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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.)
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
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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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Done at the time of Cataract Surgery OR 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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