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PC IOLs require exchange before AC IOLs, study finds

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A longitudinal study found that anterior chamber IOLs last twice as long as posterior chamber IOLs before necessitating exchange.

Vitreous prolapse was the most common intraoperative complication among both implantation sites, requiring anterior vitrectomy or dry vitrectomy in all cases, the authors noted.

Frederico F. Marques, MD, of Complexo Hospitalar Padre Bento de Guarulhos in Brazil, and colleagues reviewed outcomes for 49 eyes of 49 adult patients who underwent IOL exchange between 1986 and 2002. Fifteen eyes of 15 patients were originally implanted with anterior chamber (AC) IOLs, while 34 eyes of 34 patients had posterior chamber (PC) IOLs.

The mean interval between the first surgery and lens exchange was 83.2 months in the AC IOL group and 37.9 months in the PC IOL group. For AC IOLs, the main reason for exchange was inflammation from uveitis-glaucoma-hyphema syndrome or persistent iritis. In contrast, PC IOLs were more likely to become decentered or dislocated, according to the study.

"Symptoms related to malposition and incorrect IOL power necessitate surgical intervention sooner than signs and symptoms resulting from chronic inflammation," the authors said.

After the exchange, best corrected visual acuity in the AC IOL group improved in nine eyes (60%), was stable in four eyes (27%) and worsened in two eyes (13%). The authors cited adherent fixation of the haptics in the angle as the "major operative challenge," requiring haptic cutting or fracturing in five eyes (33.3%).

Postop BCVA in the PC IOL group improved in 17 eyes (50%), was stable in 11 eyes (32%) and worsened in six eyes (18%). In these eyes, the primary operative challenge was reopening the capsular bag, the authors said. If the bag could not be reopened, surgeons performed a sulcus or anterior chamber implantation.

"The choice of the IOL model to be implanted will depend on the conditions of the anterior segment. If there is capsule support, a PC IOL should always be the first choice," the authors said. "The surgeon may choose an AC IOL (angle supported or iris supported) recommended for patients with an AC depth greater than 3 mm and healthy iris tissue, or a PC IOL sutured at the scleral wall or iris tissue."

The study is published in the February issue of the Journal of Cataract & Refractive Surgery.