|Year : 1984 | Volume
| Issue : 6 | Page : 496-498
Intraocular lens implantation
AK Sood, S Mithal, Vinod Kumar
L.L.R.M. Medical College Meerut, India
A K Sood
L.L.R.M. Medical College Meerut 250102
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sood A K, Mithal S, Kumar V. Intraocular lens implantation. Indian J Ophthalmol 1984;32:496-8
After surgical removal of cataractous lens patient's vision is blurred which can be restored by conventional methods like, aphakic glasses/contact lens or intra-ocular lens implant. Aphakic spectacles have certain well known disadvantages. Contact lens solves these problems to some extent but their manipulation is difficult in old age and also in some occupational conditions. All these problems are satisfactorily solved by intraocular lens implant, which is the most physiological method of aphakic correction. The present study also aims to see the visual improvement and the associated post operative complications after intra-ocular lens implantation.
| Material and methods|| |
Fyodorov-Sputinik intra-ocular lens was implanted in fifty eyes. This lens is a biconvex lens, having optic and haptic portion. Optic portion is made up of Polymethyl methacrylate (PMMA) and haptic portion is made up of Polyamide fibre. This haptic part serves the function of fixation of implant inside the eye. It has got three loops and three antennae with rounded knobs at their end. The total diameter of lens is 7.5 mm and its weight in aqueous is only 0.6 mg. Sterilization of this implant is achieved by ethylene oxide gas.
All the suitable subjects taken up for implantation underwent thorough ocular examination including slit lamp examination, retinal function test and fundus examination of other eye wherever possible. It was not done in one eyed patient, patients of diabetic retinopathy, high myopia and corneal endothelial dystrophy. Prior to implantation informed consent was taken from every patient, all the patients were told about the procedure in detail.
Lens implantation was done after perfect intracapsular lens extraction, in all the cases. If there was accidental extracapsular or even the slightest disturbance of vitreous face, implantation was i not done. Insertion of pseudophakos was done by open sky technique in all the cases.
| Observations|| |
There were 33 males and 17 females. Age group of these patient varied from 50 years to 75 years. [Table - 1] shows age and sex pattern of cases.
Postoperatively patients were hospitalized for I week and for follow-up they were called after 2 weeks and 4 weeks from the date of operation. After that they were called at monthly intervals for 3 months and quarterly for further study. During follow-up slit lamp and fundus examination was done and the vision was recorded. Any undesirable eventuality if occurred during follow-up was dealt accordingly.
Follow-up period of various cases varied from 3 months to 18 months. [Table - 2] shows the follow-up period of cases.
The minimum follow-up period was 3 months and the maximum follow-up period was 18 months. Two cases did not turn up for follow-up after 1 month. The post-operative complications are shown in [Table - 3].
Visual improvement after 2 months of lens implantation is shown in [Table - 4].
Two cases did not turn up for follow up after 1 month, and one case in which dislocation of implant occurred was not considered here.
| Discussion|| |
No development in modern ophthalmology has captured the attention, interest and enthusiasm of patients and ophthalmic surgeons alike more than intra-ocular lens implant. Ever since Ridley did the first intraocular lens implantation on 29th November 1949 tremendous progress has been made in this field. Since then various modifications, in the implant design, its position inside the eye and its method of fixation has been made. Currently available implant can be grouped in three main types depending upon their place inside the eye, ant. chamber, angle fixation, post. chamber fixation and iris fixation implant.
For this study we selected Fyodorov Sputnik intra-ocular lens, because this iris fixation implant has better fixation inside the eye. Secondly this implant is inserted after intracapsular lens extraction which is a comparatively easy procedure.
In our study striate keratitis was present in 14% cases at the end of 1st week which cleared within next week in all the cases. The incidence of striate keratitis was more as compared to routine cataract surgery because of extra handling of cornea during the process of insertion of implant.
Corneal oedema occurred only in 1 case (2%) which was due to postoperative flattening of anterior chamber. In this case implant touched the back of cornea and damaged its endothelium.
Shallow anterior chamber. which is a warning sign, occurred in 4 cases, in two cases it was due to wound leak and in other two it was due to block in iridectomy. For these iridotomy was done and wound was re-stitched followed by injection of air into anterior chamber. In all these cases chamber became deep and no further complication took place.
Iritis was seen in 32% cases at the end of 1st week, this iritis was due to extra handling of iris while placing the lens inside the eye, and also due to use of miotics in initial postoperative period. However this iritis is beneficial as it helps in the formation of adhesions between iris and implant. This iritis cleared within 15 days in most of the cases, in some cases it required sub- conjunctival inj. of Decadron 0.5 ml. for one week.
Dislocation of implant into the anterior chamber occurred only in 1 case (2%), it was due to injury in postoperative period. It was taken out because of the failure to reposition the implant surgically.
Lens precipitates, which are fine brown pigments over the implant surface, were present in 4 eyes (8%). These precipitates did not give rise to any visual deterioration, they were regularly arranged over the implant surface, probably due to the pores in the implant material .
In this study we did not come across any case of cystoid macular oedema or retinal detachment.
Visual improvement after intra-ocular lens implant was quite encouraging. Vision in the range of 6/6-6/12 was achieved in 68% cases, 21% cases got vision in the range of 6/18-6/60, while remaining 11 % cases got less than 6/60 vision. This poor vision in most of the cases was due to changes in fundus, in one case it was due to corneal oedema and in one it was due to degenerated vitreous.
| Summary|| |
Data of 50 cases of IOL implantation after cataract surgery is presented.
| References|| |
Ridley, H., 1951, Trans. Ophthalmol., Soc. U. K. 71: 617.
Binkhorst, C. B., 1975, Amer. J. Ophthalmol, 80: 184.
[Table - 1], [Table - 2], [Table - 3], [Table - 4]