Transcript EVALUATION OF ANTERIOR CHAMBER SULCUS SUPPORTED …

EVALUATION OF ANTERIOR CHAMBER
SULCUS SUPPORTED INTRAOCULAR
LENS
BY
PROF. HAMED NASER EL- DIN TAHA
HAED OF OPHTHALMOLOGY DEPT.
SAUDI GERMAN HOSPITAL
JEDDAH
NO FININICAL INTREST IN THIS STUDY
INTRODUCTION
• With the universal acceptance of PC lens
implantation as the standard procedure of IOL
implantation, IOL implantation in the absence
of sufficient posterior capsule remain a
difficult management problem.
Scleral fixation IOL or AC IOL is
the available known solution.
INTRODUCTION
• There are 3 types of AC-IOL fixation
•
AC angle fixation of an AC-IOL with rigid or
semi rigid loops.
•
AC angle fixation of AC-IOL with flexible open
loops .
•
Iris fixation of an iris claw lens.
• In this study we will add a new type which is AC-IOL
sulcus supported loops.
PATIENTS AND METHODS
• This study include 6 eyes of 6 patients.
• 4 aphakic eyes ,have history of cataract
extraction .
• Informed consent was taken.
• Anterior and posterior segments examination
was done with careful attention to the corneal
clarity, integrity of the hyaloid face ,anatomy
of the iris and the presence or absence of
capsular support.
PATIENTS AND METHODS
• The other 2 eyes:
– One eye had a large defect of the capsular support
during phacoemulsification .
– One eye had a large dialysis of the posterior
capsule , more than 270 degree during
phacoemulsification.
PATIENTS AND METHODS
• corneal tunnel incision 3mm with AC opening
was done.
• Pupillary construction
• AC formation by viscoelastic substance.
• 2 peripheral iridectomies was done 180
degree apart (the far one was done by
cystotome, microsurgery knife or the
vitrectomy prob ).
PATIENTS AND METHODS
• PC IOL multiple pieces acrylic hydrophilic was
injected in AC.
• During injection of IOL, the far haptic was
directed to be pass through the peripheral
iridectomy to the ciliary sulcus
• The near haptic was grasped by forceps and
passed through the near iridectomy to the ciliary
sulcus
• Lens centration.
• Hydration of corneal tunnel.
RESULTS
• Patients age ranged from 54 to 69 years.
• Postoperative visual acuity was ranged from
0.5to 0.8.
• compared with preoperative best corrected
VA , 2 eyes had the same VA level, 4 eyes had
improvement of more than 2 lines and only
one eye has one line decreased.
• There is no postoperative increase in IOP
during the follow-up period.
RESULTS
• The pupil was rounded regular reactive in al
eyes with deep AC as the angulated haptics
push the iris back.
• No cases of pupillary block.
• Mild pigment dispersion in 4 eyes which
disappear writhen 6 months,
• No post operative uveitis or iritis.
• IOL was centralized and stable in all eyes.
DISCUSSION
• Correction of aphakia and the absence of
sufficient lens capsule support remains a difficult
management problem .
• Controversy existed as to the preferred location
for the implant. Although many researches
believes that complication rats of anterior
chamber IOL and posterior chamber IOL may be
similar. Because of the ease of the surgical
procedure, ACL insertion remains the technique
of choice for many surgeons.
DISCUSSION
• Very often ,the inadvertent insertion of too small
or to big ACL led to serous outcome.
• Long term complications associated with ACL
including bullus keratopathy, glaucoma, uveitis,
angle fibrosis and CME.
• Scleral fixation IOL is technically difficult
procedure associated with complications like
suture erosion ,vitreous hemorrhage
,endophthalmitis, greater degree of lens tilt ,
decneteation, astigmatism ,CME and subluxation
withen 6 to 7 years .
DISCUSSION
• We suggest that this new technique can avoid
many ACL and scleral supported PCL
complications.
• In this new technique sulcus supported ACL
,there is no contact between lens haptic and the
delicat AC angle structures or the corneal
endothelium which reduce the long term risk of
glaucoma or bullous keratopathy.
• Further prospective clinical trials with longer
follow-up may help to evaluate the long-term
visual outcome and complications