IOL Implantation in the Absence of Capsular Support

For correction of aphakia, the ophthalmologist has several options. Classically in bilateral cases aphakic glasses can prove useful when contact lenses are not tolerated or impractical for individual circumstances. In unilateral cases, aphakic correction with glasses is rarely tolerated due to aniseikonia. Ideally an intraocular lens (IOL) gives better correction of aphakia due to its location adjacent to the nodal point of the eye. This chapter deals with patients who need aphakia correction but are missing adequate capsular support of the bag or the sulcus. In some cases reshaping the capsular remnants of the Soemmering’s ring is needed to safely place the IOL in the sulcus. In other cases no capsular remnants are present and the situation calls for different surgical strategies. ArtisanⓇ (Ophtec, Groningen, the Netherlands) iris-fixated IOL techniques of both anterior and posterior enclavation are described. Posterior chamber (PC) IOLs can also be used but with scleral sutures, glued haptics, or using flanged haptics. The pros and cons of these techniques are discussed.