|Year : 1982 | Volume
| Issue : 5 | Page : 455-456
Simplified approach to intraocular lens implant in cataract surgery-a preliminary report
Ophthalmology Command Hospital (Western Command) Chandigarh, India
Ophthalmology Command Hospital (West Command) Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Luthra J. Simplified approach to intraocular lens implant in cataract surgery-a preliminary report. Indian J Ophthalmol 1982;30:455-6
A preliminary report of simplified tech nique of implantation of an iris-plane intra ocular lens (Copeland lens) cambined wits intracapsular extraction based on the experience of 25 cases is presented.
| Materials and methods|| |
25 patients, all over 65 years of age had advanced or mature unilateral cataract and were poor contact lens condidates. They were free from following conditions :- Endothelial dystrophy, shallow anterior chamber, Glaucoma, Diabetes, Abnormal pupil or Iris, High Myopia and previous Retinal detachment.
The Copeland lens is an all Polymethylemethacrylate lens of the shape of a symmetrical cross with the 4 haptics in the same plane as the round optical portion. The optical portion is approximately 0.38 mm thick. and supports are 0.1 mm thick. It is 9 mm from tip of one haptic to the trip of opposite haptic. It is available in the powers of 16, 17.5, 19 and 20.5 dioptres. It is entirely supported by iris and is hinged securely in the place of the pupil and is immobile even with extensive eye movement. The power of the implant is predicted from the refractive error of the other eye.
Patient kept on local antibiotics 72 hours before surgery. All surgeries have been conducted under local anaesthesia. Hypotony is ensured by oral glycerol and prolonged bulbar massage. Pupil is kept dilated with I drop of homatropine 2% and 1 drop of Drosyn 10%. If too widely dilated acetylcholine is used to constrict the pupil prior to insertion of the plant. Anterior chamber is opened with broken razor blade enlarged with scissors after a fornix based flap. The lens is extracted intracapsularly using a cryo extractor. The intraocular lens is inserted with 6 0' clock haptic behind the iris and 2 horizontal haptics in front. Then the iris at 12.0' clock was gently lifted over the 12.0' clock haptic. The wound was closed by multiple sutures with 9.0 silk to make it water tight.
| Surgical technique|| |
Post operatively oral steroids is used for 10 to 14 days as a routine. Sometimes for 3 weeks if necessary.
Surgeon used a operating loupe for magnification.
| Discussion|| |
The follow up period is only 2 to 9 months in the present series. Lens dislocation and retinal detachment were not encountered; severe iritis occurred in first four cases, probably because of excess iris manipulation or vitreous contact. Wound leak, filtering bleb and flat chambers did not occur; slight vttreous loss was seen through the peripheral iridectomy in one case for which partial anterior vitrectomy was done. Steroid glaucoma occurred in 2 cases which responded to treatment satisfactory. Pupillary membrane occurred in 2 cases, out of which one had corneal oedema.
Cystoid macular edema was seen in one patient only, which responded to systemic steroid given for 8 weeks.
Out of 25 cases, 19, cases have upto date visual acuity 6/12 or better with full field of vision. Another 5 cases have VA from 6/ 18 to 6/36.
This lens is relatively easier to insert when first starting intraocular lens surgery. The operation can be performed with the help of good corneal loupe. It does not require suture material to secure the implant. The simplicity of insertion and lack of significant complication make it a suitable implant under Indian conditions. However, long term follow up and further investigations are needed to put up the value of IOL implant surgery in its true perspective.
| Acknowledgements|| |
I wish to thank profusely Brig. M.I. Hasan for his constant encouragement and for his kind permission to read this paper.
| Summary|| |
Copeland Iris-place intraocular lens implant was carried out in 25 patients. Visual results are gratifying. Technique is relatively easy when first starting intraocular lens surgery combined with standard intracapsular cataract extraction. It can be done with a good loupe, when the facilities of a microscope are not available.