Sutured posterior chamber intraocular lenses: indications and procedure

Intraocular lens (IOL) implantation is the standard of care for treating aphakia when spectacle or contact lens correction is not viable. There is considerable controversy about the relative efficacy and safety of the different IOL implantation approaches, as well as their indications. Since the development of the modern, open-loop anterior chamber IOL (ACIOL) and the re-emergence of the iris-fixated claw IOL, ACIOL implantation for aphakia has regained popularity. However, the posterior chamber IOL (PCIOL)--namely, the capsular-supported PCIOL and, in the absence of capsular support, the iris-sutured or transsclerally sutured PCIOL--offers numerous advantages for certain patients. By virtue of their anatomic location in the eye, capsular-supported or sutured PCIOLs are appropriate for patients with glaucoma, diabetes, cornea guttata or low endothelial cell count, peripheral anterior synechiae, or known or suspected cystoid macular edema. They may also be appropriate when the patient with aphakia is young and has a relatively long life expectancy. The sutured PCIOL procedure--specifically, the transsclerally sutured PCIOL procedure--is far from benign, however, and surgical expertise is an important consideration. Recent surgical and technological advances, including the technique of burying the suture knot in sclera, use of an ab externo suturing approach in the normotonic eye, and the use of intraoperative endoscopy, have improved the accuracy of the transsclerally sutured PCIOL technique. Additional advances, including diagnostic ultrasound biomicroscopy and small-incision surgery with foldable, transsclerally sutured IOLs, may further improve patient management and clinical outcomes.