What is the Best Choice for IOL Management for Patients With Subluxated Lenses?
September 17, 2009
There is an article published in Ophthalmology Times, read the article, where the author discusses the IOL management for patients with subluxated lenses. The choices are anterior chamber lenses, posterior scleral fixated, iris sutured or posteriorly enclavated iris claw lenses. The choice depends upon many factors; health of the corneal endothelium, health and structure of the angle, age of the patient, presence of bleeding disorders, etc.
As a retinal specialist, I tend to have to make this decision more often than a cataract surgeon, that is, a lensectomy is performed to facilitate many retinal surgeries. I create aphakia during the procedure. Many times, I elect to place an IOL for the sake of time and efficiency.
Posterior scleral fixated lenses used to be very popular about 10 years ago. To me, they are not the greatest option. The sutures have been found to either degrade or often are accidentally cut leading to IOL dislocation. I have always been uncomfortable with passing the supporting sutures blindly through the pars plana. I always fear retinal detachment or massive hemorrhage developing from the ciliary body.
I have no surgical experience with iris supported lenses; sutured or not, nor have I seen the iris claw.
Most of the time, I elect to either place an ACL or consider an aphakic contact lenses post-operatively. I like the shorter operating times with an ACL, ease of insertion and relatively excellent visual results. I may be biased by the fact that my patients suffer retinal disease and do not have the capability of appreciating an ACL vs. PCL, that is, there may often be some retinal reason for decreased vision.
I would like to hear your opinion and suggestions.
Randall V. Wong, M.D.
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