The following reader-author exchange refers to “The Literature” column that appeared in our September 2014 edition.
In their discussion of the relative benefits of the glued IOL technique, Waisbren and colleagues decry the complications of anterior chamber IOLs (ACIOLs) by saying, “All of these mechanical complications relate to the anatomical position of the lens.” To support this statement, they cite a 1987 article on closed-loop ACIOLs, which, of course, are no longer available. To my knowledge, there is still no study showing that modern open-looped ACIOL outcomes are inferior to any other choice in the setting of no capsular support. Though I concur that other options are viable and may ultimately prove superior in some circumstances and in experienced hands, the discussion section of this article does a disservice to the reader, who may not notice the statement's antiquated and irrelevant source.
Lisa Brothers Arbisser, MD
While ACIOLs are certainly acceptable in some situations, it has been our experience that ACIOLs are often placed under duress, after the surgeon has broken the capsule. In our collective experience, frequently, they are misplaced or sized incorrectly, or vitreous is present in the anterior chamber, which further complicates the situation. These untoward complications may lead to chronic inflammation, corneal endothelial cell loss, and subsequent corneal failure. Based on this, it is generally agreed upon that a posteriorly placed IOL is preferable to one in the anterior chamber. Perhaps the lack of recent literature illustrates the trend away from ACIOLs.
Emily Waisbren, MD
David C. Ritterband, MD
John Seedor, MD
Jai G. Parekh, MD, MBA