Aphakia

Copy of PowerPoint presentation of

Undergraduate (MBBS-prefinal year) lecture
taken for Gandhi Medical Students in January
2007)
 Aphakia

• When the crystalline lens has been

removed condition is called aphakia. This
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, or
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 implantation
a. Posterior Chamber
b. Iris claw 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
2. Secondary IOL (IOL implantation done in
an aphakic eye). This may be posterior
chamber IOL implantation, in case where
posterior capsule is 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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 Iris Claw IOL

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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.

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