Selection of the proper IOL is also important in eyes with glaucoma. Posterior chamber silicone, polymethyl methacrylate (PMMA), and acrylic lenses appear to be well tolerated (87), although one study found higher postoperative IOP with the acrylic IOLs than with the silicone lenses (88).
Anterior chamber lenses should, in most cases, be avoided in glaucomatous eyes. However, when loss of capsular support precludes the standard implantation of a posterior chamber lens, the surgeon usually must decide between a sutured posterior chamber lens and an anterior chamber lens. Several techniques have been described for the former option (89,90,91,92,93,94), most of which use the basic principle of passing two 10–0 Prolene sutures attached to the lens haptics through the ciliary sulcus and sclera, and securing them beneath conjunctival and partial-thickness scleral flaps.
These can all be difficult techniques, however, especially if they are not performed frequently, and it has been reported that the much easier procedure of implanting a semiflexible, one-piece, open-loop anterior chamber IOL is associated with reasonable long-term IOP control in most glaucomatous eyes (95), although the tendency toward increased IOP in eyes with an anterior chamber IOL has been also observed (96,97).
Placing of releasable sutures on the scleral flap has been advocated for the combined procedure (98).
