Posters

Long-term efficacy and safety of primary flexible open-loop anterior chamber lens implantation in non-vitrectomised eyes with pseudoexfoliation and weak zonules

Poster Details

First Author: Y.Neo UK

Co Author(s):    V. Cvintal   B. Shingleton                 

Abstract Details

Purpose:

Anterior chamber lens (AC-IOL) implantation is often performed as a secondary rather than primary procedure in eyes which undergo cataract surgery without adequate capsular or zonular support. We aim to evaluate the long-term efficacy and safety of primary flexible open loop AC-IOL implantation in non-vitrectomised eyes with pseudoexfoliation (PXF) which underwent phacoemulsification surgery.

Setting:

Large tertiary hospital setting in Boston, Massachusetts, USA

Methods:

Single-centre, prospective, cohort study included twenty-six consecutive eyes from 26 patients with PXF and zonular weakness who underwent primary AC-IOL implantation at the time of phacoemulsification surgery from year 1999-2009. Patients were excluded if they had concurrent vitrectomy or previous vitrectomy in the same eye. Clinical parameters including best corrected visual acuity (BCVA), intraocular pressure (IOP), glaucoma medications requirement (GMR) pre-operative and post-operative were reported. Post-operative complications were documented. Rate of repeat surgery and final BCVA before discharge were compared to 53 PXF eyes with zonular weakness which underwent posterior capsular intraocular lens (PC-IOL) with capsular tension ring (CTR) implantation.

Results:

Mean follow-up was 25.3±6.2 months. Mean BCVA improved from 0.86±0.48logMAR to 0.41±0.36logMAR (p<0.001). Twenty-four(92.3%) achieved an improved BCVA from baseline at their final clinic visit. There is no statistical difference in IOP and GMR pre- and post-operatively (p=0.440;p=0.203). Thirteen(50%) developed posterior capsular opacification;Five(19.2%) developed cystoid macular oedema;Five(19.2%) developed acute IOP spike;Three(11.5%) developed capsular phimosis;Two(7.6%) developed corneal decompensation. One(3.8%) required lens explanation in the AC-IOL group compared to four(7.5%) in the PC-IOL group requiring further surgery for dislocated or dropped PC-IOL/CTR complex (OR 2.04; p=0.052,95%CI 0.65-7.84). There was no statistical difference between mean BCVA of both groups.

Conclusions:

Primary AC-IOL implantation is effective in eyes with PXF and weak zonules, giving excellent long-term BCVA. IOP spike and post-operative cystoid macular oedema were the commonest complications post-operatively but they tended to be acute and transient. Rate of repeat surgery was lower in the AC-IOL group compared to the PC-IOL/CTR group. Corneal decompensation was infrequent.

Financial Disclosure:

None