Clinical Analysis Of Suturing Posterior Chamber Intraocular Lens Implantation

Traumatic cataract and failure modern ECCE always induce wide-ranging posterior lens capsule disrupt and ligamentum suspensorium break which making posterior chamber artificial lens can not be implanted normally , but PC suture-fixated IOL implanting can solve this problem through polypropylene sutures effectively .We have suture-fixated PC IOL 18 patients(19eyes) from 2001.10 to 2007.4 , including Men 17(18eyes) and women 1(1eyes) , from 7 to 73 years old . Traumatic cataract was 15 eyes and age-related cataract was 2 eyes and congenital cataract was 2 eyes . Preoperative best corrected visual acuity : numerus digitorum was 1 eye ; 0.02-0.1 was 3 eyes ; 0.2-0.5 was 10 eyes ; 0.6-0.8 was 5 eyes . 10 eyes combined cornea trauma ; 8 eyes ware shallow anterior chamber ; 4 eyes had iris segmental defect . Different degree posterior lens capsule disruption existed in the 14 aphakic eyes . 3 IOL eyes were dislocated and 1 eye was unsuitable . 1 eye was traumatic cataract which crystalline lens had dislocated .2 triangular 1/2-2/3 thickness scleral flaps which based on the corneoscleral limbus were created at the 8,2 or 10,4 o'clock positions . Incision implanting IOL was maken at 12 o'clock . The straight long needle linking polypropylene suture was pricked into sclera behind limbus 1.5mm under the flap , then it was placed horizon when it appeared in the pupil . An inject needle was inserted under another flap in the same way . Put the long needle into the inject needle then drew back inject needle together with the straight needle . Suture was pulled out from incision then was shearinged and fixed to the IOL lens hapticholes . The IOL was placed in the posterior chamber , then a bite of sclera under the flap was taken , and the suture was tied to itself . In our cases , 2eyes were fixed one point and 17eyes were fixed two point due to the condition of the posterior lens capsule .The postoperative best corrected visual acuity is 0.8 . 0.02-0.1 is 1 eye ; 0.2-0.5 is 13 eyes ; 0.6-0.8 is 5 eyes . 9 eyes postoperative acuity are better than preoperative acuity and 8 eyes are equal and 2 eyes are worse . Postoperative complications : (1)Reactive iriditis : Incidence rate is 100% in this group . All cases iriditis are controlled effectively within 1 week by corticosteroid and mydriasis . This is because of multiplicity operating procedure and suture injuring . (2)Vitreous opacification : Incidence rate is 21.1% . Treatment is haemostasis and anti-inflammatory earlier , enhance blood absorption later . The blood and exudation are absorped completely 3 months later . Suturing can injury ciliary body which contains blood vessel and pigments abundantly resulting in hemorrhage and inflammatory exudates infiltrating into vitreous . Precise pricking point should be at 2 and 8 o'clock or 10 and 4 o' clock behind limbus 1.5mm otherwise will occur serious hemorrhage . (3)IOL tilt and dislocate : 10.5% cases happen . The reason of IOL tilt isâ‘ The strength and the position of two sides suture is dissymmetry .â‘¡Fiber and vitreous behind iris exert IOL unsymmetrically .â‘¢Ciliary groove can not fix IOL loop effectively . Right fix position and sufficient vitreotomy and synechiolysis can prevent IOL tilt . The reason of IOL dislocate isâ‘ The suture break while the fibrous tissue around loop can not hold it effectively .â‘¡Knot slip out the loop when overrotate IOL which is not suturing IOL .â‘¢Knot shed from sclera . Biting more sclera or 4 point suture can prevent . (4)Secondary glaucoma :Incidence rate is 5.3% . Postoperative hypertension may be attributed to the preoperative pathogenetic condition , glaucoma history , CTS using and postoperative hyphema and inflammation exudation membrane . (5) Hypotension : 26.3 % cases happen . This complication is because of vitreous lost too much during operation and inflammatory damage ciliary body induce aqua oculi secreteion decrease or intraocular fluid drain out from the pinpoint . (6)CME and RD : 15.8% cases happen CME ; no cases happen RD . Vitrea drag and preoperative trauma concussion of retina and postoperative hypotension promote CME occurrence . (7)Corneal edema : In our group this complication rate is 31.6% . It may be stem from long operative time combine with BSS continue infusing and secondary glaucoma and inflammatory reaction . All Corneal edema cases have relieved by corresponding treatment . Knot exposure and endophthalmitis are not occur in our cases .In conclusion , suturing IOL is a effective and feasible method in aphakia with insufficient capsular support , especially associated with combined anterior injury . While , this operation is still a elective method according to the high complication rate . How to diminish complication and seek a more permanent suture material is still a problem which need to be solved in the past time .