Eyeworld

EW CATARACT 43 U.S.; presumably those respondents are from outside the U.S. where it is the most popular lens for this purpose. Some of the benefits of place- ment of an AC IOL at the time of complicated cataract surgery are: • Relative simplicity of implantation • Stability • Most cataract surgeons have expe- rience from residency training and clinical practice already • Consignments of these lenses are common and readily offered by IOL manufacturers, though often contingent on use of their other IOLs Disadvantages include: • Potential for endothelial damage over time • Potential for glaucoma • Potential for UGH syndrome • Large incision required to implant with resultant astigmatism issues Opinions vary on the relative safety of AC IOLs, but these con- cerns have contributed to enthusi- asm for the development of transs- cleral fixation techniques that allow for sutureless implantation of a foldable posterior chamber three- piece IOL through a small incision. Presumably those respondents who defer implantation of an IOL until another day are planning on using one of these methods. These meth- ods may be performed as a second- ary IOL method or for IOL exchange and replacement, but there is no reason why this technique couldn't be performed at the time of com- plicated cataract surgery other than some very practical considerations. These issues will be considered in part 2 of this series. EW Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minnesota. He has no financial interests related to his comments. Contact information Gossman: n1149x@gmail.com Specific lenses used: Question four was, "For place- ment of the IOL in this complicated case, do you most commonly:" As you can see, the majority of polled cataract surgeons place an anterior chamber lens. However, a significant minority are prepared to place an IOL using a sutureless method or IOL sutured transsclerally or to the iris. The Ophtec Artisan lens is not FDA approved for im- plantation to correct aphakia in the Alcon MTA series of AC IOLs 38% Alcon MA60AC series of three-piece acrylic IOLs 19% Bausch + Lomb L122UV and S122UV AC IOLs 16% Bausch + Lomb LI61AO "SofPort" three-piece silicone 14% Ophtec Artisan 5% Aaren Scientific EC-3PAL "Aaris" three-piece acrylic 5% AMO ZA9003 three-piece acrylic 3% Anterior chamber IOL 57% Leave aphakic, plan on secondary IOL at a later date 13% Intrascleral haptic fixation (ISHF), glueless technique 11% Suture the IOL to the iris 7% Suture the IOL transsclerally 7%

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