Lens Implantation

I History.- I. Posterior Chamber Lenses.- II. Anterior Chamber Lenses.- III. Toward the Modern Implant Lenses.- II The Classic Modern Lens.- I. Design and Fixating Principles of the Classic Lens Models.- A. Iris Supported Lenses.- B. Iridocapsular and Capsular Supported Lenses.- C. Angle Supported Lenses.- II. General Nomenclature.- III Materials, Manufacture, and Sterilization.- x 1 Basic Materials.- I. Plastics for Intraocular Use.- A. Polymethylmethacrylate.- 1. Synthesis of the Monomer.- 2. Polymerization.- B. Polyamides or Nylons.- 1. Nylon 6.- 2. Nylon 6/6.- 3. Properties of Polyamides.- 4. Nylon Degradation in vivo.- C. Polypropylene.- II. The Metals.- A. Platinum.- B. Titanium.- C. Stainless steel.- x 2 Manufacture.- A. Rayner.- B. Mocher.- x3 Sterilization.- IV The Optics of Intraocular Lenses.- I. The Optical Quality of Polymethylmethacrylate Lenses.- II. The Dioptric Power of Human Crystallin.- III. The Pseudophakos as a Substitute for the Crystalline Lens.- IV. Determination of Implant Lens Power.- A. The 1.25 Diopter Rule.- B. Calculating the Lens Power from Biometrie Data.- V. Determination of the Iseikonic Lens Power.- VI. Practical Considerations on the Proper Selection of the Implant Power.- V Pre-, Per-, and Postoperative Management.- I. Preoperative Management.- A. Clean and Aseptic Surgery.- B. The Pupil.- C. General or Local Anesthesia.- D. Visibility.- E. Preparation of the Lens.- F. Obtaining a "Soft" Eye.- 1. Diuretics and Osmotic Agents.- 2. Ocular Massage.- 3. Separation of the Eyelids.- 4. Scleral Ring.- 5. Pars Plana Vitreous Tap-Vitrectomy.- 6. Anesthesia: Local and General.- II. Peroperative Management.- A. Incision.- B. Cataract Extraction.- 1. Intracapsular Cataract Extraction.- 2. Extracapsular Cataract Extraction.- a. Step I: Capsulotomy-Capsulectomy.- b. Step II: Removal of the Nucleus.- c. Step III: Evacuation of Cortical Remnants.- C. Common Points in Lens Implantation.- 1. After Intracapsular Cataract Extraction.- 2. After Extracapsular Cataract Extraction.- 3. Glides and Sleeves.- 4. Pupil Constriction.- 5. Iridectomies.- 6. Finishing Touches.- D. Wound Closure and Astigmatism.- III. Postoperative Management.- A. Postoperative Care.- B. Postoperative Complications.- 1. Shallow and Flat Anterior Chamber.- 2. Subluxation and Luxation.- 3. Decentration.- 4. Secondary Procedures for Lens Remnants.- 5. Incision of the Posterior Capsule and Secondary Membranes.- 6. Lens Removal.- IV. Stabilization of Implants by Sutures.- 1. Alpar's Approach.- 2. Simcoe's Approach.- 3. McCannel-Binkhorst Suture.- 4. The Strampelli Thread.- VI The Iris Supported Lenses.- x1 The Iris Clip Lens.- I. Introduction to the Lens and Its Evolution.- A. Binkhorst's Design Changes.- B. Binkhorst's Changes in Loop Orientation and Additional Fixation Aids.- C. Modifications of the Iris Clip Lens by Other Surgeons.- II. Implantation Techniques.- A. Binkhorst's Technique.- 1. Vertical Positioning of the Lens.- 2. Transiridectomy Suturing.- B. Other Techniques.- 1. The "Closed Chamber" Technique.- 2. Horizontal Positioning of the Lens.- 3. Modified Suturing Techniques.- III. Twenty Years of Experience with the Iris Clip Lens: 1958-1978.- A. The Developmental Period: Binkhorst's Experience, 1958-1971.- 1. Secondary Implantations: Binkhorst's First 70 Cases.- 2. Primary Implantations by Binkhorst from 1961 to 1971.- a. The First Primary Implantations of Iris Clip Lenses.- b. The Survey of J. Pearce.- c. Nordlohne's Survey of Binkhorst's Patients.- 3. Discussion and Conclusions about Binkhorst's Use of Iris Clip Lenses after ICCE during the Developmental Period.- a. The Materials Used.- b. Tissue Reaction.- c. Secondary Membranes.- d. Glaucoma.- e. Cystoid Macular Edema.- f. Retinal Detachment.- g. Hemorrhage.- h. Dislocation and Endothelial Corneal Dystrophy.- 1) The Problem of Dislocation.- - Types of Dislocation.- - Dislocation Prevention.- 2) The Problem of Endothelial Corneal Dystrophy.- - Analysis of Factors Contributing to ECD.- - Endothelial Corneal Dystrophy Prevention.- 4. Other Reports on the Iris Clip Lens after ICCE during the Developmental Period.- a. Results of Different Surgeons in 321 Cases.- b. Nordlohne's Survey of 485 Iris Clip Lenses Implantations by J. Worst.- 5. Conclusions for the Developmental Period.- B. The Current Situation: Recent Data on the Use of the Iris Clip Lens after Intracapsular Cataract Extraction.- 1. The Data Published by J. Draeger, K. Schott, and N.S. Jaffe.- 2. Conclusion.- x2 The Copeland Lens.- I. Introduction.- II. Implantation Techniques.- A. The Open-Sky Technique.- B. The Formed Chamber Technique.- III. Survey of the Early Results.- A. Jaffe's Series.- B. The Miami Series.- IV. Recent Studies.- A. Osher's Study.- B. Other Studies on the Copeland Lens.- 1. Snider's and Taylor's Series: 595 Cases.- 2. Benjamin's. Sherman's, and Gentri's Series: 101 Cases 209 V. Conclusions.- x3 Medallion Lens.- I. Introduction.- II. Implantation Techniques.- A. The Medallion Lens.- B. The Slotted Medallion Lens.- III. Development of the Medallion Lens.- A. Worst's Early Results.- B. The Developmental Period.- 1. Introduction.- 2. Worst's Modifications of the Medallion Lens.- a. The Medallion Platinum Clip Lens.- b. The Single Loop Medallion Lens.- 3. Other Lens Designs by Worst.- IV. The Current Situation: The Data Published by R. Drews, M.C. Kraff, and H. Lieberman.- V. Conclusion.- x4 The Sputnik Lens.- I. Introduction.- II. Implantation Techniques.- A. The Open-Sky Technique.- B. The Formed Chamber Technique.- III. Results.- A. Fyodorov's Series.- B. Galin's Series.- C. Kwitko's Series.- IV. Conclusion.- x5 Other Lens Designs.- I. The Krasnov Extrapupillary Iris Lens.- II. The Sachar Lens.- III. The Boberg-Ans Lens.- IV. The Rainin Anchor Lens.- V. A Soft Iris Supported Lens.- VI. The Glass Intraocular Lens.- VII. The Anis Lens.- VIII. The Iris Claw Lens.- IX. The Severin Lenses.- General Conclusion on Iris Supported Lenses.- VII Iridocapsular and Capsular Supported Lenses.- I. Advantages of Lens Implantation after Extracapsular Cataract Extraction.- A. Practical Considerations.- B. Clinical Observations.- C. Theoretical Considerations: The Barrier Deprivation Syndr..- II. The Mechanism of Capsular Fixation.- III. Lens Styles Used after Extracapsular Cataract Extraction.- x 1 Iridocapsular Lenses.- I. The Binkhorst Two-Loop Lens.- A. Binkhorst's Technique.- 1. Preliminary Steps.- 2. Implantation Technique.- 3. Postoperative Measures.- 4. Modifications of Binkhorst's Technique.- B. Binkhorst's Results.- C. Results of the Authors.- D. Results from Other Surgeons.- II. The Platinum Clip Lens.- A. Surgical Technique.- B. Results.- C. Modifications of the Platinum Clip Lens.- III. Other Iridocapsular lenses.- A. The Small Incision Lenses.- B. The Medallion Cloverleaf Lens.- C. The Medallion Slotted Boomerang Lens.- x2 Posterior Chamber Lenses.- I. The Pearce Posterior Chamber Lens.- A. Pearce's Surgical Technique.- B. Pearce's Results.- II. Other Posterior Chamber Lenses.- A. The Iridocapsular Lens as a Posterior Chamber Lens.- B. The Little-Arnott Lens.- C. The Harris Lens.- D. The Coleman-Taylor Lens.- E. The Anis Lens.- F. The Ong Capsular Lens.- G. The Sheets Lens.- III. The Shearing Lens.- A. Shearing's Surgical Technique.- B. Shearing's Results.- C. Results Obtained by Other Surgeons.- D. Modifications of the Shearing Lens.- Conclusion.- VIII Angle Supported Lenses.- I. Secondary Implantation.- A. The Developmental Period: Choyce Mark I - Choyce Mark VII.- 1. Mark I: The First 100 Cases.- 2. Modifications of the Mark I Lens.- 3. The Mark VI and Mark VII Lenses.- B. Fifteen Years of Experience with the Choyce Mark VIII Lens (1963-1978).- 1. Results and Complications with the Mark VIII: Choyce's Series.- 2. Evaluation by J. Pearce.- 3. Conclusion.- C. Secondary Implantations of the Choyce Mark VIII by Other Surgeons.- II. Primary Implantation.- A. Primary Implantation of the Choyce Mark VIII Lens by D.P. Choyce.- B. Growing Interest in Primary Implantation of the Choyce Mark VIII Lens.- C. Data on Primary Implantation of the Choyce Mark VIII Lens by Other Surgeons.- III. The Principal Problems with the Choyce Mark VIII Lens as Reported between 1976 and 1978.- A. Clinical Findings Concerning the UGH Syndrome.- B. Treatment of the UGH Syndrome.- C. Etiology of the UGH Syndrome.- 1. The Lens.- a. Warpage.- b. Improper Finishing.- c. Materials and Sterilization.- 2. Poor Surgical Judgment and Poor Surgical Technique.- IV. The Choyce Mark IX Lens.- A. Limitations of the Mark VIII Lens.- B. Description of the Mark IX Lens.- C. Advantages of the Mark IX over the Mark VIII Lens.- V. Surgical Technique.- A. Choyce's Method of Secondary Implantation.- B. Choyce's Method of Primary Implantation.- C. Additional Guidelines on the Proper Technical Management of Angle Supported Lenses.- 1. Lens Inspection.- 2. Determination of the Lens Length.- a. Preoperative Estimation of the Length.- b. Peroperative Estimation of the Lens Length.- c. Postoperative Controls.- 3. Remarks on the Incision.- 4. Remarks on the Insertion Technique.- 5. Vitreous Loss.- 6. Prevention of Iris Bulge and Pupillary Block.- 7. The Sore Eye Syndrome.- VI. Summary and Conclusions.- VII. New Lens Designs.- A. The Azar Pyramid Mark III Lens.- B. The Kelman Anterior Chamber Lens.- C. The Tennant Anchor Lens.- D. The Leiske Angle Supported Lens.- IX Mixed Results and Comparative Studies.- I. Results Obtained with Various Lens Types by the Same Surgeon or Surgical Team.- 1. J.C. Worst et al.- 2. H. Hirschman.- 3. N.S. Jaffe.- 4. D.D. Shepard.- 5. N.L. Snider and W.U. McReynolds.- 6. R. Kratz et al.- II. Intracapsular Cataract Extraction and Lens Implantation versus Extracasular Cataract Extraction and Lens Implantation.- 1. J.G.C. Renardel de Lavalette.- 2. R. Kern.- III. Pseudophakia versus Aphakia.- 1. N.S. Jaffe et al.- 2. B.S. Prokop.- 3. D.E. Williamson.- 4. R.F. Azar.- 5. W.J. Stark et al..- 6. M.A. Galin.- 7. D.M. Taylor et al..- X Secondary Lens Implantation.- I. Incidence.- II. Secondary Implantation of Iris and Iridocapsular Supported Lenses.- A. Indications.- B. Binkhorst's Fixation Modalities for Secondary Implantation.- III. Secondary Implantation of Angle Supported Lenses.- A. Indications.- B. Results.- IV. Secondary Lens Implantation Series of Various Lens Types.- A. Hardenberg's Study.- B. Shammas's and Milkie's Study.- Conclusion.- XI Lens Implantation in Children Traumatic and Infantile Cataracts.- I. Early Reports.- A. Traumatic and Infantile Cataracts: D.P. Choyce.- 1. Traumatic Cataract.- 2. Congenital Cataract.- B. Traumatic and Infantile Cataracts: CD. Binkhorst.- 1. Traumatic Cataracts.- a. Measures for the Prevention of Amblyopia and the Loss of Binocular Vision.- b. Some Technical Considerations.- 2. Congenital Cataract.- II. Later Reports.- A. Binkhorst's Latest Data on Traumatic Cataracts in Children.- 1. Functional Results.- 2. Complications.- 3. Remarks on General Management.- B. Reports by Other Surgeons.- 1. A.T.M. Van Balen's Report on 37 Traumatic Cataracts in Children.- a. Functional Results.- b. Implant Fixation and Postoperative Problems.- 2. D.A. Hiles's Report on 37 Traumatic Cataracts in Children.- a. Functional Results.- b. Some Remarks on the Technique and Postoperative Problems.- 3. Hiles's Survey of Lens Implantation in Children, 1978.- a. Traumatic Cataracts.- (1) Functional Results.- (2) Complications.- b. Infantile Cataracts.- (1) Functional Results.- (2) Complications.- Conclusions on Implantation in Children.- XII Lens Implantation and the Endothelium.- I. Postoperative Corneal Behavior as Evaluated by Pachometry and Specular Microscopy.- A. Pachometric Studies.- B. Studies with the Specular Microscope.- 1. Prospective Studies.- a. Cataract Extraction without Lens Implantation.- b. Cataract Extraction with Lens Implantation.- 2. Retrospective Studies.- a. Pseudophakic versus a Phakic Fellow Eye.- b. Pseudophakic versus an Aphakic Fellow Eye.- c. Pseudophakie versus a Pseudophakie Fellow Eye.- II. Endothelial Damage: Promoting Factors, Prevention, and Treatment.- A. Mechanical Damage.- 1. Folding the Cornea.- 2. Instrumental Touch.- 3. Damage by the Implant.- a. Damage during Surgery.- b. Damage after Surgery.- Shallow or Flat Anterior Chamber.- Decentration.- Lens Instability, Subluxation, Luxation.- B. Other Factors.- 1. Irrigating Solutions.- 2. Mydriatics.- 3. Miotics.- 4. Antibiotics.- 5. Air.- 6. Iritis and Uveitis.- III. The incidence of Endothelial Corneal Dystrophy.- Summary and Conclusion.- Keratoplasty and Lens Implantation.- A. Triple Procedures.- B. Combined Procedures in Apkakia.- C. Keratoplasty in Pseudopkakia.- XIII Lens Implantation and Inflammatory Response and Glaucoma.- I. Some Considerations on Postoperative Uveal Reaction.- II. Uveal Behaviour and Introcular Pressure Dysregulation during the Early Postoperative Period.- 1. Iris Supported Lenses.- a. Iris Clip, Medallion, Sputnik Lens.- b. Copeland Lens.- 2. Iridocapsular Supported Lens.- 3. Angle Supported Lenses.- III. Uveal Behavior and Intraocular Pressure Dysregulation during the Late Postoperative Period.- A. Late Uveal Behaviour.- 1. Iris Supported Lenses.- a. Chronic Uveal Reactions.- b. Late Atrophic Changes.- c. Problems with Metal-Looped Iris Supported Lenses.- 2. Iridocapsular Supported Lenses.- a. Chronic Uveal Reactions with Metal-Looped Lenses.- b. Late Atrophic Changes with Metal-Looped Lenses.- 3. Angle Supported Lenses.- a. Chronic Uveal Reactions.- b. Late Atrophic Changes.- c. The U.G.H. Syndrome.- B. Late Intraocular Pressure Dysregulation.- IV. Lens Implantation after Glaucoma Surgery.- XIV Lens Implantation and Cystoid Macular Edema.- I. Introduction.- A. The Clinical Picture.- B. Evolution and Prognosis.- C. Pathogenesis.- D. Treatment.- II. Incidence of Cystoid Macular Edema without Lens Implantation.- A. Clinical Cystoid Macular Edema.- B. Angiographic Cystoid Macular Edema.- III. Incidence of Cystoid Macular Edema with Lens Implantation.- A. Clinical Cystoid Macular Edema.- B. Angiographic Cystoid Macular Edema.- 1. Retrospective Study by R.L. Winslow et al..- 2. Preliminary Comparative Study by N.S. Jaffe et al..- 3. Preliminary Study of ACME and the Status of the Posterior Capsule by R.L. Winslow et al..- IV. Discussion and Conclusions.- A. Is the Incidence of Cystoid Macular Edema the same in Aphakia as in Pseudophakia?.- B. How is the Occasional Higher Incidence after Lens Implantation to be Explained?.- C. Does Pseudophakic Cystoid Macular Edema have the same Characteristics as ordinary Cystoid Macular Edema and what are the Therapeutic Consequences?.- XV Lens Implantation and Retinal Detachment.- I. Data on Aphakic Retinal Detachment without Lens Implantation.- A. Incidence.- B. Time Interval.- C. Age.- D. Factors Contributing to Aphakic Retinal Detachment.- 1. Preoperative Conditions.- 2. Peroperative Factors.- 3. Postoperative Factors.- E. Aphakic Retinal Detachment after Extracapsular Cataract Extraction (Phakoemulsification).- II. Data on Aphakic Retinal Detachment with Lens Implantation.- A. Incidence.- B. Characteristics.- C. Problems Related to Pseudophakic Retinal Detachment.- 1. Visualization of the Retina.- 2. Measures to Improve Visual Access.- D. Results in Pseudophakie Retinal Detachment.- E. Remarks on the Presence of a Pseudophakos during the Treatment of Retinal Detachment.- III. Summary and Conclusions.- XVI Guidelines.- I. Alternative Solutions.- II. Surgical Skill and Judgment.- III. The Patient.- A. Age.- B. The Patient's Requirements.- 1. Restoration of Binocular Vision.- 2. Professional and Environmental Requirements.- 3. Some Mental and Physical Conditions.- 4. Unilateral Aphakia.- 5. The One-Eyed Patient.- 6. Bilateral Lens Implantation.- 7. General Conditions as Restrictive Factors.- C. Racial Factors.- IV. The Eye.- V. The Lens and the Appropriate Techniques.- A. Lens Types after Intracapsular Cataract Extraction.- 1. Angle Supported Lenses.- 2. Iris Supported Lenses.- B. Lens Types after Extracapsular Cataract Extraction.- 1. Angle Supported Lenses.- 2. Iris Supported Lenses.- 3. Iridocapsular Lenses.- 4. Posterior Chamber Lenses.- Conclusion.