Lens implantation is the best method for correcting aphakia, rapidly restoring vision and establishing binocular single vision and stereoscopic vision. Lens implantation is suitable for people with myopia, cataracts, and other conditions. During the procedure, a minimally invasive incision is made at the edge of the cornea and sclera. A gel is then injected into the eye to protect the tissues. The flexible, retractable ICL lens is then injected into the eye and gently positioned behind the iris. Lens implantation provides both vision correction and eye treatment. Under normal circumstances, the effectiveness of the surgery will not change significantly over time.
Applicable people
Lens implant surgery is suitable for people with myopia, cataracts, etc. Lens implant surgery is a professional operation. Patients are advised to choose a regular medical institution and consult a professional ophthalmologist with rich diagnosis and treatment experience for treatment.
Taboo groups
1. Patients with acute conjunctivitis and keratitis.
2. People suffering from keratoconus, glaucoma, severe dry eye, etc.
3. Patients with severe amblyopia and extremely poor vision.
4. People with scar constitution, diabetes, and collagen diseases.
5. People with exophthalmos and incomplete eyelid closure.
6. One-eyed patients.
7. Those who are menstruating, pregnant or breastfeeding.
Technical/surgical risks
1. Corneal edema: The main measures to prevent corneal edema include preventing instruments and artificial lenses from contacting the corneal endothelium; performing surgical operations with the anterior chamber closed as much as possible; using viscoelastics to protect the endothelium; preventing foreign matter from adsorbing on the corneal endothelium; avoiding prolonged flushing; do not spray the flushing solution directly onto the corneal endothelium, and do not spray it too quickly. The liquid used for anterior chamber perfusion should be non-toxic to corneal endothelial cells.
2. Hyphema: Preventative measures include appropriate cautery to stop bleeding before corneoscleral incision; avoiding incisions at the 3 and 9 o’clock positions; and when performing iridectomy, the excision site should be as far away from the iris root as possible and slightly closer to the pupil to avoid the large iris blood vessels. If hyphema occurs, air, fluid, or viscoelastic agents can be used to increase intraocular pressure.
3. Iridocyclitis: Prevention methods include avoiding damage to the iris; using viscoelastics to protect the iris; thoroughly removing the cortex; applying eye drops of corticosteroids and prostaglandin inhibitors within 6 weeks after surgery; injecting corticosteroids under the conjunctiva after surgery; taking oral corticosteroids, and closely observing the patient after surgery.
4. Pupillary fibrinous exudate: This can cause decreased vision, pupillary obstruction, and secondary glaucoma. In such cases, laser iridotomy should be performed to relieve pupillary obstruction. Mild to moderate fibrinous exudate accompanied by posterior synechiae usually only requires routine use of corticosteroids.
5. Intraocular lens toxicity syndrome: With the improvement of the quality of intraocular lenses, toxic reactions directly related to intraocular lenses are extremely rare.
6. Endophthalmitis: Early diagnosis, isolation of the pathogen, and use of sensitive antibiotics are essential. Culture of the anterior chamber aspirate and transsermal vitreous aspirate for pathogenic microorganisms, along with drug sensitivity testing, is crucial. Timely vitrectomy and intravitreal antibiotic injection can effectively control the infection.
7. Glaucoma: Excessive use of viscoelastics, postoperative inflammation, trabecular meshwork edema, and repeated friction of the intraocular lens surface or lens loops against the posterior iris surface after surgery may lead to pigment cell loss and glaucoma. Intraocular pressure should be measured and monitored in the early postoperative period.
8. Pupil deformation: Anterior capsule residue, iris involution, and local adhesion of the posterior edge of the pupil may cause pupil deformation, which usually does not affect vision.
9. After-cataract: The most serious late-stage complication, it is associated with inflammation and epithelial cell proliferation. The incidence in adults can reach 10%-50% after three years, and children are almost always at risk. Nd:YAG laser posterior capsulotomy or surgical incision can be performed. To prevent after-cataracts after intraocular lens implantation in children, most surgeons recommend performing a posterior capsulotomy immediately after IOL implantation. The main complication of posterior capsulotomy is endophthalmitis, and it should be performed under strict aseptic conditions.
10. Retinal complications, such as cystoid macular edema, should first be identified and eliminated (e.g., inflammation, vitreous cords traction on the retina and macula). Oral or topical anti-inflammatory drugs can be used. When inflammation is significant, oral or subconjunctival corticosteroids can be used. Low-dose acetazolamide has recently been reported to be effective.
11. Abnormal intraocular lens position: During pupillary clamping, the optical portion of the intraocular lens is completely or partially positioned in front of the iris. In cases of free clamping, the iris and lens capsule are not adhered, and repositioning can be achieved by dilating the pupil first and then mioticizing it. Alternatively, after applying topical anesthesia to the operated eye, gently pressing the cornea at the location of the haptic with a cotton swab or small stick under a slit lamp can achieve repositioning. In cases of fixed pupillary clamping, the iris and lens capsule are adhered, requiring surgical repositioning.
12. Subchoroidal hemorrhage: Although rare, it can have serious consequences. If it occurs, the surgical incision should be closed immediately, and balanced salt solution or viscoelastic should be injected into the anterior chamber to increase intraocular pressure. The decision to abandon intraocular lens implantation should be made based on the severity of the condition.
Postoperative care
After lens implantation surgery, you should pay attention to local care, daily routines, follow-up examinations, etc.
1. Local care: Pay attention to eye hygiene after surgery to avoid eye infection; try to avoid splashing water into the eyes when washing your face or hair; do not apply eye makeup within 1 week after surgery.
2. Precautions in daily life: In the early period after surgery, your vision may not be very good when looking at close objects and in dim light. Try to read and use the computer in a room with good lighting. Do not overuse your eyes, and do not look at computers, mobile phones, TVs, or play games for long periods of time.
3. Follow-up examination: An outpatient examination will be conducted on the first day after surgery, and then regularly as directed by the doctor. This is usually done one week after surgery, one month, three months, six months, and 12 months after surgery, and every six months thereafter. Observe the recovery of vision and any discomfort. If any abnormality is found, seek medical attention promptly.
Preoperative precautions
1. Communicate with the doctor before the operation to understand the specific process, related risks, and plan design of the lens implantation surgery, and be mentally prepared.
2. If necessary, complete relevant examinations (such as cardiopulmonary, blood, etc.) to confirm that there is no serious systemic disease and no allergy to surgical materials or anesthetics.
3. If there is a history of surgical trauma, use of special drugs, or repair with other cosmetic materials on the eyes or other related parts, you must inform your doctor in advance.
4. Patients who use special medications (such as the antiplatelet drug aspirin) should communicate with their doctor in advance and generally stop taking the medication 1-2 weeks before surgery as directed by the doctor.
5. Women should avoid use during menstruation, lactation and pregnancy.
6. Patients with special medical histories such as local skin infection, acute or chronic inflammation, etc. should follow the doctor’s advice to delay surgery.
7. It is recommended to eat a light diet before surgery and avoid spicy, stimulating and greasy foods.
8. Correct bad living habits, such as smoking and alcohol consumption before surgery.
9. Clean your eyes before surgery.
Surgical procedure
Lens implantation surgery mainly includes making an incision, injecting viscoelastic material, and implanting an artificial lens