|Year : 1983 | Volume
| Issue : 7 | Page : 853-856
Indian intra ocular lens implants on Indian eyes
YM Paranjpe, SY Paranjpe
Paranjpe Eye Hospital, Rajewada Road Sangli, India
Y M Paranjpe
Paranjpe Eye Hospital, Rajewada Road, Sangli
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Paranjpe Y M, Paranjpe S Y. Indian intra ocular lens implants on Indian eyes. Indian J Ophthalmol 1983;31, Suppl S1:853-6
|How to cite this URL:|
Paranjpe Y M, Paranjpe S Y. Indian intra ocular lens implants on Indian eyes. Indian J Ophthalmol [serial online] 1983 [cited 2020 May 26];31, Suppl S1:853-6. Available from: http://www.ijo.in/text.asp?1983/31/7/853/29685
This paper is a study of 100 Intra Ocular Lens Implants (I.O.L.I.). These lens implants are manufactured in India. All patients were Indian. Lens is manufactured from polymethylmethacrylate.
These lenses are sterilised by manuacturer with ethelyne oxide gas and packed ready for implantation.
| Material and methods|| |
Types of I.O.L.I.: 3 Types.
1. Anterior chamber lens .. .. 25 lenses
2. Sputanik lens (Fyodorov lens) .. 36 lenses
3. Posterior chamber `T loop lens
(Shearing) . . 39 lenses
Power of lens is plus 11 Dsph. in spectacle.
Clinical material-Mean age of patients in this series is 55, youngest aged 12 years, oldest aged 77 years.
0 to 20 years 4 patients
21 to 40 years 20 patients
41 to 60 years 52 patients
61 years onwards 24 patients
Total 100 natients
One eyed patients were excluded.
35 patients had mono-ocular cataract. Their other eye vision was 6/6 with or without glasses.
65 patients had mature or immature cataracts.
Uptill now we have not done bilateral implants.
All the lenses were implanted at the time of cataract surgery (Primary Implant), except in one case where lens was implanted 10 years after cataract surgery (Secondary Implant).
- Intra-ocular tension with Applanation tonometer.
- Sac syringing.
- Slit lamp examination of cornea, iris, pupilary margin, anterior lens capsule, and if possible posterior lens capsule of other eye. We were very particular with specular microscopic examination of endothelium of cornea.
- Urine for albumin and sugar.
- Blood pressure.
- Thorough medical checkup.
- Complete haemogram.
Inj. Atropine 0.6 mg. plus Inj. Phenargan 25 mg. I.M. 1/2 hour before surgery. In apprehensive patients Inj. Calmpose 10 mg. along with Atropine. Pupil was dialated with Phenylepherence 5%.
Anaesthesia: Operative Procedure:
All cases were operated under local anaesthesia. Local anaesthesia was given using 2% Inj. Xylocaine with Adrinaline. At the same time 25 to 35 ml. of 20% Manitol was given intravenously as a bullous dose.
Lid and superior rectus sutures were taken. Fornix based conjunctival flap was raised. Small blood vessels were cauterised with ball point cautery. Eye ball was punctured at 12 O'clock at mid-limbal position with razor blade. Incision was completed by universal microcorneal scissors.
Procedure for Introduction of Implant.
Posterior chambers 'J' loop lens:
For this lens one has to do extra-capsular lens extraction. Can opener 6 to 7mm anterior central capsulotomy done with bent 27 No. hypodermic needle or with very fine cystome. This piece of capsule was removed. Lens nucleus was removed. Anterior chamber irrigated with normal saline by 20 no. canula on 10 ml. syringe to wash out lens cortex. If required cortex was aspirated by same canula. Posterior capsule polished. One 10-0 nylon suture was taken on one side so that 8 to 9 mm wound is kept open for introduction of lens. Anterior chamber filled with air bubble. This air bubble prevents scraping of corneal endothelium while introducing lens. Lens pack opened and lens washed with normal saline. Lens grasped with special forceps keeping convexity of lens anteriorly. Inferior loop introduced in the wound followed by lens proper. This lower loop is passed under lower margin of the pupil. Inferior border of lens also passes under the iris. Lens is released from forceps. With bent needle lens is engaged in a small hole in the lens and delicately manipulated so that superior loop goes under the iris. Lens is positioned by the same bent needle. Pilocarpine 2% is instilled.
Procedure for Sputanik Lens:
One can do extra or intra-capsular cataract extraction. We have done in most of the cases intra-capsular extraction. After one side suture, A.C. is filled with air. Lens is held in a special forceps so that loops are posterioraly and antinae anterioraly, 2 loops inferioraly and one superioraly. Cornea is slightly lifted to help introduction of lens. Lens introduced in A.C. through air bubble. One inferior loop is passed by forehand movement under the iris and other by backhand movement. Lens is released from forceps and forceps removed fron A.C. Iris repositor is passed horizontally behind the lens and infront of the loop. With delicate manipulations with iris repositor lens is pushed inferioraly so that upper loop goes behind iris. Some times one has to pull iris little superioraly with small forceps. Thus all the three loops are posterior to iris and antanae are anterior. Pilocarpine 2% is installed.
Procedure for Anterior Chamber Lens
If A.C. lens is to be implanted, corneal diameter has to be 11 mm. These lenses are 12 mm in length. One can implant this lens after intra or extra-capsular cataract extraction. One has to constrict the pupil fully by instilling Pilocarpine 2% immediately after cataract extraction. If pupil is not constricted iris gets entangled with bar of inferior loop.
One sclre-corneal suture is taken. A.C. filled with airbubble. Lens held with a forceps with convexity anterioraly. Lower loop is inserted through air bubble in front of iris in inferior angle of A.C. Forceps released and taken out. Scleral lip of the wound is held at 12 O' clock and pulled superiorly. With iris repositor, superior loop is just depressed so that it passes behind the scleral lip in the angle of A.C. Scleral lip forceps released. Lens automatically gets positioned.
These are three different procedures for introduction of three different implants. Wound is sutured by following technique. Corneoscleral wound is sutured with 10-0 monofilament nylon suture on atraumatic needle. Type of suturing is shoe string double continuous with burried knot at 12 0' clock position. Total 12 to 16 bites are taken so as to produce 6 to 8 crosses. With 28 No. canula A.C. is irrigated with normal saline to remove air bubble and A.C. is filled with normal saline. Subconjunctival inj. of Decadron and gentamycin is given. Chlorocort applicap ointment is put and eye is padded and bandaged. Patient walks off the table to his bed.
Post Operative Management.
Medication-Orally-Chloramphenicol 250 mg. t.d.s. for three days, predenesolone 5 mg. tab. b.d. for 8 days, oxiphanebutazon tab. b.d. for 5 days.
Medication, Locally-First dressing is done after 24 hours. Betnesol-N oint. and eye drops used. Atropine is not used for 20 days in posterior chamber and sputanik lenses. because if pupil dialates lens may get dislocated. This fear is not there in case of anterior chamber lens. So in each anterior chamber lens pupil was dialated with Atropine ointment. Patient is discharged on 4th or 5th day. On discharge eye was examined on slit lamp and vision was tested. Patient called for follow up after 15 days.
Maximum follow up is of 26 months. Every 15th day follow up is maintained for 2 months, 3 monthly follow up for one year and six monthly follow up there after.
In all the cases after one and half months all the systemic and topical drugs are omitted.
| Observations|| |
- One must be able to do a very good cataract extraction.
- One can do this procedure without operating microscope but for such precision work microscope is must. We did all implants under operating microscope with 15x magnification.
- Good hypotony of eye is very essential.
- Most difficult and tricky implantation is of posterior chamber J' loop lens.
- Sputanik is fairly difficult.
- Anterior chamber implant is easiest.
Post Operative Observations:
- Posterior chamber lens gives best results in all respects.
- From 3rd day onward on slit lamp examination iris pigment deposits on lens surfaces were found. Anterior vitereous face also showed such deposition. There was no pigment on endothelial surface of cornea. A.C. was clear.
On 5th day deposition was maximum. On first follow up on 15th day deposits were very much reduced. From 6th week deposits were minimal.
- Quality of vision-Intelligent patients say that quality of vision is as good as that was present before development of cataract. Few patients could read with there old presbyopic glasses.
- Acuity of vision
74 cases 6/6 with or without glasses
21 cases 6/12
5 cases between 6/36 to 6/18
- We did not remove a single lens because of complications.
- Infection rate in this series was zero percent