Practice patterns of cataract surgeons at academic medical centers for the management of inadequate capsule support for intracapsular or sulcus intraocular lens placement during cataract surgery

J Cataract Refract Surg. 2016 Feb;42(2):239-45. doi: 10.1016/j.jcrs.2015.09.022.

Abstract

Purpose: To determine practice patterns with regard to intraocular lens (IOL) placement during cataract surgery when there is inadequate capsule support for intracapsular or sulcus IOL placement.

Setting: Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA.

Design: Cross-sectional study of anonymous survey results.

Methods: An online survey was e-mailed to the coordinators of all Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs with a request to forward to all faculty who perform cataract surgery.

Results: Sixty-seven (57.2%) of 117 confirmed survey recipients participated. Thirty-six (62.1%) said they felt comfortable placing scleral-fixated posterior chamber IOLs (PC IOLs) independently. Faced with inadequate capsule support, 58.6% would place a primary anterior chamber IOL (AC IOL), 29.3% would place a primary scleral-fixated PC IOL, and 5.3% would leave the patient aphakic for secondary scleral-fixated PC IOL placement. Surgeons not comfortable placing scleral-fixated PC IOLs were most likely to choose primary AC IOLs (77.3%). Surgeons comfortable placing scleral-fixated PC IOLs were more evenly divided between primary AC IOLs (47.2%) and scleral-fixated PC IOLs (41.7%). Among surgeons who favored primary scleral-fixated PC IOLs, 63.7% cited a decreased risk for long-term complications as their reason for IOL choice; 50.0% of surgeons who favored primary AC IOLs cited avoidance of a second surgery.

Conclusions: In general, primary AC IOL placement was preferred in the setting of inadequate capsule support, although less so among surgeons who were comfortable placing scleral-fixated PC IOLs. Lack of comfort with scleral-fixated PC IOL placement suggests a potential unmet training need in residency and fellowship programs.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Anterior Chamber / surgery
  • Clinical Competence
  • Cross-Sectional Studies
  • Education, Medical, Graduate / statistics & numerical data
  • Educational Measurement
  • Female
  • Health Surveys
  • Humans
  • Internship and Residency
  • Lens Capsule, Crystalline / pathology*
  • Lens Implantation, Intraocular / methods*
  • Lenses, Intraocular
  • Male
  • Middle Aged
  • Ophthalmology / education
  • Ophthalmology / statistics & numerical data
  • Phacoemulsification* / education
  • Phacoemulsification* / statistics & numerical data
  • Postoperative Complications / prevention & control
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Retrospective Studies
  • Sclera / surgery
  • Suture Techniques