Secondary IOL implantation without capsular support. A laser flare cell-meter study

Purpose: The cataract surgery consist in phacoemulsification of the lens and implant of an intraocular lens (IOL). In some cases when the capsular support is absent we must use an anterior-chamber IOL (ACIOL’s) or a posterior-chamber IOL (PCIOL’s) transclerally sutured. We studied the intraocular inflammation after secondary implant of iris-fixated ACIOL, angle-supported anterior-chamber (AC)IOL and transcleral-fixated PCIOL. Methods: We enrolled 60 patients with post-surgery aphakia, for a total of 60 eyes. Twenty patients received an ACIOL (Artisan), in twenty patients was implanted PCIOL. (PC 279Y) and in the last twenty patients was implanted an (AC)IOL. Twenty patients with PCIOL in the bag were used as control group. We performed an evaluation of anterior chamber cellularity with a laser flare-cell meter (Kowa 500) 30 and 90 days after secondary implants. Results: The anterior chamber flare-cell, after 30 days, was 15,442 ± 10,435 photon/ms in ACIOL group, 22,716 ± 6,634 photon/ms in PCIOL group and 14,11 ± 7,087 photon/ms in the (AC)IOL group. (ACIOL vs PCIOL p<0.004; PCIOL vs (AC)IOL p<0.001; ACIOL vs (AC)IOL p<0.376) After 90 days the flare was 10,937 ± 7,393 ACIOL group, 18,311 ± 6,033 in PCIOL group and 10,605 ± 3,959 in (AC)IOL group. (ACIOL vs PCIOL p<0.003; PCIOL vs (AC)IOL p<0.001; ACIOL vs (AC)IOL p<0.507). Conclusions: Our study shows chronic subclinical inflammation after 30 and 90 days from implantation of all IOL types but the flare is less in the ACIOL’s and (AC)IOL groups than in the PCIOL group. So we think that in without capsular support it is better to implant an anterior-chamber iris-fixated or an angle-supported anterior chamber IOL's .