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CATARACT SESSION - III 113

AUTHOR’S PROFILE:
Dr. RUPAM DESAI: M.S., D.O.M.S.,
Presently, Consultant, Rotary Eye Institute, Navsari, Gujrat, India.
E-mail: rupamdesai72@yahoo.com

Our Experience of Secondary IOLs—Scleral Fixation with ACIOL


Dr. Rupam Desai, Dr. Falguni Mehta, Dr. Jigisha Randeri, Dr. O.P. Billore
(Presenting Author: Dr. Rupam Desai)

W hen we think about aphakic eyes, it is a


complication – comes to our mind
immediately. Scleral fixation IOL is really
62 with M:F ratio is 32:8. Systemic ailments
were ruled out.
— Primary cause of surgery was senile
boon to aphakic patients who have no
cataract in 34 patients, subluxated cataract
posterior capsule. So, patient can really enjoy
in 4 patients, traumatic cataract in 2
a good pseudophakic vision without any
patients.
corneal complications which may be induced
by ACIOLs. — The duration between primary and
secondary surgery was from 3 months to
Materials and Methods 2 years.
It was a prospective study of 40 eyes. Group A
— Preoperative vision, IOP, corneal
includes 22 eyes who underwent scleral
thickness, specular microscopy,
fixation IOL procedure. Group B includes 18
gonioscopy, SLE and fundus examination
eyes who underwent AC IOL implantation.
was done in all patients.
Patients demographic data shows mean age of
114 AIOC 2008 PROCEEDINGS

SURGICAL PROCEDURE Stitch granuloma was found in 1 case of group


P/B anesthesia was given. Complete aseptic A due to exposed knot.
precaution was taken. Conjunctival peritomy
done. Cauterization done. Scleral tunnel made
Discussion
for IOL insertion. 2 scleral pockets made 180 º Our prospective study shows that visual
apart (avoiding 3 and 9 o’clock). Vitrectomy outcome and complications were comparable
was done if required. Scleral fixation suture and few in both groups.
(10-0 prolene with straight needle) passed from Hill et all showed that 44.4 % had improved
1 scleral pocket to opposite scleral pocket. BCVA as compared to 54.54% of our study.
Suture was pulled out through superior tunnel
Lee et all (1993) revealed that scleral fixation
and suture was cut. Cut ends were tied with
may cause greater degree of tilt as compared
holes of haptics of IOL. Other end of suture was
to routine PC IOL, the tilt has little effect on
pulled and IOL was inserted in posterior
post operative astigmatism. In our study mean
chamber. Straight needle of suture was then
stigmatism is 2.5 D which may be due to large
passed through sclera and tied. Scleral pockets
were sutured with 10-0 nylon. Conjunctival incision and sutures and none of the patient
sutures taken. S/C antibiotics and steroids showed tilt of IOL.
given. Postoperatively oral antibiotics, topical AC reaction and CME may be due to
antibiotics, steroids and cyclopegics were vitrectomy.
given. All patients were followed up on 1st day, Suture erosion was reported by Solomon,
week, 1 month, 3month, 6month and year. At Heilskov, Othoff. Endophthalmitis was
each follow up patient was evaluated in details. reported in cases with exposed sutures. In our
Results study there is no endophthalmitis and only 1
case shows suture exposure.
Group – A Group – B
Ab externo approach reduces the chances of
Visual improvement 54.54 % 33.33 %
vitreous hemorrhage as compared to Ab
Visual deterioration 18.18 % 44.44 %
interno approach practiced by Uthoff.
Hypotony — 2.22 %
What ever is the cause of aphakia, proper
AC reaction 27 % 33.33 %
preoperative evaluation, good intra operative
CME 9% 22.22 %
vitrectomy followed by SF IOL implantation
IOL decent ration — 11.11 % gave good postoperative comfort and better
Mean astigmatism 2.35 D 1.25 D alternative to AC IOL.

References
1. Lawrence EW. Flexible open loop AC IOL Ophthalmic Surgery 1992.
implants – Ophthalmology 1993. 4. Deltas Uthoff, Secondary implantation of SF
2. Lee JH – Chang JH, Suture to limbus distance IOL. J. Cataract and Refractive Surgery 1998:24.
in eyes with PC IOL. IOL implantation by scleral 5. Solomon K, Gussler J.R. Gussler C, Van Meter
fixation. J.Cataract and Refractive Surgery 1993. WS –Incidence and Management of complication
3. Hill J.C. , Transclerally fixed posterior chamber of transclerally sutured PC IOLs. J. of Cataract
IOL without capsular support in PK, and Refractive Surgery 1993.