IOL fixation in the absence of capsular support

“Anterior chamber intraocular lenses (AC IOLs) have a somewhat chequered history,” said Dr Richard Packard MD, FRCS, UK, as he introduced his presentation on IOL fixation in the absence of capsular support.   Speaking to a combined EURETINA/ESCRS session yesterday morning, Dr Packard introduced delegates to this unfortunate history. “Barraquer had to remove 250 of 493 early implants due to corneal decompensation. These disasters were due to both a lack of understanding of lens design on the corneal anatomy and poor manufacturing, which included rough haptic edges which damaged the angle of the anterior chamber,” said Dr Packard.   Due to these early difficulties, the only early-development IOL still in use is the Multiflex design, adapted from Charles Kelman’s lens. “The Kelman Multiflex design is the standard shape for all AC IOLs now,” he said.   But how has the safety progressed? “The findings suggest that no significant differences in outcome exist when comparing AC IOLs to sutured posterior chamber IOLs (PC IOLs) in complicated cataract extraction with poor capsular support,” said Dr Packard. “Recent advances in AC IOL design have yielded lenses that provide a safe, effective alternative to sutured PC IOLs,” he added.   “However, while scleral-fixated PC IOLs were associated with more intraoperative and postoperative complications than AC IOLs, corneal problems remain a risk with AC IOLs,” he said.   Thus endothelial cell counts should be performed and AC IOLs reserved for older patients with relatively good endothelial cell counts.