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Whilst an anterior chamber lens implant (AC IOL) can be implanted during extracapsular cataract extraction with vitreous loss managed by anterior vitrectomy, lens implantation as a secondary procedure may avoid complications. We reviewed 47 consecutive cases of vitreous loss, 37 managed with primary and 10 with secondary AC IOLs. There was no significant difference in the level of final visual acuity but, as expected, it was reached earlier in the primary group (p less than 0.001). In the secondary group post-operative astigmatism was less marked (p less than 0.05) and the AC IOL haptic feet were correctly sited in the angle more frequently (p less than 0.05). Primary implant patients experienced more recurrent attacks of anterior uveitis (p less than 0.01) although the incidence of cystoid macular oedema and retinal detachment did not differ significantly. The results suggest that correct AC IOL positioning is more likely with a secondary procedure and that post-operative complications are fewer.

Primary or secondary anterior chamber lens implantation after extracapsular cataract surgery and vitreous loss