[Secondary posterior chamber lenses. Implantation in intact, partially intact and missing posterior lens capsule]

Between January 1988 and December 1991, 63 patients (75 eyes) underwent secondary posterior chamber intraocular lens (IOL) implantation. The mean period since primary cataract extraction was 85 months, and the mean age of these patients was 58 years. In 47 eyes with extracapsular aphakia the IOL was ciliary sulcus-fixated following polishing of the posterior capsule and synecholysis. In 8 eyes with remnants of the posterior capsule an anterior vitrectomy was performed. In 17 virtually intracapsular aphakic eyes additional transscleral suturing of the IOL was required. Mean visual acuity (VA) improved from 20/60 to 20/30. The following complications were observed during the mean postoperative follow-up of 15 (range 3-45) months. There were 6 limited anterior chamber and 1 vitreous hemorrhage that resolved spontaneously. Two IOLs required surgical repositioning--both with scleral suturing--because of postoperative IOL subluxation. A delayed but reversible fibrin reaction was seen in 1 eye, while 1 eye developed a cystoid macular edema with reduction of VA from 20/30 to 20/60. With careful attention to the status of the posterior capsule, which determines the individual surgical approach, secondary posterior chamber IOL implantation has become a relatively safe procedure that can be recommended for many patients.