Abstract
Introduction: Following vitreous loss during cataract surgery, a variety of lens options exist when the
intraocular lens cannot be placed in the capsular bag. Most surgeons however consider the flexible openloop
anterior chamber intraocular lens and the trans-sclerally sutured posterior chamber intraocular lens
to be the most acceptable alternatives. In our hospital we implant an anterior chamber intraocular lens
when faced with inadequate capsular support which usually occurs following a posterior capsule rupture
with vitreous loss. The risk of a poor visual outcome is greater with vitreous loss.
Objective: To review our experience with primary anterior chamber intraocular lens implantation in Jos.
Methods: Retrospective analysis of medical records of a consecutive series of primary anterior chamber
intraocular lens implantations carried out in the Jos University Teaching Hospital, Jos over a 5 year period
from January 2004 - December 2009. Eyes with complicated or traumatic cataracts, ocular co-morbidity
and cases of combined surgery were excluded from the analysis of visual outcome.
Results: There were 119 cases of primary anterior chamber intraocular lens implantations during the
study period. The case files of 100 eyes of 96 patients were available for review. Inadequate capsular
support following posterior capsule rupture was the commonest indication for implanting the anterior
chamber intraocular lens. Visual outcome was analysed in 76 eyes that met the inclusion criteria. Ninety
six percent had an unaided visual acuity of less than 6/60 at presentation. Postoperatively 45% had a best
corrected visual acuity of 6/18 or better, 40% <6/18 – 6/60 and 18% < 6/60. The commonest postoperative
complication was corneal oedema.
Conclusion: Our results indicate a less than satisfactory visual outcome with primary implantation of
anterior chamber intraocular lenses. Caution should be exercised when implanting an anterior chamber
intraocular lens following complicated cataract surgery, particularly in the absence of appropriate
vitrectomy equipment.
References
Kanski JJ. Clinical Ophthalmology: A systematic
approach. 3rd edition. Oxford: Butterworth-Heinemann;
Waddell KM, Reeves BC, Johnson GJ. A comparison
of anterior and posterior chamber lenses after cataract
extraction in rural Africa: a within patient randomized
trial. Br J Ophthalmol. 2004; 88:734-739.
Bergman M, Laatikainen L. Long-term evaluation of
primary anterior chamber intraocular lens implantation
in complicated cataract surgery. Int Ophthalmol. 1997;
: 295-299.
Collins JF, Gaster RN, Krol WF, et al. A comparison
of anterior chamber and posterior chamber intraocular
lenses after vitreous presentation during cataract
surgery: The Department of Veterans Affairs
Cooperative Cataract Study. Am. J. Ophthalmol. 2003;
:1-9.
Donaldson KE, Gorscak JJ, Budenz DL, et al. Anterior
chamber and sutured posterior chamber intraocular
lenses in eyes with poor capsular support. J Cataract
Refract Surg. 2005;31:903-909.
Raju NSD. Anterior chamber intraocular lens
implantation. Indian J Ophthalmol. 1989; 37(2):73-74.
Hannush SB. Sutured posterior chamber intraocular
lenses: indications and procedure. Curr Opin
Ophthalmol. 2000; 11(4):233-240.
Pojda SM, Herba E, Zatorska B, Pojda-Wilczek D,
Rycerska, A. The long term clinical outcome of
anterior chamber lenses after cataract surgery. Klin
Oczna. 2002; 104(2):99-103.
Ionides A, Minassian D, Tuft S. Visual outcome
following posterior capsule rupture during cataract
surgery. Br J Ophthalmol. 2001; 85:222-224.
Frost, N.A., Sparrow, J.M., Strong, N.P., Rosenthal,
A.R. Vitreous loss in planned extracapsular cataract
extraction does lead to a poorer visual outcome. Eye.
; 9:446-451.
Jacobs PM. Vitreous loss during cataract surgery:
prevention and optimal management. Eye. 2008;
:1286-1289.
Blomquist PH, Rugwani RM. Visual outcomes after
vitreous loss during cataract surgery performed by
residents. J Cataract Refract Surg. 2002; 28:847-852.
Chan FM, Mathur R, Ku JJK, et al. Short-term
outcomes in eyes with posterior capsule rupture
during cataract surgery. J Cataract Refract Surg.
; 29:537-541.
Shah NA, Adrianwala SD, Gondhalekar NA. Intraocular
lens implantation after vitreous loss.
J Postgrad Med. 1991; 37:205-208.
Fasih U, Ahmed I, Shaikh A, Fahmi MS. Comparison
of complications after primary and secondary
anterior chamber intraocular lens implantation. Pak J
Ophthalmol. 2010; 26(2):57-64.
Pearson PA, Owen DG, Maliszewski M, Smith TJ.
Anterior chamber lens implantation after vitreous
loss. Br J Ophthalmol. 1989; 73:596-599.
Rattigan, SM, Ellerton, CR, Chitkara, DK, Smerdon,
DL. Flexible open-loop anterior chamber intraocular
lens implantation after posterior capsule
complications in extracapsular cataract extraction.
J Cataract Refract Surg. 1996; 22(2):243-246.
Kwong, YYY, Yuen, HKL, Lam, RF. et al. Comparison
of outcomes of primary scleral-fixated versus primary
anterior chamber intraocular lens implantation in
complicated cataract surgeries. Ophthalmology.
;114(1): 80-85.
Alhassan, MB, Rabiu, MM, Ologunsua, YO. Longterm
complications of extracapsular cataract extraction
with posterior chamber intraocular lens implantation
in Nigeria. Int Ophthalmol. 2004; 25(1):27-31.
Cook NJ. Evaluation of high volume extracapsular
cataract extraction with posterior chamber lens
implantation in Sierra Leone, West Africa. Br J
Ophthalmol. 1996; 80:698-670.
Yorston D, Foster A. Audit of extracapsular cataract
extraction and posterior chamber lens implantation
as a routine treatment for age related cataract in east
Africa. Br J Ophthalmol. 1999; 83: 897-901.