Abstract

FR.14.06

Implantation of a retropupillary sutureless fixated Artisan IOL by corneal / corneoscleral tunnel incision – an alternative method for correction of aphakia in eyes without capsular support.

Angela Hahn1, Nina Niederdräing1, Klaus Schmitz2, Norbert Bornfeld1, Klaus-Peter Steuhl1, Daniel Meller1
1Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 2Universitäts-Augenklinik Düsseldorf

Objective
There are different methods available for correction of aphakia, such as anterior chamber intraocular lens implantation or scleral fixation of posterior chamber intraocular lens. But these techniques bare risks by position of haptics or difficulty of the surgical technique. Aim of the study was to evaluate the surgical technique of sutureless retropupillary implantation of an Artisan-IOL by corneal/corneoscleral tunnel incision for correction of aphakia in eyes without capsular support and its safety and efficacy.
Methods
Retrospective study of 12 patients who had undergone secondary implantation of retropupillary sutureless fixated Artisan IOL by corneal/corneoscleral tunnel incision (2006-2008). Examination was done according to best corrected visual acuity, intraocular pressure, pigment dispersion, lens position, endothelial cell loss and existence of macular oedema. Follow up was 6 months. Patients with (sub)luxation of the lens/IOL in the Vitreous were included. Prior surgery or trauma were the reasons for the (sub)luxation. The implatation of the Artisan-IOL was done as one step procedure (n=8) or as two step procedure (n=4).
Results
Best corrected visual acuity varied from 0.1 to 0.5. In 72% of the cases visual acuity improved (average of 2.4 lines), in 25% visual acuity remained unchanged, and one person showed a decreased visual acuity postoperatively. Complications were a peaked pupil (n=7), high intraocular pressure during first postoperative day (n=1) and high astigmatism (n=1). Two patients showed a dislocation of the Artisan-IOL and refixation was necessary. Atrophy of the iris (n=2) and lentodonesis (n=1) were also noted. No patient showed a macular oedema, an endothelial cell loss or pigment dispersion.
Conclusions
Retropupillary sutureless fixated Artisan IOL implantation by corneal/corneoscleral tunnel incision is an alternative method for correction of aphakia in eyes without capsular support. Further long term investigations are required to estimate the risks of endothelial cell loss, macular oedema and glaucoma by irritation of vascularized iris.

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