Objective: To evaluate the effectiveness and safety of implantation of flexible open-loop anterior chamber intraocular lens (FOAC-IOLs) and scleral fixated posterior chamber intraocular lens (PC-IOLs).
Methods: Sixty-eight eyes of 68 patients with implanted intraocular lenses in the absence of posterior capsular support were reviewed retrospectively. According to the type of intraocular lens, patients were classified into two groups. In group I (30 eyes), FOAC-IOLs was implanted primarily or secondarily. In group II (38 eyes), scleral fixated PC-IOLs was implanted primarily or secondarily. By gonioscopy and ultrasound biomicroscopy (UBM), accurate positions of IOLs' haptics and the relationship between the haptics and surrounding tissues were observed postoperatively and used to evaluate the influence of the two types of IOLs on ocular anterior segments. Follow-up was 6 to 20 months.
Results: Best corrected visual acuity of 20/40 or better was achieved in 27 eyes (90.0%) in group I, and 35 eyes (92.1%) in group II and the difference was not statistically significant (P > 0.05). In group I, 23 eyes (76.7%) had a total of 40 complications, while 13 eyes (34.2%) had 19 complications in group II (P < 0.05). Gonioscopy and ultrasound biomicroscopy showed that in group I, all haptics of IOLs contacted with the iris completely and compressed the iris to different degrees, sometimes causing the anterior chamber angles to widen. Anterior synechia of the iris was caused by the haptics of FOAC-IOLs in 12 eyes. Among the 60 IOLs haptics, 39 foot plates of the haptics were properly fixed at the ciliary band; 21 haptics (12 eyes) penetrated through the iris into the stroma of the ciliary body with accompanying recurrent uveitis. In group II, among the 76 IOLs haptics, 52 were adequately fixed in the ciliary sulcus regions, and 8 (8 eyes) were placed below the iris, causing goniosynechia. This type of angle closure was localized, with an open angle on each side of the haptics. The remaining 16 haptics were fixed onto the ciliary crown.
Conclusions: The current sutured mode of scleral fixated PC-IOLs can not ensure that IOLs haptics are placed in the ciliary sulcus. The haptics of FOAC-IOLs compress the iris and may penetrate through the iris into the stroma of the ciliary body. This can cause peripheral iris anterior synechia and chronic recurrent uveitis. The implantation of scleral fixated PC-IOLs is safer and shows better effects than that of FOAC-IOLs.