Aphakia

Copy of Power Point presentation of

Undergraduate (MBBS-prefinal year) lecture
taken by
Dr Sanjay Shrivastava
Professor of Ophthalmology
Gandhi Medical College
Bhopal (M.P.)
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Aphakia
When the crystalline lens has been removed
condition is called aphakia. In this condition
the crystalline lens is absent from its normal
position.
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Causes of Aphakia
1. Congenital:
a. True absence of lens, is a rare congenital
condition,
b. Posterior dislocation of lens (lens is
completely out of pupillary area, in posterior
segment).

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Causes of Aphakia
2. Acquired:
a. Surgical removal of lens
b. Complete absorption of lens in children
following trauma (act like surgical
procedure, needling)
c. Posterior dislocation of lens (usually
traumatic)
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Symptoms of Aphakia

Marked diminution of vision (in previously
emmetropic individuals)
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Signs of Aphakia
1. Markedly reduced visual acuity
2. Conjunctival scar may or may not be
there
3. Corneo-scleral / corneal scar
4. Deep anterior chamber
5. Tremulousness of iris
6. Jet black pupil
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Signs of Aphakia
7. Absence of lens
8. High hypermetropic fundus
9. High hypermetropic refraction

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Optics in Aphakia
Eye becomes high hypermetropic due to
removal of lens. There is only one
converging structure i.e. Cornea, which
separates two media of different refractive
indices, air and aqueous plus vitreous.
Anterior focal distance becomes 23 mm
(from 15 mm) and posterior 31 mm (from
24 mm)
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Optics in Aphakia
If the aphakic eye is 31 mm long
(equivalent to -21 D axial myopia) the
parallel light rays falling on cornea will
focus on retina.

There is total loss of accommodation in
aphakic eye.

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Optics in Aphakia
Astigmatism, against the rule in phaco
incision in upper sector , which is
minimum. With the rule astigmatism in
conventional ECCE with sutures in place in
upper part and this astigmatism decreases
after removal of sutures.
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Treatment
Spectacle
Contact Lens
Intra-ocular lens implantation
a. Posterior Chamber IOL
b. Iris claw IO lens
c. Anterior Chamber IOL
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Treatment
Spectacle :
Indications: Bilateral Aphakia, High myopic
patients (calculated IOL power less than 8
D) under going cataract surgery, and when
patient refuses IOL implantation surgery.
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Treatment
Spectacle: Patient who was emmetropic prior to
lens removal operation usually requires
For Distance: +10 D Sph and Astigmatic
correction (usually +1 to +2 D Cyl at 180 deg in
case of against the rule astigmatism, wherein
vertical curvature of cornea is flatter than
horizontal, and at 90 deg in case of with the rule
astigmatism)
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Treatment
Spectacle Correction:
For Near: Addition of +3 D Sph to distance
spherical correction.


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Disadvantages of Aphakic
Spectacle
Disadvantages of aphakic spectacle:
1. Magnification of image (seen by patient) by
30%
2. Lack of eye-hand coordination
3. Reduced visual field and poor peripheral /
eccentric acuity
4. Ring scotoma from prismatic effect of the edge
of the convex lens. Jack in the box phenomenon
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Disadvantages of Aphakic
Spectacle
5. Physical discomfort of wearing heavy
spectacle and cosmetically intolerable thick
spectacle
6. Wearing different optical correction for
different distances
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Contact Lens correction
Indications for use of Contact lens in aphakic
patients:
Young children, where IOL implantation is not
considered safe (usually below the age of 2 years)
Other aphakic patients where IOL has not been
implanted, and cornea is suitable for contact lens
fitting.
With contact lens magnification is around 8% which
is tolerable, without causing binocular diplopia
even in uniocular aphakics.
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Disadvantages of Contact
Lens
1. Fitting and removal of contact lens is
cumbersome procedure for most of our patients
2. Contact lens requires proper hygiene and
cleaning of contact lenses
3. It may be difficult for elderly patients with
tremors to manipulate contact lenses
4. Additional near (and sometimes intermediate
distance) correction is required
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Intra-ocular lens (IOL)
implantation
Best tolerated, there are no optical aberrations,
magnification is negligible (usually 1-2%),
IOL can be implanted in almost all cases
undergoing cataract surgery
Additional near (and sometimes intermediate
distance) correction is required (except in
those patients where multi-focal IOL is
implanted)
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Intra Ocular Lens Implantation
1. Done at the time of Cataract Surgery OR
2. Secondary IOL (IOL implantation done in an
aphakic eye). This may be posterior chamber
IOL implantation, in case where posterior
capsule is intact/present. Iris claw or anterior
chamber IOL. Posterior chamber IOL
implantation is preferred over other two types as
there is minimum risk of complications.
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Posterior Chamber IOL
Implantation
In the bag posterior chamber IOL

or

Sulcus fixated posterior chamber IOL
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Posterior Chamber IOL In the bag
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Posterior Chamber IOL Sulcus Fixated
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Anterior Chamber IOL
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Anterior chamber IOL
Complications:
There is higher risk of corneal endothelial
decompensation leading to corneal edema.
Uveitis, Haemorrhage and Glaucoma
(UGH) syndrome.