Comm Eye Health Vol. 15 No. 41 2002 pp 14. Published online 01 March 2002.

Letter. ACIOLs in Guatemala

John Cheatham MD

Obras Sociales del Hermano Pedro Antigua, Guatemala

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Dear Editor

I have followed with interest the very favourable responses to John Sanford- Smith’s earlier appeal for a reappraisal in selected circumstances of ICCE with the newer ‘open loop’ ACIOL’s. We have used hundreds of ACIOL’s in Guatemala over the past ten years – both the classic 4point Kelmann and more recently the Omnifit’ 12.8mm 3point Kelmann (Aurolab A5528). This is in large part due to the very high incidence of pseudoexfoliation among the Mayan population.

We have noticed no more postoperative problems than with PCIOL’s.

As our patients are poor and often from isolated mountainous areas, I have the feeling we may not be seeing the long range effects of posterior capsule opacification. Our clinic has a YAG laser but few understand its purpose or are able to return to take advantage of it. In the occasional case of operating on one eye with ICCE/ACIOL and the other with ECCE/PCIOL, I have been surprised to see how quickly the patient reports subjectively clearer vision following the former procedure – even though tested visual acuity may at the time be the same.

We routinely use the above ACIOLS after vitreous loss with often just a scissors vitrectomy. Again, we see few complications. Not to use an intraocular lens in the case of vitreous loss is virtually to ensure a 100% complication rate.