Cataract surgery with ciliary sulcus fixation of intraocular lenses in patients with uveitis

PURPOSE: To describe intentional placement of intraocular lens haptics in t he ciliary sulcus of patients with uveitis who are at high risk for postope rative posterior synechiae and lens dislocation. METHODS: We reviewed our experience with 16 eyes of 12 patients with uveiti s who underwent cataract surgery with ciliary sulcus fixation of intraocula r lenses. Patients were followed for a median of 16.5 months (range, 9 to 4 4 months) after surgery. We evaluated eyes for surgical technique and the f ollowing preoperative and postoperative factors: best-corrected visual acui ty, intraocular pressure, anterior chamber cells, and posterior synechiae. The following additional postoperative factors were sought: lens dislocatio n, lens edge capture, and evidence of pigment dispersion, RESULTS: Posterior synechiae were present in 13 eyes before surgery; postop erative posterior synechiae developed in only three of these eyes. These ad hesions resulted in lens edge capture in one eye and limited lens decentrat ion in another. Scant pigment was present on the lens optic or in the anter ior chamber, suggesting pigment dispersion, in four eyes. We found no evide nce of consistently increased anterior segment inflammation or intraocular pressure after surgery when compared with preoperative levels for this grou p of patients. Postoperative posterior synechiae were seen more often in ey es that had can-opener anterior capsulotomy than in eyes that had continuou s, curvilinear capsulorhexis (P = .036). CONCLUSIONS: Ciliary sulcus fixation allows the intraocular lens to serve a s a physical barrier between the iris and the lens capsule remnants. This t echnique may be useful for reducing the risk of postoperative posterior syn echiae in patients with uveitis without increasing the risk of other postop erative problems. (Am J Ophthalmol 1999;128:21-30. (C) 1999 by Elsevier Sci ence Inc. All rights reserved.)