Possible Complications of Glued Intraocular lenses During and after Cataract Surgery
The Concept of gluing an Intraocular lens into position is one that started in 2007 with Dr. Amar Agarwal, who is not only an ophthalmic surgeon, but also a professor of ophthalmology at Ramachandra Medical College in India. While the use of glue to secure an IOL is only necessary if the integrity of the posterior capsule is compromised, the concept of using glue, rather than an Anterior chamber Intraocular lens or sutures is relatively new to the field of cataract surgery.
What Complications Can Arise From Gluing the IOL Into Position?
The General consensus of whether or not the use of Fibrin glue is safe for the operative eye is that the procedure is relatively safe with few serious visually threatening complications. However, as with any procedure there are risks, and this being a procedure that has only been in practice for 7 years, there is always room for improvement.
The dangers of gluing an Intraocular lens in place are lens decentration, which can occur of the scleral flaps are eccentric. This can leave the haptics externalized underneath the flap, placing continuous stress on the haptic and eventually leading to Intraocular lens decentration or even subluxated lens.
If the surgeon closes the wounds improperly, there can be cases of hypotony (low intraocular pressure), or choroidal detachment.
This places a great deal of pressure on the surgeon to assure that all aspects of the surgery are extremely precise and no mistakes are made.
In the event that one or both of the haptics should extrude from the operative eye, the patient would require another tip to the Operation Room to correct this, again this is dependent upon the skill level of the surgeon and their ability to properly tuck the haptics into place before closing the wound.
In a study performed by Dr Agarwal, the re-op rate, out of 208 eyes, was only 16 and the post operative vision ranged between 20/40-20/60 or better in the patients involved in the study.
There were some occurrences of intraocular lens decentration and increased inflammation in the Anterior chamber, along with other complications that can occur with typical cataract surgery as well.
Overall the study showed satisfactory outcomes for the patients with glued IOLs, maintaining that the possible complication rate does not outweigh the advantages of avoiding having to use sutures to keep the IOL in position.