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PUBLICATION EXCLUSIVE: Through the years of fixating IOLs in challenging cases

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In the 1980s as the director of the Cornea Service at the University of Minnesota, I was referred several hundred patients with closed-loop anterior chamber IOLs, usually so-called Leiske anterior chamber lenses originally manufactured by Surgidev, with significant complications. The typical patient would present with pseudophakic bullous keratopathy. Most of these eyes had undergone intracapsular cataract extraction, so there was no capsular support. Often there was associated peripheral anterior synechiae, cystoid macular edema and, in many cases, secondary glaucoma. The surgery to rehabilitate these eyes in those days involved penetrating keratoplasty combined with IOL exchange. After dissecting out the closed-loop IOL and performing subtotal anterior vitrectomy and in many cases a suture iridoplasty, I was uncomfortable placing another anterior chamber IOL.

Working with several fellows, including Steve Lane, MD, S. Gregory Smith, MD, Thomas Lindquist, MD, PhD, and Richard Duffey, MD, we developed an effective method using ab interno methods to scleral fixate a one-piece or three-piece posterior chamber IOL to the sclera under a scleral and conjunctival flap. With Alcon, we designed the all-PMMA CZ70BD posterior chamber IOL with a 7-mm optic, and with Storz, the P366B one-piece all-PMMA posterior chamber IOL with a 6.5-mm optic. These IOLs had a fixation hole in the haptic, which for me made the surgery easier. I started with 10-0 polypropylene suture and was very happy with my outcomes.

Unfortunately, I was surprised 10 to 15 years later when some of these patients presented with a broken suture. Biodegradation or perhaps chafing on the hole in the haptic were potential causes of the broken sutures. The ones where I could see the area of suture failure suggested the most likely cause was biodegradation. Most of the time I was able to fix these by suturing the subluxated haptic to the iris, and I learned to suture both sides to avoid a second subluxation a few years later if the other suture failed.

• Click here to read the full publication exclusive, Lindstrom's Perspective, published in Ocular Surgery News U.S. Edition, January 25, 2016.