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    How to manage aphakic correction in eyes without capsular support

    IOL type, technique, plus surgeon comfort among deciding factors for appropriate strategy

     

    TAKE HOME:

    The decision on IOL type and fixation method in eyes without adequate capsular support should take into account the specific clinical presentation.

     

     

    Portland, OR—Surgeons have a host of viable options for aphakic correction in an eye without adequate capsular support. Though some approaches may be better than another in a given clinical scenario, no one technique stands out as superior overall, said Richard S. Hoffman, MD.

    Dr. Hoffman reviewed available evidence supporting the efficacy and safety of modern open-loop anterior chamber (AC) IOLs, scleral-sutured posterior chamber (PC) IOLs, iris-sutured PC IOLs, and implantation of a PC IOL with intrascleral haptic capture. He also reviewed contraindications to use of the various techniques and provided some technical tips.

    “In making your decision, my suggestion is to do what you are comfortable doing,” said Dr. Hoffman, clinical associate professor of ophthalmology, Oregon Health and Science University, Portland. “However, it is important to be familiar with all of the techniques, and never stop learning new approaches.”

    AC IOLs

    In contrast to older-style, closed-loop AC IOLs that were associated with an array of serious complications, modern Kelman-style, open-loop AC lenses have a much better safety profile, Dr. Hoffman noted.

    “The modern AC IOLs are easy to insert, have a polished finish that make them biocompatible, feature solid footplates without position holes—which limits goniosynechiae formation—and have flexible haptics that mitigates sizing issues,” Dr. Hoffman said.

    Use of AC IOLs is contraindicated in eyes with >90° of peripheral anterior synechiae, glaucoma (especially if intractable), a shallow AC, or insufficient iris tissue. Their presence can make certain endothelial keratoplasty procedures more difficult, but the transplant procedures can still be performed in the hands of experienced corneal surgeons.

     

    NEXT: Scleral-fixated PC IOLs + Video

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