JAN 29, 2010
Cataract/Anterior Segment
Anterior segment surgeons face one of their most difficult challenges in severely subluxated crystalline lenses. Recently developed adjunctive devices such as capsule hooks, anchors, and others facilitate lens removal and IOL concentration, but they also increase the potential for intraoperative and postoperative complications. In this report, the authors presented two cases demonstrating the efficacy of using a primary anterior chamber IOL (AC IOL) for severe subluxation. Patients achieved excellent postop results and there were no intraoperative complications.
In the first case, a 34-year-old woman with bilateral subluxated crystalline lenses chose to have phacoemulsification and IOL implantation in the left and far less severely subluxated eye to improve visual acuity. On the first postoperative day, the IOL slipped through an opening in the inferior zonules, resulting in marked IOL subluxation. The posterior chamber IOL was then exchanged for an AC IOL after a limited anterior vitrectomy and peripheral iridectomy, and the achieved visual acuity was 20/15. For her right eye she also chose an AC IOL. There were no intraoperative complications, and at two weeks follow-up she could see 20/20, corrected.
In the second case, a 55-year-old male with a severely subluxated cataract in the right eye received an AC IOL and a peripheral iridotomy with the Nd:YAG laser. Two hours later his uncorrected distance visual acuity (UDVA) was 20/50, and on the first postoperative day, his UDVA was 20/30. After zonulysis, the UDVA improved to 20/20. At two to three weeks follow-up, the UDVA had improved to 20/15.
Although crystalline lens extraction may be required to clear the visual axis in mild to moderate lens subluxations, the authors propose insertion of a primary anterior chamber IOL without lens extraction in severe subluxations when the eye is optically aphakic or can be made functionally aphakic following neodymium:YAG laser zonulysis.