title: Preoperative assessment of secondary intraocular lens implantation for aphakia: a comparison of 2 techniques.
abstract: OBJECTIVE
  To compare the preoperative evaluation of secondary intraocular lens (IOL) implantation in aphakic adults following cataract extraction in childhood using slitlamp examination and high-frequency ultrasound (HFU).
  
  
  METHODS
  In a prospective case series, patients who had had lensectomies for congenital cataracts without primary implantation IOL were evaluated for secondary IOL insertion. Slitlamp examination and HFU were performed to study the degree of ciliary sulcus support and iridocapsular adhesions. The choice of IOL (posterior sulcus supported or anterior chamber) was compared using the 2 techniques.
  
  
  RESULTS
  Nine eyes of 5 patients (3 men and 2 women aged 15 to 40 years) were assessed for secondary IOL insertion. Clinical slitlamp examination suggested that 3 of 9 eyes had inadequate sulcociliary support, but HFU of these eyes revealed more than adequate capsular remnants. In all 9 eyes, sulcus-supported posterior chamber IOLs were implanted. No postoperative complications were observed, and no patients required surgery for dislocated IOL.
  
  
  CONCLUSIONS
  High-frequency ultrasound is a useful adjunct for the preoperative assessment of secondary ciliary sulcus-supported IOL implantation in aphakic patients who had congenital cataract extraction without IOL implantation. In patients in whom inadequate dilation precludes the detection of capsular support, posterior ciliary sulcus-supported secondary IOL implantation should be considered preoperatively. Although the technique enhances surgical planning and informed patient consent, the final decision occurs at the time of surgery with direct visualization of the ciliary sulcus support.
authors.affiliation: Department of Ophthalmology, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: D J
authors.initials: DJ
authors.lastname: De Silva
authors.forename: Ken K
authors.initials: KK
authors.lastname: Nischal
authors.forename: R B
authors.initials: RB
authors.lastname: Packard
mesh_terms: D000293:Adolescent; D000328:Adult; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging*; D001036:Aphakia, Postcataract / Q000601:surgery*; D002386:Cataract / Q000151:congenital; D002387:Cataract Extraction; D002924:Ciliary Body / Q000000981:diagnostic imaging*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007498:Iris / Q000000981:diagnostic imaging*; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D014463:Ultrasonography