Causes of Secondary Intraocular Lens Implantation and Surgical Outcomes

Yıl 2019, Cilt: 21 Sayı: 2, 249 - 253, 31.08.2019

Tevfik Oğurel , Nesrin Büyüktortop Gökçınar , Yaprak Akbulut , Fatma Özkal Nurgül Örnek , Zafer Onaran

https://doi.org/10.24938/kutfd.591109

Öz

Objective: The
aim of this study is to determine preoperative ocular risk factors and
indications for secondary intraocular lens (IOL) implantation surgery and to
compare the visual outcomes of this procedure.

Material and Methods: Nineteen
patients who underwent secondary IOL implantation between January 2018 and
February 2019 at Kırıkkale University Faculty of Medicine were included in the
study. Preoperative causes of secondary IOL implantation, additional ocular
pathologies such as pseudoexfoliation (PEX), uveitis, trauma, systemic
syndromes, best corrected visual acuity (BCVA) before and after surgery,
surgical procedures and possible postoperative complications were noted
separately.

Results: Nineteen
eyes of 19 patients were included in this study. Eleven (57.9%) of the patients
were female and 8 (42.1%) were male. The mean age of all patients was 69.16 ±
6.92 (59-80) years. When the patients were evaluated preoperatively, the most
common cause was surgical aphakia secondary to intraoperative complications due
to primary surgery in 11 patients (52.6%). The second most common cause was IOL
subluxation in 6 patients. IOL implantation with iris or scleral fixation was
performed in patients who did not have sulcus support and the other IOLs were
inserted to the sulcus. Preoperative mean BCVA was 0.223 ± 0.187, and
postoperative mean BCVA was 0.702 ± 0.209. The difference between preoperative
and postoperative mean BCVA was statistically significant (p <0.001).

Conclusion: IOL
implantation in the sulcus is easier and the complication rate is lower than
the iris and scleral fixation IOL implantation methods. The results of iris
fixation or scleral fixation in cases without sulcus support are also
promising.

Anahtar Kelimeler

Secondary IOL implantation, cataract, IOL subluxation

SEKONDER GÖZ İÇİ LENS İMPLANTASYONU NEDENLERİ VE CERRAHİ SONUÇLARIMIZ

Öz

Amaç: Sekonder göz içi
lens (GİL) implantasyonu yapılan hastalarda, preoperatif oküler risk faktörlerini ve ikincil GİL cerrahisi
endikasyonlarını belirlemek ve bu işlemin görsel sonuçlarını karşılaştırmak
amacıyla yapılacaktır.

Gereç ve
Yöntemler: Kırıkkale Üniversitesi Tıp Fakültesi’nde, Ocak 2018 ve Şubat
2019 tarihleri arasında sekonder GİL implantasyonu yapılan ve postoperatif en
az 3 ay takibi olan 19 hasta çalışmaya dâhil edildi. Ameliyat öncesinde
hastaların sekonder GİL implantasyonu nedenleri; psödoeksfoliyasyon (PEKS),
üveit gibi ek oküler patolojiler, travma, sistemik sendromlar, ameliyat öncesi
ve sonrası düzeltilmiş en iyi görme keskinlikleri (DEGK), uygulanan cerrahi
yöntem ve olası postoperatif komplikasyonlar ayrı ayrı not edildi.

Bulgular: Çalışmaya 19
hastanın 19 gözü dahil edildi. Hastaların 11 (%57.9)’i kadın, 8 (%42.1)’i
erkekti. Tüm hastaların yaş ortalaması 69.16±6.92 (59-80) idi. Hastalar
operasyon öncesi değerlendirildiğinde, en sık neden, primer cerrahi sonrası
intraoperatif komplikasyonlara sekonder gelişen cerrahi afaki idi (%52.6,
n=11). İkinci en sık neden ise 6 hastada görülen GİL subluksasyonu idi. Sulkus
desteği olan hastalara sulkus yerleşimli GİL diğer hastalara ise, iris ya da
skleral fiksasyonlu GİL implantasyonu yapıldı. Hastaların cerrahi öncesi DEGK
0.223±0.187 iken cerrahi sonrası DEGK 0.702±0.209 idi. Ameliyat öncesi ve
sonrası görme düzeyleri değerlendirildiğinde aradaki fark istatistiksel olarak
ileri düzeyde anlamlıydı (p <0.001).

Sonuç: Sulkus
yerleşimli GİL implantasyonu, iris ve skleral fiksasyonlu GİL implantasyonu
yöntemlerine göre daha kolay ve komplikasyon oranı daha düşük bir yöntemdir.
Sulkus desteğinin olmadığı durumlarda iris fiksasyonu ya da skleral fiksasyon
yönteminin sonuçları da yüz güldürücüdür.

Anahtar Kelimeler

Sekonder GİL implantasyonu, katarakt, GİL subluksasyonu

Kaynakça

• 1. Elfiky M, Saad H, Elseht R, Selima A. Role of ultrasound biomicroscopy in the planning for secondary implantation of intraocular lens in aphakia. Int Ophthalmol. 2016;36(3):391-400.
• 2. Chan TCY, Lok JKH, Jhanji V, Wong VWY. Intraocular lens explantation in Chinese patients: different patters and different responses. Int Ophthalmol. 2015;35(5):679-84.
• 3. Jones JJ, Jones YJ, Jin GJC. Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol. 2014;157(1):154-62.
• 4. Jin GJC, Crandall AS, and Jones JJ. Intraocular lens exchange due to incorrect lens power. Ophthalmology. 2007;114(3):417-24.
• 5. Fernández-Buenga R, Alió JL, Pinilla-Cortés L, Barraquer RI. Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses. Graefes Arch Clin Exp Ophthalmol. 2013;251(9):2141-6.
• 6. Schulze S, Bertelmann T, Sekundo W. Implantation von Intraokularlinsen in den Sulcus ciliaris. Ophthalmology. 2014;111(4):305-9.
• 7. Chang SHL, Wu WC, Wu SC. Late-onset secondary pigmentary glaucoma following foldable intraocular lenses implantation in the ciliary sulcus: a long-term follow-up study. BMC Ophthalmol. 2013;13(1):22.
• 8. Friedman NJ, Khater TT, Koch DD. Secondary intraocular lens implantation. In (eds): Philadelphia, PA: Lippincott, Williams, & Wilkins, 2006.
• 9. Sorenson R, Scott IU, Tucker SH, Chinchilli VM, Papachristou GC. Practice patterns of cataract surgeons at academic medical centers for the management of inadequate capsule support for intracapsular or sulcus intraocular lens placement during cataract surgery. J Cataract Refract Surg. 2016;42(2):239-45.
• 10. Drolsum L. Long-term follow-up of secondary flexible, open-loop, anterior chamber intraocular lenses. J Cataract Refract Surg. 2003;29(3):498-503.
• 11. Lyle WA, Jin JC. Secondary intraocular lens implantation: anterior chamber vs posterior chamber lenses. Ophthalmic Surg. 1993;24(6):375-81.
• 12. Chen Y, Liu Q, Xue C, Huang Z, Chen Y. Three-year follow-up of secondary anterior iris fixation of an aphakic intraocular lens to correct aphakia. J Cataract Refract Surg. 2012;38(9):1595-601.
• 13. Rusu I, Chen Z, Zizva J, Myung JS, Wald KJ. Incidence of cystoid macular edema with iris-fixated posterior chamber intraocular lenses in patients presenting with lens dislocation. Int Ophthalmol. 2014;34(5):1153-8.
• 14. Rho S, Song WK, Sung Y, Kwon HJ, Lew H. Scleral fixation technique using a hydrophobic foldable intraocular lens with ring-shaped connecting bridges. J Cataract Refract Surg. 2015;41(2):262-7.
• 15. Ganekal S, Venkataratnam S, Dorairaj S, Jhanji V. Comparative evaluation of suture-assisted and fibrin glue-assisted scleral fixated intraocular lens implantation. J Refract Surg. 2012;28(4):249-52.
• 16. Kjeka O, Bohnstedt J, Meberg K, Seland JH. Implantation of scleral-fixated posterior chamber intraocular lenses in adults. Acta Ophthalmol. 2008;86(5):537-42.
• 17. Evereklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg. 2003;29(2):301-8.
• 18. Mimura T, Amano S, Sugiura T, Funatsu H, Yamagami S, Oshika T et al. 10-year follow-up study of secondary transscleral ciliary sulcus fixated posterior chamber intraocular lenses. Am J Ophthalmol. 2003;136(5):931-3.
• 19. Price MO, Price FW, Werner L, Berlie C, Mamalis N. Late dislocation of scleral-sutured posterior chamber intraocular lenses. J Cataract Refract Surg. 2005;31(7):1320-6.