Secondary Intraocular Lens Techniques

*Intraocular Lens*

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**Chapter 9**

**Abstract**

Secondary Intraocular Lens

Secondary intraocular lens (IOL) implantation has evolved over the past few decades. Several new techniques, lens options, and materials now exist. Careful patient selection is important to determine the optimal secondary IOL technique. Intraocular lens placement in the capsular bag is the most ideal followed by sulcus placement. However, the best option when no capsular support exists in an aphakic patient remains unclear. Surgeons should be aware of contraindications for each technique; however, there are several situations where anterior chamber intraocular lens (ACIOL), scleral-fixated intraocular lens (SFIOL), and iris fixation can all be used. In those cases, surgeon familiarity and comfort with the secondary IOL

*Niranjan Manoharan and Pradeep Prasad*

technique can determine the type of surgery performed.

anterior chamber intraocular lens

and surgical considerations.

**2. Indications**

**1. Introduction**

**Keywords:** secondary intraocular lens, aphakia, scleral fixated, iris fixated,

Secondary intraocular lens implantation is defined as implantation of an intraocular lens following an initial surgery that resulted in aphakia or a deficient intraocular lens. The indications for secondary intraocular lens insertion have evolved with improved surgical outcomes of modern cataract surgery. Newer surgical techniques and lenses has also advanced the field of secondary intraocular lenses. The first wave of secondary intraocular lenses to be implanted was the anterior chamber intraocular lens (ACIOL) [1]. Secondary intraocular lenses can now be implanted in a variety of anatomic locations with different techniques used to support the lens (sutured, iris claw, etc.). Specifically, sutured IOL and intrascleral fixation techniques have been gaining popularity. Szigiato et al. found a 538% increase in secondary sutured IOL techniques from 2000 to 2013 [2]. However, with the advent of several new techniques there is no clear guidance for the best technique for secondary IOL placement. This chapter aims to discuss the variety of secondary intraocular lenses, the indications for use,

Modern cataract surgery has evolved the role of secondary intraocular lens implantation since there is now less incidence of surgical aphakia after cataract surgery [2]. With current technology and improved cataract surgery technique, the most common reason for secondary lens implantation is IOL exchange. The rates of IOL exchange also have declined over the years with recent studies showing
