ARE THERE ACCEPTABLE ANTERIOR-CHAMBER INTRAOCULAR LENSES FOR CLINICALUSE IN THE 1990S - AN ANALYSIS OF 4104 EXPLANTED ANTERIOR-CHAMBER INTRAOCULAR LENSES

Purpose: The authors pose the question as to whether there are any ant erior chamber intraocular lenses (AC IOLs) acceptable for clinical use in the 1990s. Methods: Data on the incidence and types of complicatio ns of 4104 AC IOLs that were submitted to the Center for IOL Research from 1982 to 1993 were retrieved from the laboratory database and anal yzed using cumulative frequency calculations and the chi-square test. Normalized explantation rates were related to implantation rates that were derived from market-share analysis. Results: Of 4104 explanted IO Ls, 50% were closed-loop designs (n = 2095/4104); 26% (1100/4104) were miscellaneous, older designs; and 22% (919/4104) were open-loop lense s. The most important complications were corneal pathology (2065/4104) and inflammation (1370/4104). Closed-loop designs were responsible fo r almost 80% of corneal pathology, with an increasing complication rat e with ongoing implant duration (P < 0.0001). Open-loop AC IOLs showed , in relation to their normalized rate of implantation, a significantl y lower rate of complications and explantations (P < 0.01). Conclusion : Complication rates of flexible, open-loop AC IOLs are much lower tha n previously assumed. They should be distinguished clearly from most o lder AC IOL designs. Consideration of these lenses as an alternative t o sutured posterior chamber IOLs for secondary or exchange implantatio n may be warranted for selected clinical indications. They also could provide an alternative to the aphakic spectacle rehabilitation program in developing countries, which will have a positive impact on the ove rwhelming backlog of patients with cataract in the underprivileged wor ld.