Expert gives pearls for secondary IOL implantation in aphakic eyes
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NEW YORK – Certain IOLs are better suited to sutured or sutureless secondary IOL implantation techniques in aphakic eyes, according to a presenter at OSN New York Retina.
Anton Orlin, MD, said that while anterior chamber IOLs can be very effective, they can lead to some complications, including corneal decompensation and iritis, particularly in patients with a history of anterior segment disease.
Scleral fixated IOLs are preferred to anterior chamber IOLs in certain patients with sutured IOL and sutureless flanged IOL techniques gaining in popularity, according to Orlin.
“Ultimately, the surgical technique depends on various patient factors, such as age and anatomic consideration, in addition to surgeon preference.” Orlin said.
For the sutured scleral fixation technique using CV 8 Gore-Tex sutures, Orlin uses the Akreos AO60 (Bausch + Lomb), which he said is technically feasible, relatively safe and provides good vision outcomes. He said the lens can easily be folded and inserted through a small incision, and its four eyelets provide stable, four-point fixation resulting in less tilt or risk for dislocation.
However, due to potential for lens opacification, he cautioned against using the lens in patients who are at risk for multiple surgeries or future tamponade.
Another option for Gore-Tex suture is the enVista MX60 (Bausch + Lomb), Orlin said. Since the lens is hydrophobic, there is no risk for opacification, and although it only has two eyelets, it still provides pseudo four-point fixation.
Sutureless IOL scleral fixation can help avoid risk for suture erosion or slippage and can be used to implant three-piece IOLs, like the CT Lucia 602 (Zeiss).
Orlin said he likes this particular lens because it is hydrophobic and has polyvinylidene fluoride haptics, making it malleable and less susceptible to breaking during surgery.
“There are many techniques to place an IOL,” Orlin said. “None are perfect. They all have their advantages and disadvantages. It’s really surgeon and patient dependent.”
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Orlin A. Aphakia secondary IOL placement. Presented at: OSN New York and OSN New York Retina; Oct. 15-17, 2021; New York.
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