|Year : 1984 | Volume
| Issue : 1 | Page : 1-4
Iris tissue damage following suture-fixated binkhorst type intraocular lenses
Gurinder Singh, Rolf Guthoff, D Von Domarus
University Eye Clinic Eppendorf Martinistrasse 52, 2000 Hamburg 20, (West Germany)
D Von Domarus
Augenklinik, Universitats Krankenhaus Eppendorf Martinistrasse 52, 2000 HAMBURG 20, west Germany
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh G, Guthoff R, Domarus D V. Iris tissue damage following suture-fixated binkhorst type intraocular lenses. Indian J Ophthalmol 1984;32:1-4
Reports have been accumulating in favour of the in-fashion Posterior Chamber Intraocular Lens (IOL) implants,,. Keeping in view the risks of major complications like damage to ciliary body and major ciliary vessels of posterior chamber implants,,,, many surgeons still stick to iris-supported IOL. The loops of iris-supported lenses are slipped behind and in front of iris diaphragm and implants are held in position by miotics, sutures and metal-clips. Some advocates of posterior chamber lenses state that iris-fixated IOL cause iris-tissue damage which is minimal with posterior chamber lenses.
The purpose of this study was to evaluate clinical results of 4-loop Binkhorst type IOL implants and to see the possible iris tissue damage caused by iris sutures placed to fix these implants to iris. The assessment of this possible and spoken of tissue damage was based on clinical and iris-angiographic studies.
| Material and methods|| |
Our study included 190 eyes operated-on for cataract extraction and followed by implantation of suture-fixated iris-supported 4loop Binkhorst type IOL. Besides clinical evaluation of these implants, specifically considering intra and post operative changes and complications, 98 iris-angiographies were studied. These angiogrammes were performed 23 times before and 40 times after nine post operative days, while remaining 35 angiographies were done between 4 to 20 months post-operatively. For control study of normal iris vascular pattern, 14 patients were. evaluated by iris-angiographies done pre and post operatively to intra-capsular cataract extraction without any primary ocular pathology.
In all, this study deals with 190 IOL implants 4-loop Binkhorst type, iris-fixated with Prolene sutures at University Eye Clinic, Hamburg (West Germany) in 1979-80. In 85 eyes the lens implants were horizontally placed and iris-fixated with two sutures placed on both the anterior loops (Series 1). Other 105 eyes had vertically placed IOL with one suture placed at the upper loop for iris fixation (Series 2). Average age of patients was 74 years with range form 42 to 89 years. 59 eyes were operated under local infiltration and 131 eyes under general anaesthesia.
| Observations|| |
1. Iris-angiographic Results: The iris-fluorescein angiographies done on 98 eyes revealed early post-operative phase of increased and diffuse permeability of iris vasculature. Also, it was equally appreciable in the control study of 14 intra-capsular cataract operated eyes without lens-implantations. In early post-operative period, very often, we observed small leakage points on the pupillary border of iris. It was seen without any provable and obvious anterior chamber inflammation. This finding was also seen in normal control-study eyes without lens implants. These findings have been reported with IOL earlier also,,.
In one eye was seen sectorial filling defect central to the suture-knot. But, obviously in that case too much of iris tissue was strangulated by the big suture bite. Surprisingly, the long term follow-up of this case showed no deterioration of the condition. In no eye the area of iris with suture showed any abnormal tissue swelling and flourescein leakage. Iris neovascularisation was also not observed at such suture site in this study.
2. Clinical Results: Intra and post operative complications have been tabulated in [Table - 1]. Vitreous disturbances and loss were noted in about 8% of cases of both the groups (Series 1 and 2). Post operative macular oedema was also comparable in two series (in about 4% eyes). Same was true for corneal oedema seen in about 1.8% eyes and it resolved in about one week. Late corneal oedema caused by subluxated vertically fixated IO.L was seen in 4% of cases of this series, It was not noticed in any case of horizontally placed and two sutures fixated lenses. Post operative retinal detachment was noted in total of 4 patients and developed from 6 months to 2 years of lens implantations. In one case of series 2 the serious complication of Expulsive haemorrhage developed as the second iris suture was being tied on a horizontally placed lens. Complications like iritis causing posterior synechiae and pupillary distortion were also negligible.
The significant difference in complications in two series of patients with intraocular lens implants was noted in subluxation of IOL implant. It developed in as many as 10 cases (about 9%) of one suture fixated vertically placed IOL which developed as early as on seventh day to as late as 2 years post operatively. In all these subluxations the lower UN fixated loop subluxated either posteriorly or anteriorly touching cornea in 4 cases and causing corneal haze and opacification. As expected this complication of subluxation was never seen in horizontally placed lenses which were fixated at both the loops.
Permanent iris vasculature damage which could be seen by flourescein leakage was never seen in any eye on long term follow-up. Same was true for other complications like permanent corneal oedema, loosening of iris sutures and development of post lenticular membrane.
| Discussion|| |
Clinical evaluation of intraocular lens implants, supported by iris-angiographies, give us the basis to speak in favour of iris-fixated IOL held in position by Prolene sutures. The iris-angiographies were specifically done to study and evaluate the iris tissue damage caused by sutures used to fix these implants,,. The long term follow-up failed to show neovascularisation of iris in the area of sutures. Prolene sutures placed on the lens loops did not show any untoward damage to iris vasculature, cornea or the eye as a whole. On the other hand, we analysed that unfixated IOL have greater chances of subluxation or dislocation as we also saw that iri as many as 9%, cases of vertically placed one suture fixated IOL. Only the unfix ated lower loop subluxated and it caused vitreous disturbance, corneal oedema and pupillary distortion. Further, to repose these subluxated lenses we had to expose the eyes, once again, to the risks of complications of anaesthesia and operations procedures.
As expected, the two-loops fixated lenses were held in position without any complications. We. had the great advantage of diagnostic mydriasis in these eyes to see the fundus for follow-up and early detection of post operative retinal detachment. This important advantage of mydriasis can not be over-looked.
Complications like sectorial filling-defect detected on iris-angiography and pupillary distortion depend upon the surgical man ouvering and techniques in placing the sutures. These were the big and abnormally placed bites of sutures which led to such complications. These could be safely avoided by better handling at the time of suture placement.
Expulsive haemorrhage was the only complication against fixated lens implants. It developed when the second suture was being tied-up and might not have occurred had we closed the eye earlier. But this complication occurs during simple cataract extraction also, so can not be considered against iris fixated IOL implants.
To conclude, the iris-angiographic study of iris fixated IOL implants show that the two sutures used to fix the implants on the iris are better than one suture because it avoided many complications and had no tissue damage as supported by iris-angiographic study. Suture material did not cause iris tissue damage or induced iris-neovascularisation.
The iris-angiographic study of 190 eyes operated on for iris-supported suture-fixated 4-loop Binkhorst type intraocular lens implants showed that the suture material used for lens-fixation did not cause any tissue damage, swelling, abnormal vascular trauma or neovascularisation at the suture site on iris. It was further noticed that IOL iris-fixated by two sutures proved better when compared to those fixed by one' suture only. Vertically placed one loop fixated lenses developed subluxation and late corneal oedema-the complication not seen with lenses fixated with twoiris-sutures.
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[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]