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Rebecca Sorenson, Steven H Tucker, Ingrid U Scott, George C Papachristou; Practice Patterns With Regards to Management of Inadequate Capsular Support for Intracapsular or Sulcus Intraocular Lens Placement During Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2810.
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To investigate the practice patterns with regards to management of inadequate capsular support for intracapsular or sulcus intraocular lens (IOL) placement during cataract surgery.
An online survey was constructed using multiple-choice and Likert-style questions regarding surgical experience, fellowship, comfort with placement of anterior chamber IOL (ACIOL) and scleral (or otherwise) fixated posterior chamber IOLs (SF PCIOLs), and IOL choice in the setting of inadequate capsular support in several clinical scenarios. The survey link was emailed to the program coordinators of all 113 ACGME-accredited ophthalmology residency programs, with a request to forward our email to all faculty who perform cataract surgery and to reply with the number of faculty to whom the link was sent.
Of the confirmed 117 recipients, 63 completed the survey (response rate=54.7%). Respondents were, on average, 16.5 years out of residency (range, 1-41 years). Sixty-five percent (n=41) completed fellowship, most in cornea (n=23, 56%) and glaucoma (n=11, 27%). All felt comfortable placing ACIOLs, while 63% (n=34) felt comfortable placing SF PCIOLs independently. Of those not comfortable placing SF PCIOLs, 95% (n=19) reported access to surgeons who perform SF PCIOL placement in their institution or community. In the setting of inadequate capsular support, 59.3% (n=32) would place a primary ACIOL, 27.8% (n=15) would place a primary SF PCIOL, and 5.6% (n=3) would leave the patient aphakic for secondary SF PCIOL placement. Primary reasons indicated for IOL choice include less long-term complications (n=20, 37.0%) and avoidance of a second surgery (n=19, 35.2%). Surgeons not comfortable placing SF PCIOLs were most likely to choose primary ACIOLs (n=15, 75%). Surgeons comfortable with placing SF PCIOLs were also most likely to choose primary ACIOLs (n=17, 50%), followed by primary (n=13, 38.2%) and secondary (n=1, 3.0%) SF PCIOLs.
Cataract surgeons with access to SF PCIOL placement at academic centers show a preference towards ACIOLs in the setting of inadequate capsular support during cataract surgery. Older patient age and anticoagulation shifted surgeon preference towards ACIOLs, while younger patient age, presence of corneal guttata, history of glaucoma, and dropped nuclear fragments shifted preference towards SF PCIOLs.
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