US Southwestern ophthalmologist Kishan G. Patel and colleagues present several techniques for placement of the secondary intraocular lens in a recent article. (Image credit: Getty Images)
DALLAS – January 23, 2023 – Patients undergoing cataract surgery usually have their natural lenses replaced with an artificial intraocular lens (IOL). However, complications sometimes arise that require the placement of a more surgically difficult secondary IOL.
Kishan J Patil, MD
Several techniques for secondary intraocular lens placement are available, each with their own advantages and disadvantages, according to an ophthalmologist at the University of Southwestern University. Kishan J Patil, MDAssistant Professor in Department of Ophthalmology.
Dr. Patel, who specializes in retinal surgery and complex secondary placement of the lens of the eye, outlined four surgical techniques for the procedure in a recent issue of retina today.
“There is no consensus on the best technique. The surgeon will decide the preferred method for a particular patient based on their specific condition,” said Dr. Patel, lead author of the review article.
UTSW’s Department of Ophthalmology is among the top providers of secondary intraocular lenses in North Texas and beyond. The department is emerging as a regional and national resource in the placement of secondary IOL and similar surgeries with highly trained surgeons, advanced equipment and the ability of surgeons to work together on complex complex cases when necessary.
Cataracts, which is a clouding of the normally transparent lens of the eye, usually develop in the elderly and eventually lead to visual impairment. Cataracts are treated with cataract removal followed by intraocular lens placement. If there is insufficient support in the eye for a conventional IOL, placement of a secondary IOL may be necessary.
Secondary lens surgeries in patients who no longer have their natural lenses, or in patients who have aphakia, a condition in which there is no lens, present challenges. In this article, Dr. Patel and three colleagues provide a collection of written descriptions and photographs detailing surgical advice for surgeons to help them succeed in caring for these patients.
For anterior chamber IOLs, or those placed in the anterior chamber of the eye, the study offers insight into surgical approaches to reduce the risk of visual impairment caused by surgery, the latest intraocular lens models, and more. The no-sew endotracheal fixation technique involves placing an intraocular lens within the sclera, or white layer of the eye, without the use of stitches. For this technique, the authors recommend the use of intraocular lenses made of a special material and minimal surgical manipulation to avoid dislocation or movement of the intraocular lens.
For IOLs with sutures on the sclera, Dr. Patel and colleagues describe strategies to prevent intraocular lens tilting and avoid postoperative complications as well as provide guidance on preferred types of sutures and other techniques to improve outcomes. The final technique for placing an intraocular lens involves fixing the lens inside the iris, the colored part of the eye. For this procedure, the authors recommend the use of a specific type of suture and knot and outline the maneuver to be used for IOL fixation.
“Our review offers unique techniques for addressing these challenging issues,” said Dr. Patel.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates groundbreaking biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 investigators of the Howard Hughes Medical Institute. Our 2,900-plus full-time faculty are responsible for groundbreaking clinical developments and are committed to rapidly translating scientific research into new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency situations, and oversee nearly 4 million outpatient visits annually.