Primary Posterior Chamber Intraocular Lens Research Articles

Pars Plana Vitrectomy, Lensectomy, or Extraction in Transscleral Intraocular Lens Fixation for the Management of Dislocated Lenses in a Family With Marfan's Syndrome

Congenital lens subluxation may be a difficult therapeutic problem. Surgical treatment options include iris manipulation or lens decision, aspiration, intracapsular or extracapsular extraction, and lensectomy through the pars plana. It is not established which kind of aphakic correction is the most appropriate in these cases. A father and his two sons with Marfan's syndrome were operatively treated for lens dislocation in both eyes. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in three eyes and with an intracapsular method in three eyes. The outside-in scleral fixation technique was used for primary posterior chamber intraocular lens (PC IOL) implantation in all cases. All eyes achieved good visual acuity (20/20-20/25). Time of observation ranged between 8 and 20 months. There were no intraoperative or post-operative complications. Pars plana vitrectomy and primary scleral-fixated IOL implantation is a safe procedure and gives good visual rehabilitation in adult patients with Marfan's syndrome.

Primary posterior capsulorhexis with and without anterior vitrectomy in congenital cataracts

Purpose: To determine whether anterior vitrectomy is necessary along with primary posterior capsulorhexis in children less than 5 years of age with congenital cataracts.Setting: Iladevi Cataract & IOL Research Centre, Ahmedabad, India.Method: This prospective study comprised 18 eyes of 16 children whose mean age was 2.3 years (range 3 months to 5 years). Primary posterior continuous curvilinear capsulorhexis (PCCC) and posterior chamber intraocular lens (IOL) implantation were performed in all eyes. No vitrectomy was done in 8 eyes (Group 1); an anterior vitrectomy was performed in 10 eyes (Group 2). Optic capture through the posterior capsule was achieved in 3 eyes in Group 1 and in 5 eyes in Group 2. Average follow-up was 13.3 months.Results: Five eyes (62.5%) in Group 1 needed secondary pars plana vitrectomy because the visual axis was obscured; no eye in Group 2 needed a secondary procedure. Four Group 1 eyes developed significant complications (updrawn pupil, decentration, occlusio pupillae, transient glaucoma). While no Group 2 eye developed a serious complication, some degree of pigment dispersion was noted in all the eyes.Conclusion: The results suggest that anterior vitrectomy is desirable along with primary PCCC in children younger than 5 years with congenital cataracts.

Intraocular lens implantation in infants with congenital cataracts

We evaluated 21 eyes of 13 infants between two and eight months old who had primary posterior chamber intraocular lens (IOL) implantation for congenital cataracts between 1988 and 1993. Twelve eyes had a posterior capsulorhexis or plaque peeling at the time of implantation and one eye had a vitrectomy. Eight eyes had no posterior capsule procedure during the initial surgery. Follow-up ranged from six months to five years. All eyes developed one or multiple posterior synechias and all, except one, required secondary capsulectomy and vitrectomy between one month and one year. Twenty eyes attained stable IOL fixation and a clear visual axis. In one eye, the IOL decentered downward. Patients with bilateral cataracts had greater visual improvement than those with a cataract in one eye only. No patient could manage spectacles postoperatively. Our findings show the benefits of posterior capsulectomy and anterior vitrectomy done in the early postoperative period and that IOL implantation in infants is a reasonable treatment in some parts of the world.

Pupillary Fibrin Membrane: A Frequent Early Complication after Posterior Chamber Lens Implantation in Japan

The incidence of pupillary fibrin membrane formation, a relatively frequent complication of cataract surgery in Japan even for experienced surgeons, was noted in 2038 consecutive cases of senile cataract removal and primary posterior chamber intraocular lens (PC IOL) implantation. The overall incidence was 4.4%. Comparisons among cases showed the incidence to be significantly higher among: (1) patients who received dry- versus wet-sterilized lenses (P < 0.001), (2) eyes with premature, subcapsular, or nuclear cataracts than among those with mature cataracts (P < 0.05), (3) patients with systemic hypertension (P < 0.01), (4) eyes not treated postsurgically with topical antiprostaglandins (P < 0.001), and (5) patients who had undergone previous PC IOL implantation in the fellow eye (P < 0.001). These findings suggest that the formation of the fibrin membrane is a kind of immunologic reaction. Accordingly, use of antiprostaglandin agents and complete removal of lens material and epithelial cells are recommended, especially for patients undergoing secondeye operations or those with a predisposition to breakdown of the blood-aqueous barrier.

A new technique of congenital cataract surgery with primary posterior chamber intraocular lens implantation

We present a series of nine cases involving primary intraocular lens implantation in congenital cataracts. Because of the problems encountered with the technique used in the earlier cases, we developed a new surgical technique that may be described as primary epilenticular posterior chamber lens implantation followed by pars plana endocapsular lensectomy. This new technique ensures a clear pupillary area, minimizes postoperative complications, and ultimately prevents amblyopia, resulting in useful vision.