Intraocular Lens Complications and Management

In 5 B.C., Sanskrit manuscripts first described couching, the procedure by which a needle is placed into the eye and an opa lescent lens pushe d into the vit reous cavity in order to clear the visual axis. In 1748, Jacques Daviel performed the first extracapsular cataract extraction, and then, in 1967, Charles Kelman invented what is known today as phacoemulsification, considered by many in the Western world to be the current standard for cataract surgery [1]. While cataract extraction has been performed since Dav-iel first introduced the procedure, the intraocular lens (IOL) did not become available until 1949, when Harold Ridley, an ophthalmologist at Moorfield's eye hospital, London, observed that two fighter pilots who had penetrating globe injuries with material from the polymeth-ylmethacrylate (PMMA) canopies had a surprising lack of an intraocular immune response. Thus, the first IOL, made of PMMA, was implanted by Ridley in 1949. In the 1980s and 1990s, foldable IOLs became the mainstay of implants due to the smaller incisions required.

While the evolution of IOLs has brought us to modern day small incision phacoemulsification where the vast majority of IOLs are placed in the capsular bag in the posterior chamber, decentration and dislocation of IOLs continues to be a pertinent issue with the prevalence of conditions such as pseudoexfoliation (XFS), capsular contraction syndrome, and trauma. In addition, iatro-genic zonular or capsular injury intraoperatively, inadvertent bag/sulcus haptic placement, and improper lens sizing or placement, especially for anterior chamber IOLs (ACIOL), contribute to both short- and long-term IOL decentration and dislocation.