Combined surgical management of capsular and iris deficiency with glued intraocular lens technique.

PURPOSE: To determine the outcome after glued aniridia intraocular lens (IOL) and glued IOL with iridoplasty in eyes with combined lens capsular and iris deficiency. METHODS: Twenty-seven eyes of 25 patients (6 had congenital aniridia with subluxated cataract and 19 had acquired lens/iris defects) were included. Glued IOL with aniridia IOL (Intra Ocular Care, Gujarat, India) was performed in eyes with total aniridia and iridoplasty with glued IOL with a three-piece foldable IOL (Sofport; Bausch & Lomb, Rochester, NY) was performed in eyes with partial aniridia. The postoperative outcomes were analyzed at follow-up examination (range: 6 to 48 months). RESULTS: Eleven eyes underwent glued aniridia IOL and 16 eyes underwent glued IOL with iridoplasty. There was significant improvement in (spectacle) corrected distance visual acuity (CDVA) (P = .002). Postoperatively, pigment dispersion on the IOL (n = 1) and raised intraocular pressure was seen in the glued aniridia IOL group and chronic uveitis (n = 1), cystoid macular edema (n = 1), and hyphema (n = 1) in the glued IOL with iridoplasty group. The CDVA remained unchanged in 14 eyes (51.8%) and improved in 13 eyes (48.1%). There was a difference in postoperative CDVA (P = .001) between eyes with glued aniridia IOL and glued IOL with iridoplasty. There was no IOL decentration, retinal detachment, corneal decompensation, or endophthalmitis. There was reduction in glare and photophobia. CONCLUSIONS: Both glued aniridia IOL and glued IOL/iridoplasty showed good functional and anatomical results with fewer complications in eyes with lens capsule and iris deficiency. However, long-term follow-up is required.[J Refract Surg. 2013;29(5):342-347.].

In vivo analysis of glued intraocular lens position with ultrasound biomicroscopy.

PURPOSE: To report ultrasound biomicroscopic (UBM) findings of glued transscleral-fixated posterior chamber intraocular lenses (IOLs) in eyes with inadequate capsules. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Case series. METHODS: Eyes with glued IOLs for inadequate capsule support were examined with UBM. Optic tilt was measured in relation to the iris plane. Haptic location, iris-IOL contact, vitreous incarceration, and central anterior chamber depth (ACD) were measured and correlated clinically with vision and refractive error. RESULTS: The mean follow-up was 24.6 months ± 14.3 (SD). Of the 46 eyes, 8 (17.4%) showed optic tilt and 38 (82.6%) showed no optic tilt. Of 92 haptics examined, 85 (92.4%) were in the ciliary sulcus and 7 (7.6%) in the pars plicata. There was no significant association between the presence of optic tilt and haptic location (P=.585, chi-square test). The mean ocular residual astigmatism (ORA) was 0.5 ± 0.2 diopter (D). There was no significant difference in ORA between eyes with tilt and eyes without tilt (P=.079). There was no significant correlation between ORA and IOL position. There was no correlation of optic tilt and postoperative vision or cylinder. Other features included iris-IOL contact (6.5%), vitreous incarceration (5.4%), and ACD difference (P=.002). CONCLUSIONS: No significant IOL optic tilt affecting the postoperative vision was detected with glued transscleral-fixated IOLs. The technique reliability was good, with the haptics located in the intended position in more than 90% of eyes. FINANCIAL DISCLOSURE: Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.