EyeWorld India March 2015 Issue

32 EWAP CATARACT/IOL March 2015 by Lauren Lipuma EyeWorld Staff Writer Extracapsular IOL fixation: ACIOLs versus PCIOLs As presented at the “Cataract Dilemmas” symposium at the 2014 ASCRS•ASOA Symposium & Congress W hen conditions arise that require extracapsular IOL fixation, cataract surgeons have several options, but it can be difficult to determine which course of action will yield the best visual results for the individual patient. Richard S. Hoffman, MD , clinical associate professor, Casey Eye Institute, Oregon Health & Science University, Portland, Ore., discussed the merits and challenges of selecting anterior chamber lenses (ACIOLs) and fixated posterior chamber lenses (PCIOLs) for extracapsular IOL fixation at the “Cataract Dilemmas” symposium at the 2014 ASCRS•ASOA Symposium & Congress. Audience response questions, answers An audience response question during the symposium revealed that the majority of surgeons— about 58%—place the IOL in the anterior chamber when there is a lack of capsular support. About 33% of the respondents use a sutured or glued PCIOL, and about 9% close and refer the patient to a colleague. Of the surgeons who use PCIOLs, about 43% suture the IOL to the iris, about 49% suture the IOL to the sclera, and about 8% glue the IOL to the sclera. Implanting the IOL in the anterior chamber is the simplest approach, Dr. Hoffman said, so it makes sense that the majority of respondents use anterior chamber lenses. Because the glued IOL technique is a newer procedure and many surgeons feel confident with an ACIOL or sutured PCIOL, it is not surprising that only 8% continued on page 36 Audience members at the symposium were asked what technique they use if there is a lack of capsular support. Source: ASCRS of respondents who prefer PCIOLs use it. “Surgeons who have become very good at it feel that it’s easier than suturing in a posterior chamber lens, so that would be the main advantage,” he said. “Once you get over the learning curve, it’s probably faster and easier than using a scleral sutured posterior chamber lens.” The presentation In his presentation at the symposium, Dr. Hoffman discussed several scenarios that a cataract surgeon might run into that would require extracapsular IOL fixation, reviewed the various approaches that a surgeon can take, and offered pearls for each option. While anterior chamber lenses are the most popular, they do have several contraindications, such as peripheral synechiae, uncontrolled glaucoma, a shallow anterior chamber, and large iris defects, Dr. Hoffman said in his presentation. Although some surgeons do not place ACIOLs in eyes that have corneal endothelial dystrophy, it is still possible to perform endothelial keratoplasties in the presence of an anterior chamber lens, he said. Dr. Hoffman also discussed complications associated with