ArticleBMC ophthalmology2026
Custom-made anterior chamber intraocular lens for aphakia: a case report.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAphakia without adequate capsular support requires alternative intraocular lens (IOL) fixation strategies. Standard options include sulcus-fixated posterior chamber IOLs and retropupillary iris-claw lenses, both of which depend on specific anatomical prerequisites. When these are absent, anterior chamber IOLs (AC-IOLs) become one of the few remaining options; however, the only widely available angle-supported model has been the rigid Kelman Multiflex (PMMA), unchanged since its FDA approval in 1980. We describe the development and three-year clinical outcome of a custom-made, foldable, hydrophilic-acrylic, angle-supported AC-IOL implanted in an eye in which neither sulcus nor iris-claw fixation was feasible. CASE PRESENTATION: A 21-year-old woman presented with right-eye aphakia following congenital cataract surgery in early childhood, with contact lens intolerance. Extensive posterior iris-capsule-vitreous synechiae and a maximum pupil diameter of 4.0 mm precluded both sulcus-fixated posterior chamber IOL and retropupillary iris-claw implantation. A custom foldable, three-haptic, angle-supported AC-IOL (VKL Type 37 F, Design Kermani; Morcher GmbH, Stuttgart, Germany) was designed under MDR Article 2(3) for custom-made devices and, after a development period, implanted at 24 years of age through a 2.6 mm incision under topical anaesthesia. Over 36 months, uncorrected distance visual acuity improved from 20/400 to 20/25 and corrected distance visual acuity reached 20/20. Intraocular pressure remained stable at 20 mmHg. Endothelial cell density decreased from 2927 to 2704 cells/mm² (- 7.6%). Scheimpflug imaging confirmed an IOL-to-endothelium distance of 1.68 mm and IOL rotation of less than 5°. No inflammation, pupillary distortion, or secondary glaucoma was observed.
conclusionsThis custom-made, foldable, angle-supported AC-IOL demonstrated stable centration, refractive predictability, and acceptable endothelial cell loss over three years. It may offer a minimally invasive secondary IOL option for selected aphakic eyes in which sulcus or iris-claw fixation is not feasible, and may represent a contemporary alternative to the rigid PMMA designs that have dominated the angle-supported AC-IOL segment since 1980.
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