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Providing eye surgery in Cheshire, Manchester, Lancashire and all surrounding areas.

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Dislocated lens and aphakia:

How does it occur?
Sometimes the natural human lens, or an artificial lens implant, can become displaced making the vision out of focus. This may occur by:

  • Inherited conditions: the natural lens can be wobbly and out of position (ectopia lentis) caused by conditions such as idiopathic Ectopia lentis and Marfan’s syndrome.
  • Eye injuries: the natural lens or a lens implant can become displaced after severe trauma.
  • Complicated cataract surgery: If a cataract operation is complicated the lens may not be securely placed within the eye and can be come displaced, or a lens may not have been implanted.

What is Aphakia?

Sometimes the lens or lens implant has had to be removed at a previous operation so that there is no lens in the eye, this is called aphakia. The eye is then severely out of focus.

What can be done if natural lens is displaced?

The displaced natural lens can be removed usually combined with a vitrectomy. In young patients it can be best with replace the focussing power with a contact lens, but in older patients lens implantation can be considered. However, because the lens capsule is usually absent a lens implant cannot be placed in the usual way.

How can a lens implant be placed without a lens capsule?

There are various different technique, each with benefits and potential complications.

  • Anterior chamber lens implant (ACIOL): a straightforward technique the ACIOL is placed in front of the pupil, but can cause raised pressure (glaucoma) and damage to corneal endothelium long term. Used in older patients and not in the young.
Anterior Chamber Lens Implant

Anterior chamber lens implant (ACIOL)
visible in front of iris

  • Artisan lens implant: a lens implant is placed in front of the pupil with tiny clips that attach the lens to the iris (coloured part surrounding the pupil). This is a straightforward technique but needs a healthy iris, but may be associated with corneal damage long term.
Artisan Lens

Artisan lens implant seen in front of iris

  • Scleral haptic fixation of lens implant: this is a new technique which is more complex but may give a better long term result. The tiny loops attached to the lens (haptics) are attached to the inner aspect of the eye by tiny tunnels in the sclera. Sometimes this technique can be used with a displaced lens implant already in the eye, or a new lens can be implanted.
Before Implant Surgery After Implant Surgery

Before surgery:
lens implant displaced inferiorly

After scleral haptic fixation
the lens is stable and well centred
so vision is improved

Mr Charles has experience of all these different techniques and will advise what might be best in your case.

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