National Survey on the Choice of Secondary Intraocular Lens

Implantation in the UK

James TildsleyJames Tildsley

Sathish SrinivasanSathish Srinivasan

Alan GaskellAlan Gaskell[All authors have no financial interest][All authors have no financial interest]

Ayr Hospital, Ayr, Scotland, UKAyr Hospital, Ayr, Scotland, UK

Introduction

270,000 cataract procedures were performed in 270,000 cataract procedures were performed in UK National health service in 2008.UK National health service in 2008.11

The reported incidence of PC rupture and zonular The reported incidence of PC rupture and zonular dehiscience is 1.92% and 0.46% respectively. dehiscience is 1.92% and 0.46% respectively. 22

Both of these complications have the potential to Both of these complications have the potential to prevent primary lens insertion and aphakiaprevent primary lens insertion and aphakia

Introduction

Secondary lens implant is now the standard for Secondary lens implant is now the standard for managing aphakia.managing aphakia.3 3 However there is a wide However there is a wide variation in the choice of lenses for secondary lens variation in the choice of lenses for secondary lens implant.implant.

Given how common a secondary IOL may be Given how common a secondary IOL may be required we conducted this national survey with required we conducted this national survey with the aim to collect data on current practice of UK the aim to collect data on current practice of UK Ophthalmology consultants on secondary IOL Ophthalmology consultants on secondary IOL choicechoice

Method

An anonymous questionnaire was mailed to all 896 NHS An anonymous questionnaire was mailed to all 896 NHS ophthalmology consultants currently practicing in the UK. ophthalmology consultants currently practicing in the UK.

Data on surgical experience, number of secondary IOLs Data on surgical experience, number of secondary IOLs performed, preferred choice of secondary IOL with no performed, preferred choice of secondary IOL with no capsular support +/- associated open angle glaucoma capsular support +/- associated open angle glaucoma (POAG) and closed angle glaucoma (CAG) / peripheral (POAG) and closed angle glaucoma (CAG) / peripheral anterior synechiae (PAS), and personal experience of using anterior synechiae (PAS), and personal experience of using the lenses were collected.the lenses were collected.

Questionnaire

Results - Surgical experience

A total of A total of 420420 questionnaires were received, questionnaires were received, with a response rate of 47%. with a response rate of 47%.

50%50% perform perform 5-105-10 cataract procedures a cataract procedures a week, week, 30%30% over over 1010 and and 20%20% less than less than 55..

75%75% had less than had less than 22 complications leading complications leading to aphakia, to aphakia, 16%16% had had 2 - 52 - 5 and and 7%7% had over had over 55

Results - choice of lens

Results - choice of lens

Results - experience with other lens types 19%19% familiarized themselves with Artisan iris clip lens, familiarized themselves with Artisan iris clip lens,

mainly by wet lab. mainly by wet lab. 12%12% have used the Artisan lens in 18 have used the Artisan lens in 18 months. months. 21%21% say it has changed their practice say it has changed their practice

23%23% have used an iris suture lens have used an iris suture lens 92%92% personally undertake open loop ACIOL insertion. For personally undertake open loop ACIOL insertion. For

scleral sutured PCIOL, Artisan iris clip lens and iris scleral sutured PCIOL, Artisan iris clip lens and iris sutured PCIOL the results were sutured PCIOL the results were 43%, 27%43%, 27% and and 22%22% respectivelyrespectively

20 to 25%20 to 25% would prefer to refer to the appropriate sub- would prefer to refer to the appropriate sub-specialty for insertion of a secondary IOL other than open specialty for insertion of a secondary IOL other than open loop ACIOLloop ACIOL

Conclusion NHS Ophthalmology consultants currently working in the UK are NHS Ophthalmology consultants currently working in the UK are

using secondary IOLs for management of aphakia as recommended.using secondary IOLs for management of aphakia as recommended.

3,4,5,63,4,5,6

Overall the open loop ACIOL was the most popular secondary IOL. Overall the open loop ACIOL was the most popular secondary IOL. However this changed with associated POAG and CAG/PAS However this changed with associated POAG and CAG/PAS suggesting there are limitations of the open loop ACIOL and suggesting there are limitations of the open loop ACIOL and advantages using an Artisan iris clip lens, iris sutured PCIOL and advantages using an Artisan iris clip lens, iris sutured PCIOL and particularly the scleral sutured PCIOL. This result was supported by particularly the scleral sutured PCIOL. This result was supported by other studies.other studies.3-6, 8,10-133-6, 8,10-13

Conclusion

Previous studies so far conclude that the outcomes of all Previous studies so far conclude that the outcomes of all the different secondary IOLs are comparable to each other the different secondary IOLs are comparable to each other but further research is required, and the choice of lens is but further research is required, and the choice of lens is based mainly on personal experience of using a lens.based mainly on personal experience of using a lens.3, 3,

7,9,12,13 7,9,12,13

Our study found the same result, but due to the fact that Our study found the same result, but due to the fact that the different lens techniques investigated have been the different lens techniques investigated have been available for at least 28 years it suggests that different lens available for at least 28 years it suggests that different lens techniques are not being attempted.techniques are not being attempted.13,1413,14

References1.1.DoH. DoH. Hospital Activity and Episode Statistics. Hospital Activity and Episode Statistics. http://www.http://www.dohdoh..govgov..ukuk/public/stats//public/stats/htmhtm

2.2.Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P. The Cataract National Dataset electronic multicentre audit Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P. The Cataract National Dataset electronic multicentre audit of 55567 operations: updating benchmark standards of care in the United Kingdom and internationally. of 55567 operations: updating benchmark standards of care in the United Kingdom and internationally. Eye. Eye. 2007 Nov 232007 Nov 23

3.3.Wagoner MD, Cox TA, Ariyasu RG, Jacobs DS, Karp CL American Academy of Ophthalmology. Intraocular lens implantation Wagoner MD, Cox TA, Ariyasu RG, Jacobs DS, Karp CL American Academy of Ophthalmology. Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology. in the absence of capsular support: a report by the American Academy of Ophthalmology. Ophthalmology. Ophthalmology. 2003 Apr; 2003 Apr; 110(40:840-59110(40:840-59

4.4.Zheng G, Chen Y, Wang L, Chen G, Zhang X. The choice of methods of intraocular lens implantation in traumatic cataract in Zheng G, Chen Y, Wang L, Chen G, Zhang X. The choice of methods of intraocular lens implantation in traumatic cataract in the absence of capsular and zonular support. the absence of capsular and zonular support. Zhonghua Yan Ke Za Zhi. Zhonghua Yan Ke Za Zhi. 1998 Sep; 34(5): 327-91998 Sep; 34(5): 327-9

5.5.Dick HB, Augustin AJ. Lens implant selection with absence of capsular support. Dick HB, Augustin AJ. Lens implant selection with absence of capsular support. Curr Opin Ophthalmol. Curr Opin Ophthalmol. 2001 Feb; 12(1): 47-572001 Feb; 12(1): 47-576.6.Hannush SB. Sutured posterior chamber intraocular lenses: indications and procedure. Hannush SB. Sutured posterior chamber intraocular lenses: indications and procedure. Curr Opin Ophthalmol. Curr Opin Ophthalmol. 2000 Aug; 11(4): 2000 Aug; 11(4):

233-40233-407.7.Rosa N, Lanza M, Borrelli M. Artisan phakic intraocular lens. Rosa N, Lanza M, Borrelli M. Artisan phakic intraocular lens. OphthalmologyOphthalmology. 2007 Jun;114(6):1133-42. 2007 Jun;114(6):1133-428.8.Guell JL, Manero F. Artiflex(foldable iris claw IOL) secondary implantation for correction of aphaia after penetrating ocular Guell JL, Manero F. Artiflex(foldable iris claw IOL) secondary implantation for correction of aphaia after penetrating ocular

injury. injury. J Refract Surg. J Refract Surg. 2004 May-Jun;20(3):282-32004 May-Jun;20(3):282-39.9.Kwong YY, Yuen HK, Lam RF, Lee VY, Rao SK, Lam DS. Comparison of outcomes of primary scleral-fixated versus primary Kwong YY, Yuen HK, Lam RF, Lee VY, Rao SK, Lam DS. Comparison of outcomes of primary scleral-fixated versus primary

anterior chamber intraocular lens implantation in complicated cataract surgeries. anterior chamber intraocular lens implantation in complicated cataract surgeries. Ophthalmology. Ophthalmology. 2007 Jan;114(1):80-52007 Jan;114(1):80-510.10.Bellamy JP, Queguiner F, Salame N, Montard M. Secondary intraocular lens implantation: methods and complications. Bellamy JP, Queguiner F, Salame N, Montard M. Secondary intraocular lens implantation: methods and complications. J Fr J Fr

Ophthalmol.Ophthalmol. 2000 Jan:23(1):73-80 2000 Jan:23(1):73-8011.11.Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Por YM, Lavin MJ. Techniques of intraocular lens suspension in the absence of capsular/zonular support. Surv Ophthamol.Surv Ophthamol.

2005 Sep-Oct;50(5):429-622005 Sep-Oct;50(5):429-6212.12.Krause L, Bechrakis NE, Heimann H, Salditt S, Foerster MH. Implantation of scleral fixated sutured posterior chamber lenses: Krause L, Bechrakis NE, Heimann H, Salditt S, Foerster MH. Implantation of scleral fixated sutured posterior chamber lenses:

a retrospective analysis of 119 cases. a retrospective analysis of 119 cases. Int Ophthalmol. Int Ophthalmol. 2008 Apr 10.2008 Apr 10.13.13.Everklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open loop anterior Everklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open loop anterior

chamber and scleral fixated posterior chamber intraocular lenses. chamber and scleral fixated posterior chamber intraocular lenses. J Cataract Refract Surg. J Cataract Refract Surg. 2003 Feb; 29(2): 301-82003 Feb; 29(2): 301-814.14.McCannel MA. A retrievable suture idea for anterior uveal problems.McCannel MA. A retrievable suture idea for anterior uveal problems. Ophthalmic surg. Ophthalmic surg. 1976 summer; 7(2): 98-103 1976 summer; 7(2): 98-103