|Year : 1983 | Volume
| Issue : 5 | Page : 566-567
Intraocular lens implantation
M C Nahata
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nahata M C. Intraocular lens implantation. Indian J Ophthalmol 1983;31:566-7
The present study describes my experiences of 20 patients with an intraocular lens. Those cases who gave a consent, could come for regular follow up and without any systemic disorder like diabetes, hypertension and chronic cough were selected.
The lenses were put in the A.C. after an extra capsular cataract surgery. The lenses remain in position because the loops of the lens go behind the iris, one at 12 O'clock and other at 6 O'clock position.
Chemical sterilisation of IOL
After one hour in 10% NaOH, the lenses are to be stored in 0.1 % NaOH, because this concentration of NaOH is a safe storage medium at room temp. One day before operation, the lens is removed from 0.1% NaOH and transferred to 1% NaHCO 3 (Sodium Bi carbonate) which is a neutralising solution. Lens is kept in 1 % NaHCO 3 for 30 minutes and then the lens is thoroughly washed with normal saline for 10 minutes and then is kept in a bottle of Genticyn. The lens is then directly brought out just before the implantation.
Steps for operation
Under general anaesthesia a limbus based conjunctival flap was made and then a 180° three step incision was made with a blade. The corneo scleral section was enlarged and 3 preplaced 8/0 Nylon sutures were put.
A circular cut was made in the anterior lens capsule with worth's cystitome about 2 mm. anterior to equator. The circular piece of anterior capsule thus made is caught with toothed anterior capsule forceps and removed and the nucleus exposed out.
The A.C. is then thoroughly irrigated with normal saline. Only posterior lens capsule is left behind.
Pupil is constricted by injection of Pilocarpine solution in to A.C. so as to achieve an approximate size of 4 mm.
Introduction of implant: Acrylic lens is held with a long fine forceps near the root of upper loop. The assistant reflects the cornea by holding it with a plane forceps. The lens is brought forwards with its lower loops directing downwards and backwards, so as to slip the lower loop behind the iris in the fornix of capsular bag. When the optical part of lens reaches the central position, the lens is gently pressed by the iris repositor. The upper part of iris is engaged over superior loop.
Now the preplaced suture is tied at 12 O'clock position and air is injected into A.C. Then other two stitches are tied and two more sutures are applied.
Conjunctival flap is reposited and closed by continuous key pattern sutures of 6/0 silk.
S/c inj. of Decadron + Garamycin is injected.
Antibiotic drops + Pilocarpine drops instilled. Binocular pad and bandage applied.
Problems during surgery
In these 20 cases, bulge of iris lens diaphragm was noticed in 2 cases, excessive pupillary dilatation in 3, chek of posterior capsule in 1, vitreous bulge in 2 and 5 cases needed excessive irrigation.
Of the 20 cases, there were 5 cases with traumatic cataract, 13 with presenile cataract and two with senile cataract. (Patients ageing between 11 to 50 years were taken).
Early complications like iridocyclitis (4 eyes), striate keratopathy and corneal oedema (disappeared after 2 weeks in all, except 3 cases) (15 cases), were seen.
Late Complications like cystoid macular oedema in one eye and persistent corneal oedema were seen in 3 eyes.
It is necessary to follow the cases to look for development of any complication and to assess the visual results. We have operated on 20 cases till now. Out of these 5 were operated during last three months. So we have 15 operated cases with about 1 year follow up record. The visual results were as below:
Final visual results were encouraging:
6/ 12 or better vision was achieved in 60.0%
6/18 in -do- 26.7%
6/60 in -do- 13.3%