|Year : 1979 | Volume
| Issue : 4 | Page : 39-40
Intraocular lens implants
SS Sangha, SC Aggarwal
G.G.S. Medical College, Faridkot, Punjab, India
S S Sangha
Professor of Ophthalmology, G.G.S. Medical College, Faridkot, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sangha S S, Aggarwal S C. Intraocular lens implants. Indian J Ophthalmol 1979;27:39-40
There are no two opinions that a good intraocular implant, for the bilateral cataract in general and unilateral in particular, is not only convenient for the patient, but is optically ideal also. Stereopsis is better than with contact lenses. Aniseikonia is only 2% to 0.2%,(12) as compared to 5-7% with contact lenses and 30-33% with ordinary aphakic glasses. Visual fields are bigger with no peripheral aberrations and ring scotoma as seen with aphakic glasses.
The purpose of this communication is to try and evaluate an indigenous model of intraocular lens implant manufactured by M/s. Shah of Calcutta.
| Material and methods|| |
Six male patients in the age group of 58-75 years, having senile cataract, who attended the G.G.S. Medical College Hospital, were selected for the implant surgery. After the routine physical examination and relevant laboratory tests they were admitted a day prior to surgery. Antibiotic drops were frequently instilled and two tablets of acetazolamide 250 mg each were given to each patient.
Operation was done under local anaesthesia. Three plane step incision under a limbal based conjunctival flap was made and three preplaced 8/0 virgin silk sutures were applied. A small peripheral iridectomy was done at 12'O clock position. Intraocular lens extraction was accomplished by Amritsar (modified Smith) technique.
It was made certain that the anterior face of the vitreous was undisturbed. In the event of vitreous herniation, attempt at implantation was abandoned and operation completed as such.
The Shah lens which had already been got ready by immersing in NaOH 1% solution for half an hour and then putting it in normal saline, was picked up with a forceps and one of the loops was slipped behind the pupil at 6'O clock position and then the upper loop was negotiated behind the iris at 12'O clock. As soon as the lens was in place, pupil contracted a bit. The upper loop was visualised in the iridectomy coloboma. One stitch with 10/0 perlon suture was applied through the fenestration of the upper loop with one limb of iris coloboma. After tying a double knot the ends were snipped as close to the iris as possible. The preplaced sutures were tied and 1/2 cc of 0.5% pilocarpine, (injectable, Macarthy Ltd.) was injected in the anterior chamber. Three post placed sutures were added and the operated eye was bandaged. One four loop implant was used in the similar manner.
Post operatively, routine antibiotics, chloramphenicol 250 mg every six hours was given by mouth for 4 days. Dressing was changed daily, neither atropine nor pilocarpine was used. Oral corticosteroids were used only in cases of post-operative uveitis.
Patients were discharged on 7-8 day with local corticoids and were checked up every 15 days for 6 weeks and then every month. Visual acuity and any other abnormalities were noted down.
Minimum follow up was 3 months and maximum 1 year.
| Observation|| |
The age, sex, visual results and the complications have been tabulated in [Table - 1].
Anterior subluxation: It was noted on the second day in case 1. The lower loop was seen lying anterior to the iris. The pupil was of normal size. With the hope of slipping the lens behind the iris, pupil was dilated with 10% Drosyn, but it did not succeed. Anterior chamber was then opened at 6'O clock at limbus and with the help of an iris hook, the iris was pulled down and then slipped in front of the lower loop of the lens. The pupil was immediately constricted with 0.5% pilo„arpine injected into the anterior chamber.
Posterior subluxation: It was seen on 4th day in case 4. The pupil was dilated (It was suspected that some assistant had put atropine inadvertently the previous day). The prepupillary part of the lens was also behind the pupil and the lens was seen hanging from the iris in the upper part. Anterior chamber was opened on the lateral side and with the help of an iris repositor, lens was negotiated forwards and pupil constricted with pilocarpine and stroking of iris with the repositor.
Shallow anterior chamber: In five patients the anterior chamber was normal throughout. In case: 3, it was shallow on the first post operative day and was shallower each successive day to be almost flat on 4th day. Intraveneous mannitol did not help. Anterior chamber was opened at 12'O clock at limbus and with a wide bore needle Lc c. of fluid with vitreous was aspirated through the iridectomy coloboma and air was injected in the anterior chamber. In 3-4 days air was absorbed leaving the chamber flat again and lens started almost touching the cornea. On 10th day the lens was removed and wound restitched. He made an uneventful recovery later on.
Iridocyclitis: In cases: 4 and 6 moderate to severe iridocyclitis was seen on 4th day and 2nd day respectively. They were put on 40 mg prednisolone daily by mouth for four days and then the dose was tailed off. A fine membrane formed behind the lens in the pupillary area.
Keratopathy: It was seen in case: 3 who had persistently shallow chamber. After removal of the lens, the process did reverse to some extent.
Diplopia was not experienced by any patient. Fundus could not be examined in two cases and in case: 6 there was slight macular oedema.
| Discussion|| |
The visual results obtained in the present series, though very small, are none too happy. The best vision was only 6/18 in 33.4% and in other, it was 6/60-6/36 only.
Intraocular tension in all patients except case 3 in whom lens had to be removed, was normal.
| Summary and conclusions|| |
Shah intraocular implants, 5 two looped and one four looped were tried in six male patients after extraction of senile cataracts. They were followed for 3 months to one year. One implant had to be removed due to persistently shallow anterior chamber and onset of keratopathy. Quite severe iridocyclitis was seen in 33.4%. Best vision obtained was 6/18 and less than 6/24 in others.
It is concluded that:
1. Present model of two loop Shah lens implant, claimed to be an iris clip lens, is unsuitable to be used after an intracapsular extraction, due to the poor support it gets from the surrounding tissues and leads to bad centering. However, it could be utilised in a better manner as iridocapsular lens implant after extracapsular extraction.
2. Comparatively higher rate of iridocyclitis raises an accusing finger at the sterilisation and/ or material of the implant which need a further thorough probe.
[Table - 1]