Intraocular lens

Intraocular lens

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  INTRAOCULAR LENSES BY J.BHANU PRATHAP ROLLNO: 57
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  HISTORICAL ASPECTS  PRESENTDAY IOLs  Classification  Design  Material  PREMIUM IOLS  PHAKIC AND ASPHERIC IOLS  COMPLICATIONS RELATED TO IOLs  RECENT ADVANCES AND THE FUTURE
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   K
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  WHAT IS INTRAOCULARLENS? • An artificial lens implanted in the eyes • Replaces the crystalline lens • Tocorrect the optical power of the eyes following:- Lens being clouded by cataract Refractive surgery
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  PARTS OF ANIOL • OPTIC Part of the lens that focuses light on the retina. • HAPTIC Small filaments connected to the optic that hold the lens in place in the eye HAPTEN OPTIC
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  PARTS OF ANIOL • OPTIC Part of the lens that focuses light on the retina. • HAPTIC Small filaments connected to the optic that hold the lens in place in the eye HAPTEN OPTIC
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  PARTS OF ANIOL • OPTIC Part of the lens that focuses light on the retina. • HAPTIC Small filaments connected to the optic that hold the lens in place in the eye HAPTEN OPTIC
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  CLASSIFICATION
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   FIRST GENERATIONIOLS
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  SECOND GENERATION IOLS Rigid and semi-rigid anterior chamber IOLs  the anterior chamber, with fixation of the lens in the angle recess  Baron, in France, is generally credited as being the first designer and implanter of an anterior chamber lens ADVANTAGES • Less decenteration • Decreased reaction DISADVANTAGES • Corneal decompensation • Pseudophakic Bullous keratopathy • Uveitis • Secondary glaucoma
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  THIRD GENERATION IOLS Iris suppoted lens  Cornelius Binkhorst, Iris clip lens; four-loop (1957)  Iridocapsular fixation; two loop (1965) ADVANTAGES • Away from angle structures • Rate of dislocation was less • Less contact with corneal endothelium DISADVANTAGES • Iris chaffing • Pupillary distortion • Transillumination defects • Chronic inflammation • CME • Distortion on pupillary dilatation • Endothelial decompensation
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  FOURTH GENERATION IOLS Intermediate ACIOL  Flexible loops with multiple point of fixation  More stable  Advantages – more stable, better design, less complications  Disadvantages – anterior chamber is not the physiological site for IOL
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  FIFTH GENERATION IOLS PMMAlenses Rigid posterior chamber IOL Sixth generation IOLs Foldable IOL Seventh generation IOLs Multifocal IOL Eighth generation IOLs Accomodative IOL Phakic refractive IOL
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  COMPLICATIONS OF CATARACT SURGEY
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  CLASSIFICATION  Complications ofanesthesia General anesthesia Regional / Local anesthesia  Intraoperative  Early postoperative  Late postoperative
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  ANESTHESIA COMPLICATIONS REGIONAL ANESTHESIA
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  PERIBULBAR / RETROBULBARANESTHESIA  Lids trauma (ecchymosis)  Ptosis  s/conj hemorrhage  Muscles damage  Globe penetration & its related complications  Retrobulbar hemorrhage  Optic nerve damage  Putscher-type retinopathy *  Brainstem anesthesia
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  RETROBULBAR HEMORRHAGE  Commoncomplication  Causes proptosis & raised IOP  Incidence of severe RBH = 0-3%  Reported case of CRAO *  Management  Continue with surgery if minimal  Lateral canthotomy for severe cases