Posterior chamber intraocular lens implantation in the absence of capsular support
W. J. Stark, J. D. Gottsch, D. F. Goodman, G. L. Goodman and K. Pratzer
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD 21205.
To avoid the complications associated with anterior chamber intraocular
lenses (IOLs), we have developed a technique for the implantation of a
posterior chamber IOL in the absence of capsular support. The IOL is
secured in the ciliary sulcus by suturing the haptics to the sclera at the
ciliary sulcus inferiorly and to the sclera or iris superiorly. We have
used this technique for secondary IOL implantation in 16 contact
lens-intolerant patients with aphakia with a mean follow-up of 9 months
(range, 5 to 20 months) and in eight eyes at the time of IOL removal. All
eyes with secondary implants had equal or improved vision postoperatively;
none developed persistent angiographic cystoid macular edema. In the 8
patients with IOL exchange, visual acuity improved in five eyes, remained
the same in two, and decreased two lines in one. Suturing of an IOL in the
ciliary sulcus has enabled us to use a posterior chamber IOL in eyes
without a posterior capsule when secondary IOL implantation or IOL exchange
is indicated. Secondary posterior chamber IOL implantation is recommended
only when satisfactory vision cannot be achieved with glasses or contact
lenses, and further follow-up is needed before this procedure can be widely
recommended.
