PubMed · 13030028
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A COWAN. 1953. Monocular aphakia.. https://pubmed.ncbi.nlm.nih.gov/13030028/
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The evolution of cataract surgery during the recent 2 centuries, and especially in the last 50 years, witnessed essential changes--from reclination of the lens and a traditional extracapsular cataract extraction to cataract microsurgery including phacoemulsification. A lack of the lens in the eye, i.e. aphakia, is considered to be a serious complication. The optic extraocular correction of aphakia is implemented mainly by the use of spectacles and contact lenses, which are not deprived of essential shortcomings. H. Ridley was the first to implant, in 1949, a polymethylmethacrylate (PMMA) intraocular lens (IOL). After that, anterior-chamber and iris-clips lenses as well as extrapupillary lenses with fixation to Sulcus cyliaris, which had by some complications, were offered. Only in 1973, we offered, for the first time in the world practice, an intracapsular implantation and intercapsular fixation of IOLs of various models. The designed intraocular correction of aphakia was checked by time and it is used now in cataract microsurgery, including small-incisions as well as ultrasound and laser phacoemulsification. The use of the lens bag as a natural bed for the fixation and isolation of IOL from intraocular structures is a priority direction in the Russian research ophthalmology.
INTRODUCTION: There are several surgical options available for the correction of aphakia. We investigated if retropupillary fixation of an iris claw lens is a method combining the advantages of posterior chamber implants with a new low-risk method of intervention. PATIENTS AND METHODS: An iris claw lens was implanted in 48 eyes in the plano-convex direction (model 205 Y). For the calculation of the IOL power we estimated an A-constant of 116.8. The lens was pushed via a 5-mm wide corneal incision vertically in the anterior chamber and was fixed in the retropupillary position after turning in the horizontal direction. After aspiration of the viscoelastica the corneal incision was closed by a 10-0 nylon suture. RESULTS: The implantation was successful in all patients. A visual improvement was noted in 27 patients (56.2%), an unchanged visual acuity was seen in 18 patients (37.5%) while 3 patients (6.2%) showed a loss of visual acuity. A cystoid macular edema was found by fluorescein angiography in two cases. Leakages in the area of the enclavation were not seen. SUMMARY: The retropupillary fixation of an iris claw lens seems to have the advantages of a true posterior chamber implantation with a low intra- and postoperative risk profile. The easy implantation process with this technique could replace the normally applied sclera suture fixed implantation of a posterior chamber lens as the method of choice.
The authors give an account on spontaneous reduction and absorption of cataracts in nine children. The initial symptom where leukocoria predominated was as a rule detected already in infant age. In one case the affection was bilateral and was manifested by partial pseudoaphakia. The observation comprised also classical secondary aphakia in a 4-year-old girl. Resorption of lenticular masses of cataracts into the shape of membranous discs or reduced masses of a fibrous character took on average 18 months on seven eyes and this process was associated with vascular activity in four lenses. In two of these patients during resorption panuveitis was observed with a hyperergic response in humoral and cellular immunity without obvious general antigenic action which caused atrophy of the optic nerve. Surgical solution of cataract was used in four eyes, PC IOL was implanted in one patient which had a favourable effect on visual function. Histological examination was successful of the extracted reduced lens only in one case. Inside the lenticular capsule was a mixture of the original fibrotically altered cataract masses with ingrowing vascular tissue.