Urgent-IOL implant Benefits and difficulties that encountered in spectacle lens

[evonchan]

Hello all, i got a urgent question will like to ask all of you. What is the benefits of a intra-ocular lens (IOL)? and what's the difficulties encountered in spectacle lenses for a Unilateral Aphakia patient.

Give me as lots as benefits and problem encountered as much as possible. Thanks!

[npdr]

First, has the operation already occurred?
Second, if it has occurred, is the question then whether to do a secondary implant vs spectacles or contact lens.

1. Supposing situation 1 - no one plans to do an ICCE / aphakia. It might occur serendipitously because of a complication while a ECCE is being planned such as a more than rigid nucleus or an accidental displacement of the lens. I don't think any surgeon plans for an ICCE even if the patient is -19 to -25.

2. If situation 2 occurs, doing a secondary implant has many quesionable benefits but I have seen very successful ones but many more with poor outcomes. a) corneal decompensation and persistent bullous b) essential iris atrophy c) persistent uveitis d) second time around risk for endophthalmitis. In the hands of a good surgeon, though, I would not wing it. This is an elective procedure and should always entail lenghtly discussion and consent between secondary implant and just aphakia.

Hope this helps.

[evonchan]

First, has the operation already occurred?
Second, if it has occurred, is the question then whether to do a secondary implant vs spectacles or contact lens.

1. Supposing situation 1 - no one plans to do an ICCE / aphakia. It might occur serendipitously because of a complication while a ECCE is being planned such as a more than rigid nucleus or an accidental displacement of the lens. I don't think any surgeon plans for an ICCE even if the patient is -19 to -25.

2. If situation 2 occurs, doing a secondary implant has many quesionable benefits but I have seen very successful ones but many more with poor outcomes. a) corneal decompensation and persistent bullous b) essential iris atrophy c) persistent uveitis d) second time around risk for endophthalmitis. In the hands of a good surgeon, though, I would not wing it. This is an elective procedure and should always entail lenghtly discussion and consent between secondary implant and just aphakia.

Hope this helps.

Thanks for your reply!
Both of this is a different case. 1st is a first time infra-ocular lens (IOL) i have to tell them what is the benefits after the surgery.

Another one will be a Unilateral Aphakic. Unilateral Aphakic is not possible to correct with spectacle that is best if correct with Contact Lenses. But what is the problem that they encountered with spectacle lenses?

[Oedema]

Thanks for your reply!
But what is the problem that they encountered with spectacle lenses?

Anisometropia. Correction with spectacles results in a larger image size in the aphakic eye (assuming the phakic eye is not high hyperopia). The difference in image size is a problem bc the patient will not be able to fuse the two images, or if they can it will cause severe distortion and probably a oh so un-pleasant headache.

[evonchan]

Anisometropia. Correction with spectacles results in a larger image size in the aphakic eye (assuming the phakic eye is not high hyperopia). The difference in image size is a problem bc the patient will not be able to fuse the two images, or if they can it will cause severe distortion and probably a oh so un-pleasant headache.

Oh, Thank you very much! This the answer i want.

Ya, Isokonic lens is a solutions because different prism in both eye, but if the phakic eye is low Visual Zcuity this will be not a good solution.

1.) Need to treat with isokonic lens
2.) Different prism so difference image size and the patient not able to fuse the image.

But about the last want unwanted distortion. Will they cause distortion with the spectacle lenses?

[chip anderson]

Don't understand why the surgeon isn't doing all this explaination. Isn't that what they get the big bucks for?
Now to your last question. The best thing you can do with an aphakic patient is a good well fitted well managed PMMA contact lens. However since you had to ask the question, obviously someone else should be fitting and managing this.
Image size is seldom a problem with this, peripherals distortsion, ring scotoma is not a problem.
Only problem other than fitting, and adjusting Rx is getting and elderly patient conviced they need it, and they can handle it.

Chip

[Oedema]

Don't understand why the surgeon isn't doing all this explaination. Isn't that what they get the big bucks for?
Now to your last question. The best thing you can do with an aphakic patient is a good well fitted well managed PMMA contact lens. However since you had to ask the question, obviously someone else should be fitting and managing this.
Image size is seldom a problem with this, peripherals distortsion, ring scotoma is not a problem.
Only problem other than fitting, and adjusting Rx is getting and elderly patient conviced they need it, and they can handle it.

Chip

PMMA? I would definitely not use PMMA, especially in an elderly, post-surgical patient.

[chip anderson]

Oedema:

You would if you had followed as many of these as I have for over 50 years and had some go for 65 years. The corneal pathology, vascularization, abrashion rate from foriegn (as well as naturally present in the eye) deposits is so much less. The vision is so much better in these thicker lenses in PMMA than anything else, there is no comparison.
And the amount of gas permeation when lenses get this thick is nill.
Not to mention these elderly non-seeing (without corrections) are far more likely to break, chip, and injure the eye with the more fragile materials.
Find an old experienced fitter not currently involved in the merchandising of HGP's at wholesale that will not agree with the above.

Chip