Glued IOLs in Complicated Situations
To evaluate the results and complications of Glued IOLs in eyes with subluxated or dislocated cataracts or IOLs or with deficient/ absent capsular support along with associated ocular pathologies.
In this study, 250 eyes underwent glued IOL implantation for various indications including traumatic subluxated cataracts, subluxated/ dislocated IOLs, and aphakia with absent posterior capsule. An IOL was placed in the eye and the haptics brought out through a sclerotomy created under scleral flaps made 180 degrees away from each other. The IOL haptics were tucked into a scleral pocket to prevent any side-wards or up-down movement. This was re-enforced with fibrin glue, scleral flaps repositioned and conjunctiva closed with the same glue. In addition, associated complications such as secondary glaucoma, corneal decompensation, corneal scars etc were treated with trabeculectomy or valve implantation and penetrating keratoplasty or DSEK as required.
BCVA at 6 weeks of surgery was ≥ 6/12 in 180 of the 250 eyes. Surgical time was reduced and sutures were eliminated. IOP was controlled with medical management when possible but trabs and valves were used in 24 eyes while PK and DSEK were performed in 15 eyes in the same sitting. Transient hypotony was seen in 15 eyes which recovered after 1 week. Vitreous hemorrhage which resolved within 2 weeks occurred in 26 eyes. Two cases of haptic exposure was seen which was replaced in an alternative scleral tunnel under the scleral flap. One patient had an expulsive haemorrhage which was surgically drained. Till last follow up all patients had a stable IOL.
Fixating a posterior chamber IOL using Fibrin Glue is a viable option in patients with deficient capsular support. After an initial learning curve, excellent results are obtained in terms of IOL stability and centration, reduced incidence of CME, elimination of sutures and lesser surgical time. With greater experience this procedure maybe combined with additional surgeries as required to improve surgical and visual outcomes.