Indian Journal of Ophthalmology

ARTICLES
Year
: 1983  |  Volume : 31  |  Issue : 7  |  Page : 954--957

A comparative study of anterior chamber lens implants and fyodorov lens implants


NSD Raju 
 General Hospital, Ernakulam, Kochin, India

Correspondence Address:
NSD Raju
Ophthalmic Surgeon, General Hospital, Ernakulam, Cochin
India




How to cite this article:
Raju N. A comparative study of anterior chamber lens implants and fyodorov lens implants.Indian J Ophthalmol 1983;31:954-957


How to cite this URL:
Raju N. A comparative study of anterior chamber lens implants and fyodorov lens implants. Indian J Ophthalmol [serial online] 1983 [cited 2022 Jan 28 ];31:954-957
Available from: https://www.ijo.in/text.asp?1983/31/7/954/29715


Full Text

The problem of correction of aphakia has always been a difficult one in many patients who have been operated for cataract. The dis­advantage and difficulties of wearing the spectacle connection or the contact lens are too well known to elucidate. But the advent of intra ocular lens implantation has indeed ushered in a new era in ophthalmology. The tremendous research work in this new form of surgery for a decade or so has established beyond doubt the safety and usefulness of the intra ocular lens implants.

 MATERIALS AND METHODS



In this study 24 cases of Intra Ocular Lens Implants were taken up, 12 cases each of Anterior Chamber Lens and Iris-clip lens of Fyodorov ([Figure 1], Anterior Chamber Lens, [Figure 2] Fyodorov Sputnik Lens). The cases were done by the author at the Ophthalmic Department attached to the General Hospi­tal, Ernakulam. The lenses were obtained from M/s. Shah & Shah, Calcutta. The period of study was from January 1982 to August 1982, cases done from January to June 1982 being followed up. Follow up period varied from 8 months to 3 months.

Intra Ocular Lens Implantations were done in these cases for unilateral cataracts, senile cataract in illiterate manual labourers, who would not use aphakic spectacles and in unilateral traumatic cataracts.

In all the cases the implantations were done after intra capsular cryo extraction. An operating spectacle (Jaggi) was used for the surgery. A fabricated Honan's Baloon with a pressure cuff and manometer with a pressure of 30 mm Hg applied over the eye ball for 20 minutes ensured a soft eye ball during sur­gery. Mannitol was not given routinely.

A standard technique of cataract extrac­tion was adopted in all the cases with a limbal flap and an ab-externo corneo-scleral section from 9 O'clock to 3 O'clock position with two pre-extraction sutures at 10 O'clock and 2 0' clock position. In anterior chamber lens impalnts the horizontal diameter of the cor­nea was measured prior to the section, and the vertical height of the implant was 1 mm more, so as to keep it snugly fit at the lower and upper angle of the anterior chamber. After the extraction of the cataract the anterior cham­ber was reformed with sterile air. A lens hold­ing forceps was used to hold the lens while it was being introduced into the anterior cham­ber. In case of the anterior chamber lens the inferior loop was engaged in the 6 0' clock position and by gentle retraction of the scleral lip at 12 0' clock the superior loop was also engaged in the 12 0' clock position. In Fyo­dorov lens, the three loops were manipulated behind the iris with the help of the lens spatula and a fine iris hook 5. corneo-scleral sutures and continuous sutures for con­junctiva in all cases.

 OBSERVATIONS



Of the 12 Fyodorov lens implants 7 were males and 5 females, the average age being 71 years.

Of the anterior-chamber implants 8 were females and 4 males, average age being 66 years [Table 1].

8 cases (66%) of anterior chamber implants developed moderate anterior ureitis in the immediate post operative period and these cases had to be given systemic steroids in a dose of 60-80 mg. and they had to be main­tained on low dose of steroid ranging from 5­10 mg per day fro 2-3 weeks. The incidence of anterior uveitis was only 16% (2 cases) in Fyodorov lens implants and systemic steroids had to be given in these case also.

A low grade inflammation with mild cir­cumcilary flush persisted for 2-3 months in 5fl% (6 cases) of anterior chamber implants. These cases also had globe tenderness espe­cially at the upper and lower limbal regions. None of the Fyodorov lens implants cases developed this complication [Table 2], 11 cases of anterior chamber lens implants had pigment deposits on the back of the lens whereas only 2 such cases were seen in the Fyodorov lens series.

One case of anterior chamber lens implant developed an internal iris prolapse in the immediate post operative period and this was controlled by mydriaties.

None ofthe cases of either series and cytoid macular oedema. The incidence of retinal detachment was nil.

An analysis of the final visual results showed that 75% of Fyodorov lens implants had 6/9 or better vision, none of the case hav­ing vision less than 6/24. [Table 3] only 25% of anterior chamber lens implants had a final visual acuity of 6/9 or better, 60% having vision between 6/12-6/18.15% had vision 6/24 and below.

About 50% of patients with Fyodorov lens implants complained of glare phenomenon, this being notably absent from the other group of anterior chamber lens implants. The fairly large hexagonal pupil probably accouned for the glare phenomenon.

 DISCUSSION



The selection of the correct size of the anterior chamber lens was sometimes a pro­blem, the horizontal diameter not always being a sure guide to the actual size of the implant required. In the present series, however no such problem was encountered. There was no incidence of "Hyphaema­uveitis-galucoma" syndrome, nor eras there any dislocation of the lens. Fyodorov lens implanted patients were kept on mioties for one month to prevent possible dislocation of the lens.

On the whole, Fyodorov lenses showed only minimal reaction and generally a smooth post-operative period. In all the cases a standard power equivalent to +10 diopters of spectacle correction was used, assuming that the patient was emmotrapic before. Pro­bably better visual results could have been obtained, had there been facilities for estimat­ing the power of intra ocular lens pre-opera­tively. The reason for the relatively low visual acuity in anterior chamber lens implants is not quite obvious.

No damage to theseorneal endothelium was detected in either series. Of course, a specular miscroscope is essential to assess the integrity of the corneal endothelium and in the absence of such a microscope only the slit­lamp examination could be relied upon.

 SUMMARY



This short study shows that if correctly done, Fyodorov lenses are better tolerated and give good visual results than anterior chamber lens implants. Probably it is too early to assess the final results, but the initial results are definitely encouraging. This study also shows that intro ocular lens implantation can successfully be done with operating spectacles where operating microscope is not available. Another important observation is that intra ocular lens manufactured in India are quite good and comparable to any s ' n­dard lenses manufactured abroad.[5]

References

1S.N. Fyodorov. E.V. Egorova and L.N. Zubareva,1981, Am, Intraocul, Implant Soc. J. 7,147-153.
2R. Parker, 1981, Trans Ophthalmol. Soc NZ, 33.99­101.
3A.T. Morris, 1981, Trans Ophthalmol Soc NZ 33.97­98.
4M. Miki, M. Hyashi and T. Kondo, 1981, Jpn J. Clin Ophthalmol 35, 491-95.
5Benjamin F. Boyd, 1978-1979, Highlights of Ophthalmology, Benjamin F. Boyd p.p: 175.