**11. Conclusion**

Ophthalmology has seen an evolution in secondary intraocular lens implantation. Particularly, in the past decade, the implantation of scleral-fixated intraocular lenses has gained popularity along with ACIOL implantation [36]. Careful patient selection is critical to determine the optimal secondary IOL technique. When possible, placement of the secondary intraocular lens in the capsular bag is preferred, followed by placement in the sulcus with optic capture. When capsular support is absent, ACIOL implantation, iris fixation and scleral fixation of a secondary intraocular lens can be considered. The variety of surgical options with respect to secondary IOL implantation illustrates the lack of an optimal consensus technique. Indeed, several studies have compared these techniques with no clear favorite [38–41]. In most cases, patient ophthalmic history and anatomic considerations in addition to surgeon familiarity and comfort with the secondary IOL technique may determine the type of surgery performed.

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**Author details**

Niranjan Manoharan and Pradeep Prasad\*

provided the original work is properly cited.

\*Address all correspondence to: prasad@jsei.ucla.edu

Stein Eye Institute, University of California, Los Angeles, CA, United States

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Secondary Intraocular Lens*

*DOI: http://dx.doi.org/10.5772/intechopen.89569*

*Secondary Intraocular Lens DOI: http://dx.doi.org/10.5772/intechopen.89569*

*Intraocular Lens*

different meridian.

scleral or corneal incision is closed.

determine the type of surgery performed.

**11. Conclusion**

and/or uveitis glaucoma hyphema. The angle to angle measurement measured by a UBM or OCT is the most accurate option for fitting an ACIOL. More commonly however the white-to-white distance is measured intraoperatively with calipers and 1 mm is added to size the ACIOL. The white-to-white distance is not always a

Many of the complications of ACIOL implantation can be prevented with an appropriately-sized lens, however, limited sizes are available. An overly small lens can be mobile and cause damage to the corneal endothelium leading to corneal decompensation. A small lens can also cause trauma to iris tissue leading to inflammation and cystoid macular edema. Similarly, an overly large lens can cause inflammation, cystoid macular edema and corneal endothelial failure. A large lens can be noted if the iris is distorted or ovalized during placement. This is due to the footplates not being seated well in the angle. Since the vertical and horizontal angle to angle dimensions are different the lens can be rotated to see if it fits better at a

A scleral tunnel is created in either a frown or linear configuration. This can be placed temporally or superiorly based on surgeon preference. A corneal incision is avoided to minimize astigmatism however can be used if needed. The benefits of a corneal incision include preserving conjunctiva/sclera for potential glaucoma interventions. Miosis is induced and viscoelastic is then injected. The ACIOL is then inserted with or without a use of a lens glide. The purpose of the lens glide to secure placement of the ACIOL across the pupil so as not to get the lens or haptic caught on the iris at the pupillary margin. The ACIOL is then positioned such that the footplates of the IOL are well-seated in the angle and the pupillary margin is round. Gonioscopy can be performed to confirm appropriate placement of the ACIOL footplates. Once the ACIOL is positioned, a peripheral iridectomy is created and the

Ophthalmology has seen an evolution in secondary intraocular lens implantation. Particularly, in the past decade, the implantation of scleral-fixated intraocular lenses has gained popularity along with ACIOL implantation [36]. Careful patient selection is critical to determine the optimal secondary IOL technique. When possible, placement of the secondary intraocular lens in the capsular bag is preferred, followed by placement in the sulcus with optic capture. When capsular support is absent, ACIOL implantation, iris fixation and scleral fixation of a secondary intraocular lens can be considered. The variety of surgical options with respect to secondary IOL implantation illustrates the lack of an optimal consensus technique. Indeed, several studies have compared these techniques with no clear favorite [38–41]. In most cases, patient ophthalmic history and anatomic considerations in addition to surgeon familiarity and comfort with the secondary IOL technique may

reliable equivalent to the actual angle to angle distance.

**10.1 Anterior chamber intraocular lens implantation technique**

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