Posterior Chamber Intraocular Lens Implantation in the Absence of Capsular Support

To avoid the complications associated with anterior chamber intraocular lenses (IOLs), we have developed a technique for the implantation of a posterior chamber IOL in the absence of capsular support. The IOL is secured in the ciliary sulcus by suturing the haptics to the sclera at the ciliary sulcus inferiorly and to the sclera or iris superiorly. We have used this technique for secondary IOL implantation in 16 contact lens-intolerant patients with aphakia with a mean follow-up of 9 months (range, 5 to 20 months) and in eight eyes at the time of IOL removal. All eyes with secondary implants had equal or improved vision postoperatively; none developed persistent angiographic cystoid macular edema. In the 8 patients with IOL exchange, visual acuity improved in five eyes, remained the same in two, and decreased two lines in one. Suturing of an IOL in the ciliary sulcus has enabled us to use a posterior chamber IOL in eyes without a posterior capsule when secondary IOL implantation or IOL exchange is indicated. Secondary posterior chamber IOL implantation is recommended only when satisfactory vision cannot be achieved with glasses or contact lenses, and further follow-up is needed before this procedure can be widely recommended.