Intraoperative Management of Crystalens Intraocular Lens

Abstract

 

Purpose

 

To understand intraoperative management of Crystalens accommodating intraocular lens

 

Methods

 

We retrospectively analyzed visual acuity (VA), biomicroscopy, axial length and manifest refraction before and after cataract surgery in 3 consecutive patients (5 eyes) with Crystalens accommodating intraocular lens. IOL master or Lenstar was used to measure the axial length. A 5.5-6 mm capsulorrhexis was made in each case.

 

Results

 

The results are summarized in table 1. In 3 of 5 eyes, the Crytalens IOL was positioned well intraoperatively and patients had 20/20 vision at distance and near postoperatively. The fourth eye had intraoperative Z-syndrome upon insertion of the Crystalens and a capsular tension ring was placed. The Z-syndrome did not resolve and decision was made to remove the Crystalens IOL and replace it with another Crystalens with the same power. Intraoperative mannitol was also given. The new replaced Crystalens was positioned well and patient’s postoperative uncorrected vision was 20/20 at distance and near. The last eye with the shortest axial length of 22.04 mm had asymmetric posterior vaulting of Crystalens IOL upon insertion. The incision was watertight but a suture was placed for extra safety. The anterior chamber (AC) shallowed during suture placement and when AC was reformed, aqueous misdirection was noted. Intravenous mannitol was given intraopertively and the lens was noted to be in a planar configuration. Postoperative UCVA at distance was 20/150. Postoperative refraction was -3.25 which progressed to -4.00 +1.25x075. Ultrasound biomicroscopy was performed to better illustrate the IOL position (figure 1). This patient had an IOL exchange with placement of a ZA9003 27.5 D sulcus IOL three months after initial surgery.

 

Conclusions

 

Capsular tension ring (CTR) can help with the position of Crystalens accommodating intraocular lens. CTR can expand the capsular bag and accomplish anatomical stability and better haptic position especially in patients with shorter axial length. To our knowledge there are no studies in the literature that have addressed the utility of CTR in correct positioning of Crystalens. It is also important to recognize intraoperative complications such as asymmetric posterior vaulting or Z-syndrome and address them even if it requires intraoperative IOL exchange.

 

 

Table 1

 

 

Figure 1: Crystalens in capsular bag in eye #5 with one haptic vaulted posteriorly while another haptic is vaulted more anteriorly

 

Keywords: 445 cataract • 567 intraocular lens • 404 accommodation