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Expert Interview Cornea
Pearls for Secondary Intraocular Lens
Implantation An Expert Interview with Marjan Farid
Gavin Herbert Eye Institute, University of California, Irvine, California, US
Marjan Farid is Director of the Cornea, Cataract, and Refractive Surgery Faculty and Vice-chair of the Ophthalmic Faculty at
the Gavin Herbert Eye Institute (GHEI) at the University of California, Irvine (UCI), California, US. Dr Farid’s clinical practice is divided
between patient care, teaching, and research. She enjoys teaching ophthalmology to medical students, ophthalmology residents, and
cornea fellows. She serves on the Residency Education Committee and is the Director of the cornea fellowship program at the GHEI.
Her research interests focus on corneal surgery, specifically in the use of the femtosecond laser for corneal transplantation. She
performs all forms of corneal transplantation—femtosecond enabled and lamellar keratoplasty (DSEK and DALK). Dr Farid is also the
founder of the severe ocular surface disease center at UCI. She performs limbal stem cell transplants, as well as artificial corneal
transplantation for the treatment of patients with severe ocular surface disorders. She serves as an associate medical director for the
Sight Life Eye Bank. Her work has been published in numerous peer-reviewed journals, she has authored six textbook chapters, and
travels to multiple national meetings to present her research work. She serves as an Editorial Board member of Ophthalmology, the
leading journal in her field. Dr Farid graduated summa cum laude from UCLA with a degree in biology. She earned her medical degree at
UC-San Diego in 2002 and completed a transitional year internship at Scripps-Mercy Hospital in San Diego. She completed her residency
training in ophthalmology at UCI. She subsequently completed her fellowship training in the area of cornea/external disease and
refractive surgery under the mentorship of Dr Roger Steinert at UCI.
G aining expertise in a number of surgical approaches to secondary intraocular lens (IOL) implantation allows retina specialists to tailor
the procedure to the patient. In this expert interview, Marjan Farid of Gavin Herbert Eye Institute shares some tips for the optimal
use of surgical techniques, including iris fixation suture lens implantation, intrascleral fixation of posterior chamber IOLs, and anterior
chamber lens implantation.
Keywords Secondary intraocular lens implantation,
intrascleral fixation, posterior
chamber, anterior chamber
Disclosure: Marjan Farid has no conflicts of interest to
declare. No funding was received in the publication of this
article. This is an expert interview and as such has not
undergone the journal's standard peer review process.
Acknowledgements: Editorial assistance was
provided by Katrina Mountfort, Freelance Medical
Writer, supported by Touch Medical Media.
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility
for the integrity of the work as a whole, and have
given final approval to the version to be published.
Open Access: This article is published under the
Creative Commons Attribution Noncommercial License,
which permits any noncommercial use, distribution,
adaptation, and reproduction provided the original
author(s) and source are given appropriate credit.
Received: February 6, 2017
The role of secondary intraocular lens (IOL) implantation has evolved. Following advances in cataract
surgery, surgical aphakia is becoming uncommon, and secondary IOL implantation is now most
commonly performed as part of an IOL exchange procedure. A number of techniques and IOLs are
available for secondary IOL implantation, and debate persists regarding which methods are best for
eyes lacking sufficient capsular support. It is therefore important to consider specific techniques,
choice of IOL, sutures, and medication regimens, in order to tailor the approach to the individual
patient. In an expert interview, Marjan Farid of Gavin Herbert Eye Institute discusses the optimal use
of some of the most widely used techniques.
Q: What are the advantages and disadvantages of iris fixation
suture lens implantation in aphakic eyes?
The main advantages to iris-fixated IOLs as a secondary lens option are that they can be performed
through a small cataract-sized clear corneal incision and do not require conjunctival or scleral surgery.
Standard foldable three-piece IOLs are the preferred lens option in these cases as one-piece acrylic
IOLs cannot be used for iris fixation, since they can cause iris chafing. This technique does, however,
require normal iris anatomy. The disadvantages to this technique are the potential for pupil ovaling if
the sutures are not placed peripheral enough. Furthermore, since manipulation of the iris is required,
the risk of uveal irritation and cystoid macular edema (CME) are present.
Published Online: February 23, 2017
Citation: US Ophthalmic Review, 2017;10(1):13–4
Corresponding Author: Marjan Farid, MD, University of
California-Irvine, Gavin Herbert Eye Institute, 850 Health
Sciences Road, Irvine, CA 9269, US. E: email@example.com
TOU CH MED ICA L MEDIA
Q: What surgical techniques can minimize complications in the
implantation of iris fixation suture lenses?
In order to perform iris-fixated IOLs, certain instrumentation is required and will greatly improve
the chances of success. A set of hooks to manipulate the IOL and iris (such as Lester or Kuglen
hooks), small incision forceps and scissors, and a heavy molecular weight viscoelastic are
essential. A combined cohesive and dispersive ophthalmic viscoelastic device (OVD) is my
preferred viscoelastic for these cases as it provides excellent endothelial protection, pushes the