Transcript National survey on the choice of secondary lens

National Survey on the Choice
of Secondary Intraocular Lens
Implantation in the UK
James Tildsley
Sathish Srinivasan
Alan Gaskell
[All authors have no financial interest]
Ayr Hospital, Ayr, Scotland, UK
Introduction

270,000 cataract procedures were performed in
UK National health service in 2008.1

The reported incidence of PC rupture and zonular
dehiscience is 1.92% and 0.46% respectively. 2

Both of these complications have the potential to
prevent primary lens insertion and aphakia
Introduction

Secondary lens implant is now the standard for
managing aphakia.3 However there is a wide
variation in the choice of lenses for secondary lens
implant.

Given how common a secondary IOL may be
required we conducted this national survey with
the aim to collect data on current practice of UK
Ophthalmology consultants on secondary IOL
choice
Method

An anonymous questionnaire was mailed to all 896 NHS
ophthalmology consultants currently practicing in the UK.

Data on surgical experience, number of secondary IOLs
performed, preferred choice of secondary IOL with no
capsular support +/- associated open angle glaucoma
(POAG) and closed angle glaucoma (CAG) / peripheral
anterior synechiae (PAS), and personal experience of using
the lenses were collected.
Questionnaire
Results - Surgical experience
A total of 420 questionnaires were received,
with a response rate of 47%.
 50% perform 5-10 cataract procedures a
week, 30% over 10 and 20% less than 5.
 75% had less than 2 complications leading
to aphakia, 16% had 2 - 5 and 7% had over
5

Results - choice of lens
Results - choice of lens
Results - experience with other
lens types




19% familiarized themselves with Artisan iris clip lens,
mainly by wet lab. 12% have used the Artisan lens in 18
months. 21% say it has changed their practice
23% have used an iris suture lens
92% personally undertake open loop ACIOL insertion. For
scleral sutured PCIOL, Artisan iris clip lens and iris
sutured PCIOL the results were 43%, 27% and 22%
respectively
20 to 25% would prefer to refer to the appropriate subspecialty for insertion of a secondary IOL other than open
loop ACIOL
Conclusion

NHS Ophthalmology consultants currently working in the
UK are using secondary IOLs for management of aphakia
as recommended. 3,4,5,6

Overall the open loop ACIOL was the most popular
secondary IOL. However this changed with associated
POAG and CAG/PAS suggesting there are limitations of
the open loop ACIOL and advantages using an Artisan iris
clip lens, iris sutured PCIOL and particularly the scleral
sutured PCIOL. This result was supported by other
studies.3-6, 8,10-13
Conclusion

Previous studies so far conclude that the outcomes of all
the different secondary IOLs are comparable to each other
but further research is required, and the choice of lens is
based mainly on personal experience of using a lens.3,
7,9,12,13

Our study found the same result, but due to the fact that the
different lens techniques investigated have been available
for at least 28 years it suggests that different lens
techniques are not being attempted.13,14
References
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2.Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P. The Cataract National Dataset electronic multicentre audit
of 55567 operations: updating benchmark standards of care in the United Kingdom and internationally. Eye. 2007 Nov 23
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in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology. 2003 Apr;
110(40:840-59
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the absence of capsular and zonular support. Zhonghua Yan Ke Za Zhi. 1998 Sep; 34(5): 327-9
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233-40
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12.Krause L, Bechrakis NE, Heimann H, Salditt S, Foerster MH. Implantation of scleral fixated sutured posterior chamber lenses:
a retrospective analysis of 119 cases. Int Ophthalmol. 2008 Apr 10.
13.Everklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open loop anterior
chamber and scleral fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2003 Feb; 29(2): 301-8
14.McCannel MA. A retrievable suture idea for anterior uveal problems. Ophthalmic surg. 1976 summer; 7(2): 98-103