Question

What are their intraoperative  & postoperative complications and their management? 
 

Hint:

Regular follow-up visits after phakic IOL implantation are crucial to detect complications early, such as cataract formation, endothelial damage, or glaucoma.

Answer 1

While phakic IOLs are generally safe and effective for correcting refractive errors, there are potential intraoperative and postoperative complications that must be managed carefully.
Intraoperative Complications and Management:
1. Corneal Injury:
- During the implantation of the IOL, there is a risk of corneal damage due to the surgical technique, especially when working in the anterior chamber.
- Management: Careful surgical technique, including proper hydration and use of protective shields, can prevent such injuries. In case of corneal abrasion, antibiotics and anti-inflammatory medications are prescribed.
2. Incorrect IOL Positioning:
- The IOL may become improperly positioned within the eye, which can cause visual disturbances and require repositioning.
- Management: Proper preoperative measurement and intraoperative checks are crucial. If necessary, the IOL can be repositioned during surgery.
3. High Intraocular Pressure (IOP):
- High IOP can result from overfilling of the anterior chamber during the procedure or blockage of the aqueous outflow by the IOL.
- Management: If high IOP occurs, medications such as mannitol or acetazolamide may be used to reduce pressure. In some cases, the IOL may need to be repositioned or removed.
4. Perforation of the Iris:
- Iris perforation or damage to the pupil can occur during implantation, particularly with anterior chamber IOLs.
- Management: Careful handling of the iris and use of appropriate surgical instruments can reduce the risk. Postoperatively, the use of anti-inflammatory drops may be required for healing.
Postoperative Complications and Management:
1. Endothelial Cell Loss:
- Phakic IOLs, particularly anterior chamber IOLs, can lead to endothelial cell loss over time due to contact with the corneal endothelium.
- Management: Regular monitoring of corneal endothelial cell count and early detection of any corneal edema can help in managing this complication. If significant endothelial damage occurs, the IOL may need to be replaced or removed.
2. Cataract Formation:
- The development of a cataract is a known risk with posterior chamber phakic IOLs over time, particularly in older patients.
- Management: If cataract formation occurs, phacoemulsification and IOL exchange may be necessary.
3. Intraocular Lens (IOL) Dislocation:
- Phakic IOLs, especially anterior chamber lenses, can become dislocated due to improper fixation or trauma.
- Management: If the IOL dislocates, repositioning or re-implantation may be required. In some cases, a different type of IOL may be necessary.
4. Glaucoma:
- Increased intraocular pressure (IOP) can occur postoperatively, particularly if the phakic IOL obstructs the outflow of aqueous humor.
- Management: Monitoring and treatment of IOP with antiglaucoma medications or surgical intervention, such as trabeculectomy, may be required.
5. Uveitis:
- Inflammation (uveitis) can occur as a result of irritation from the IOL.
- Management: Postoperative use of topical steroids and anti-inflammatory medications can help manage inflammation. If persistent, the IOL may need to be adjusted or removed.