attempts in 1954 of fixating a posterior chamber IOL following intracapsular extraction using a suture technique. Selective literature research via PubMed was undertaken and additional literature retrieved by a manual search was included. The conventional opinion that suture fixation of intraocular lenses was carried out since the 1980s and that Pearce in 1975 and Shearing in 1977 solved this problem by using haptics made of polypropylene is not quite correct: In 1954, by using a thin wire anchored in the IOL material, the British ophthalmologist, T. G. W. Parry, managed the first suture fixation of a Ridley IOL in the posterior chamber. This remarkable medical historical innovation was however overshadowed by the rapid development of intraocular lenses, from iris-fixated lenses ("collar stud": Epstein 1954, "iris-clip": Binkhorst 1959), anterior chamber lenses (Baron 1952, Strampelli 1953) to three-piece lenses for capsular bag fixation by Pierce and Shearing in the 1970s. However it becomes obvious that already in the 1950s it was possible to correct aphakia in cases with inadequate capsular support.