Surgeons weigh pros, cons of fixated, anterior chamber IOLs
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CHICAGO — The benefits of fixated IOLs outweigh the benefits of anterior chamber IOLs due to the increased risk for glaucoma, intraocular inflammation and corneal decompensation seen with anterior chamber IOLs, a surgeon postulated here in a debate of the issue.
“We are comfortable with anterior chamber IOLs, and the surgery is simple and effective in our hands,” Jonathan L. Prenner, MD, said during a presentation at the Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology meeting. “But, there’s no debate. AC-IOLs are macroincisional, they cause glaucoma, [cystoid macular edema] and corneal decompensation. It’s because the lens is not in the right place.”
To avoid complications from AC-IOL placement, Prenner recommended techniques like sutureless scleral fixation and transconjunctival approaches.
“Modern ophthalmic surgery is predicated on microincisional approaches,” Prenner said. “If we all accept a bit of a learning curve, we and our patients will all benefit.”
On the other side of the debate, Richard S. Kaiser, MD, defended AC-IOLs as the safer technique.
“The modern open-loop Kelman-style AC-IOL actually deepens the anterior chamber,” he said. “There’s no accelerated endothelial cell loss associated with it, no [uveitis-glaucoma-hyphema] syndrome,” Kaiser said.
Kaiser reviewed literature on three alternative techniques when there is no capsular support: fixating the lens to the sclera, fixating the lens to the iris or placing the lens in the anterior chamber. The final visual results and the overall complications are similar in his findings.
“Serious complications, albeit rare, are more frequent with the scleral and iris fixated IOLs. Retinal detachment, hemorrhagic choroidal detachment, late onset IOL dislocation occur more frequently with the fixated lenses,” he said.
Disclosure: Prenner is a consultant for Alcon Laboratories, Genentech, Ophthotech, Panoptica and Regeneron and is equity owner of Ophthotech and Panoptica. Kaiser is a consultant for Ophthotech, Panoptica and Regeneron and is an equity owner of Ophthotech.