Primary anterior chamber intraocular lens implantation in Jos, Nigeria

Introduction: Following vitreous loss during cataract surgery, a variety of lens options exist when the intraocular lens cannot be placed in the capsular bag. Most surgeons however consider the flexible openloop anterior chamber intraocular lens and the trans-sclerally sutured posterior chamber intraocular lens to be the most acceptable alternatives. In our hospital we implant an anterior chamber intraocular lens when faced with inadequate capsular support which usually occurs following a posterior capsule rupture with vitreous loss. The risk of a poor visual outcome is greater with vitreous loss. Objective: To review our experience with primary anterior chamber intraocular lens implantation in Jos. Methods: Retrospective analysis of medical records of a consecutive series of primary anterior chamber intraocular lens implantations carried out in the Jos University Teaching Hospital, Jos over a 5 year period from January 2004 - December 2009. Eyes with complicated or traumatic cataracts, ocular co-morbidity and cases of combined surgery were excluded from the analysis of visual outcome. Results: There were 119 cases of primary anterior chamber intraocular lens implantations during the study period. The case files of 100 eyes of 96 patients were available for review. Inadequate capsular support following posterior capsule rupture was the commonest indication for implanting the anterior chamber intraocular lens. Visual outcome was analysed in 76 eyes that met the inclusion criteria. Ninety six percent had an unaided visual acuity of less than 6/60 at presentation. Postoperatively 45% had a best corrected visual acuity of 6/18 or better, 40% <6/18 – 6/60 and 18% < 6/60. The commonest postoperative complication was corneal oedema. Conclusion: Our results indicate a less than satisfactory visual outcome with primary implantation of anterior chamber intraocular lenses. Caution should be exercised when implanting an anterior chamber intraocular lens following complicated cataract surgery, particularly in the absence of appropriate vitrectomy equipment.