Glued intraocular lenses: our experience in a tertiary eye care center in south India

Session Details

Session Title: Cataract Surgery Complications

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 09:02

Venue: Boulevard A

First Author: : B.John INDIA

Co Author(s): :    S. Mohan   M. Rajan   N. Ganesh   H. Malkani     

Abstract Details

Purpose:

Fibrin glue assisted sutureless posterior chamber intra ocular lens implantation(PCIOL) is a new technique for IOL implantation in eyes with inadequate capsular support. The aim of our study was to analyse the visual outcomes of glued, sutureless posterior chamber IOL implantation in eyes with inadequate capsule support in a tertiary eye care hospital in South India.

Setting:

Rajan Eye Care Hospital Pvt LTd, Chennai India

Methods:

All patients who had intra ocular lens implantation with fibrin glue between August 2009 to January 2014 were included. Inclusion criteria included aphakic patients with deficient capsular support and patients with >180 degrees of subluxated cataracts. Indications of surgery were noted as primary or secondary depending on whether the glued IOL was implanted during the primary procedure or as a secondary procedure later. Patients who had glued IOL done as a secondary procedure were divided into 3 groups. We had a total of 4 groups in our study. All patients underwent a complete ophthalmic evaluation which included history, best spectacle corrected visual acuity(BSCVA), slit lamp and fundus evaluation. IOL power was calculated with SRK-T formula. All glued IOL’s were performed by a single surgeon under local anaesthesia. IOL which was used was either rigid PMMA lenses or foldable acrylic lenses. Post operatively the patients were followed up at 1 month, 6 months and 1 year. At each follow up visit BSCVA, IOP, slit lamp and fundus examination was done.

Results:

We had a total of 94 patients in our study who underwent glued intra ocular lens implantation in the period between August 2009 and February 2014. 7 patients had glued IOL’s done as a primary procedure while in 87 patients it was done as a secondary procedure. Among the secondary glued IOL’s, 46 patients had only glued intra ocular lens implantation after the primary aphakia while 25 had procedures like vitrectomy before the patient was taken up for glued IOl and in 16 patients glued IOL’s were combined with other procedures like penetrating keratoplasty, silicon oil removal etc. Out of 94 patients, 29 had rigid IOL’s while 65 had foldable IOL’s The follow up period ranged from 1 month to 4 years. 3 patients were lost to follow up. Intra operative complications included broken haptic, ciliary body bleeding and deep scleral flap. 77 patients(84.6%) maintained or improved on their pre operative best corrected visual acuity(BCVA) while 14 patients(15.3%), lost 1 line or more when compared to the pre op BCVA. Post operative complications included cystoid macular edema, epiretinal membrane, IOL tilt and secondary glaucoma.

Conclusions:

Glued intra ocular lenses are a good option in rehabilitating patients with aphakia without adequate capsular support. In our study, majority of the patients maintained or improved on their pre operative best corrected visual acuity. The technique of Glued IOL implantation does not have a long learning curve and we did not face any significant intra operative complications. The post operative problems we encountered in patients in whom visual acuity deteriorated were related more to the bad surgical history of the patients and multiple surgeries which many of our the patients underwent and not primarily due to the glued IOL implantation. We recommend that glued Intra ocular lens implantation should be included in the surgical armamentarium of cataract surgeons.

Financial Interest:

NONE