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| ARTICLES |
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| Year : 1989 | Volume
: 37
| Issue : 2 | Page : 78-79 |
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Analysis of complications in 1000 cases of posterior chamber intra ocular lens implantation
J Sudhakar, RD Ravindran, G Natchiar
Aravind Eye Hospital, 1 Anna Nagar, Madurai-625 020, India
Correspondence Address:
G Natchiar
Aravind Eye Hospital, 1 Anna Nagar, Madurai-625 020
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 2583786 
Analysis of complications in 1000 cases of primary posterior chamber intraocular lens implantation done, during a period of one year was undertaken for the study. The cases included uncomplicated as well as those with various associated conditions like diabetes, traumatic cataracts, complicated cataracts, myopia and developmental cataracts. The important postoperative complications were uveitis (9%), endophthalmitis (0.5%), malposition of IOL (2.8%) and cystoid macular edema (0.3 %). Posterior capsule opacification was seen in 11.5 % of cases and was treated by YAG laser capsulotomy. More than 80% cases had 6/6-6/12 vision. In our experience posterior chamber IOL implantation has become an extremely successful and satisfying procedure along with the availability of YAG laser facility to manage posterior capsule opacification.
How to cite this article:
Sudhakar J, Ravindran R D, Natchiar G. Analysis of complications in 1000 cases of posterior chamber intra ocular lens implantation. Indian J Ophthalmol 1989;37:78-9 |
| Introduction | |  |
The posterior chamber being closest to the nodal point of the eye, offers several advantages as a site for implantation of an intra ocular lens. The advantages are elimination of edge glare, glitter and dazzle associated with other lenses. The pupil is readily dilatable offering a better view of the fundus. Being further away from the corneal endothelium and trabecular meshwork minimal or no damage occurs to these important structures. It offers the best quality of vision almost comparable to that of a phakic eye. Lastly it is the most pleasing lens cosmetically.
Considering the popularity of posterior chamber IOL implantations it is important to consider critically their complications. Complications are also increasing due in part to longer follow-up and increased use of intraocular lenses. Complications with posterior chamber lenses are relatively less when compared to other lenses. The occurence of hyphema, uveitis and glaucoma are minimal with posterior chamber lenses.
We report our experiences of complications in 1000 cases of primary posterior chamber IOL implantations done during a one year period.
| Material and Methods | | |
The subjects included uncomplicated cases as well as those with various associated conditions like diabetes, myopia, traumatic cataracts, complicated cataracts and developmental cataracts. All patients underwent thorough ocular examination including slit lamp examination, retinal function test and tonometry. IOL power was estimated by keratometry and Ascan. All cases were operated under the operating microscope (Zeiss OPMI 6-SFC). Surgery was done under local anaesthesia. Fornix based limbal section was made by using an ordinary razor blade fragment. A Can-opener type anterior capsulotomy was done by using bent 25G needle. Nucleus was expressed by the pressure and counter pressure method. Cortical lens matter was removed by infusion-aspiration technique using a Simcoe cannula. 'Balansal' was used for infusion. After forming the anterior chamber with an air bubble IOL insertion was done by the open sky technique. Surgidev, Cilco, Iolab, and American Medical Optics lenses were used with modified J-Loop, J-Loop and C-loop types. The lens was positioned either in the cilliary suicus or in the capsular bag. A peripheral iridectomy was done. The section was closed using 10-0 Nylon (Interrupted or continuous sutures). Postoperatively patients were hospitalised for one week. For follow-up they were called after a month. Suture removal (or suture relaxation) was done after 7 weeks to correct the astigmatism. Glasses were prescribed after 8 weeks.
| Observation and Results | | |
In this series of 1000 cases, there were 656 males and 344 female patients. The mean age of patients at surgery was 53 years. 255 patients had various associated conditions as shown in [Table - 1].
Of the 1000 cases, 57.1 % had post-operative visual acuities of 6/9 or better and only 2.2 % had visual acuity of less than 6/60, as shown in [Table - 2]
The complications classified as early and late are listed in [Table - 3] the most frequent of which we noticed was the posterior capsular opacification, showing an incidence of 11.5%
| Discussion | | |
Posterior chamber IOL implantation has become very popular because of the best quality of vision associated with least number of complications. It has solved the optical problems associated with the use of aphakic glasses and the long term problems of aphakic contact lenses.
In this series the visual acuity results were excellent; 80.7 % had visual acuity of 6/12 or better, similar to that reported by other authors [1],[2],[3],[4].
Implant related problems were few and did not significantly contribute to the decrease in vision, with the possible exception of one patient with a posteriorly dislocated implant who had good vision with spectacle correction.
Mild degree of striate keratitis was seen in nearly all cases which cleared within 3 days. Transient ocular hypertension with corneal oedema was noted in 17 cases which cleared with anti-glaucoma medications within 5 days and needed no treatment beyond that period. Some authors [1],[2],[3] have reported cases of secondary glaucoma in pseudophakics. We found no case of secondary glaucoma.
Iritis was present in 4.8 %, which was mild in 2.7 %, moderate in 1.1 % and severe in 1 % of cases which was treated depending upon its severity with topical, subconjunctival and systemic steroids. The probable cause of iritis was extra handling of iris tissue during surgery. Persistent iritis was noted in 1.4 % of cases. Other authors [2],[3] have reported a slightly lower incidence.
In our series, the incidence of endophthalmitis was 0.5%, only one of which was due to infection [8] . Of the 4 aseptic type, 2 occured in traumatic cataracts.
Pupillary block was present in one case (0.1%) [3],[4] which was treated by YAG laser iridotomy. The antreior angulation of the haptics prevented pupillary block. Vitritis was present in 1 % of cases [2] .
Pseudophakic cystoid macular oedema was. clinically encountered in 0.3 %
Kratz. et al reported an incidence of 2.1 %. The lower incidence in this series is probably due to absence of primary capsulotomies in our series.
Malpositions were seen in 2.8%; 1.2 % of which needed no treatment, 1.5 % of cases had pupillary capture, of which 0.5 % were corrected by using Phenylephrine eye drops, postural adjustment and then constricting the pupil when the malposition was corrected. The remaining cases were left alone, as the implant was stable within a quiet eye with good visual acuity. There was one case of posteriorly dislocated implant into the vitreous, which was left alone as it caused no reaction.
Opacification of the posterior capsule was the main late postoperative complication observed, showing an incidence of 11.5 %. This complication can be easily managed by noninvasive YAG laser capsulotomy as was done in 65 cases in this series.
We report no cases with corneal decompensation. Air was used as a buffer between the comeal endothelium and the implant during insertion [6] . Sodium hyaluronate was used in difficult and complicated cases [7].
| Conclusions | | |
In our experience, posterior chamber IOL implantation has become an extremely successful and satisfying procedure, both for the surgeon and the patient. The visual acuity results are very satisfactory with few implant-related post-operative complications.
| References | | |
| 1. | Paula C. Sourthurck, Ph.D. Randall J. Olson, M.D. 318-324, Am Intra Ocular Implant Soc J - Vol 10, Summer 1984.  |
| 2. | Richard P. Kratz the Shearing intra ocular lens, a report of 1000 cases. An intra ocular implant soc J Vol 7, Jan. 1981. |
| 3. | Stark et al. Ophthalmology 90: 311 - 317 19 &3 |
| 4. | Manus C. Kraff M.D. et al -The results of posterior chamber lens implantation. Am Intra Ocular Implant Soc J. Vol. 9, Num. 21983. |
| 5. | (Boume et al) willian M Boume et al, Use of air to decrease Endothelial cell loss during intraocular lens implantation Arch Ophthalmol - Vol 97, August 1979. |
| 6. | Pope, LG, Balazs, EA: The use of sodium hyaluronate in human anterior segment surgery. Ophthai 87 - 699 1980. |
| 7. | Wetning Pc, Thatcher, DB, Christiansen, J.M. The intra capsular X extracapsular cataract technique in relationship to retinal problems. Trans Amer. Ophthal soc 77: 339. 1979. |
| 8. | Jaffe N.S. Endophthalmitis in cataract surgery and its complications (3rd) C.V.Mosby,St Louis Missouri, 1981. |
[Table - 1], [Table - 2], [Table - 3]
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