gms | German Medical Science

To avoid anterior chamber lens implantation in aphakic eyes without capsular or zonular support, the laborious scleral fixation of a standard posterior chamber IOL is widely used despite potential complications (macular edema, IOL tilt / decentration, suture erosion, vitreous hemorrhage). A sutureless iris-fixed ciliary sulcus implantation of a posterior chamber IOL (Binder-IOL, Fa. Iolution, Munich) designed especially for such cases represents an alternative.

At the end of both haptics of this IOL with a 6 mm optic zone, a T-shaped anchor is mounted at an angle of 45° from the optic plane. These anchors are inserted from behind the iris into peripheral iridotomies performed pre-op. with a YAG-laser or intra-op. with a vitrectomy cutter. The long, C-shaped haptics are thus secured in the ciliary sulcus.

After slight modification of the technique, the implantation can be performed securely and reproducible. In all 8 implantations performed up to now, the IOL was well centered and stable. A hyperemia of the iris vessels around the haptic anchor was noticed in the early pre-operative course. Later post-operatively, the iridotomies enlarged slightly. No further side effects have been observed.

Iris fixation of posterior chamber IOLs reveals less complications compared to scleral fixation. The methods of iris fixation so far (suture fixation or enclavation of an inversely implanted "phakic" lens) comes along with a marked anterior-posterior mobility of the IOL due to the loosened iris diaphragm in aphakic eyes. This complication has not been observed with the technique presented here. The required large incision still represents a disadvantage, however, a foldable type of this lens is currently developed.