thirty - three eyes of 33 patients who underwent implantation of pc iols into the ac between may 2006 and july 2008 were evaluated retrospectively . fourteen eyes had inadequate support due to posterior capsular rupture during phacoemulsification , and 19 eyes were previously aphakic . the procedures were performed under topical or subconjunctival anesthesia . if the remaining capsular support was considered to be insufficient for iol implantation during phacoemulsification , an anterior vitrectomy was performed and acetylcholine was injected into the ac for miosis . the vacuum level of the vitrectomy was set to 200 mmhg and the frequency to 50 cuts / min . two iridectomies were performed on the midperipheral iris with a vitrectomy cutter at the 7 and 1 oclock positions . the iols were implanted in the ac with the haptics passing through the iridectomies to the pc . the first five patients received polymethylmethacrylate ( pmma ) iols ( aurolab , madurai , tamil nadu , india ) , while single piece foldable iols ( ocuva , vsy , istanbul , turkey ) were implanted in the remaining 28 patients . ( a ) intraoperative posterior capsule rupture and desantralization of the sulcus - fixated iol . ( d - f ) using the same probe at 50 - 100 mmhg vacuum , two iridectomies were created at the 1 and 7 oclock positions . ( g and h ) iol haptics were implanted into the iridectomies using a dialer with the aid of ocular viscoelastic substance . ( i - o ) suturation of the inferior and superior iol haptics to the iris using mccunnel 's technique the procedures were performed under topical or subconjunctival anesthesia . if the remaining capsular support was considered to be insufficient for iol implantation during phacoemulsification , an anterior vitrectomy was performed and acetylcholine was injected into the ac for miosis . the vacuum level of the vitrectomy was set to 200 mmhg and the frequency to 50 cuts / min . two iridectomies were performed on the midperipheral iris with a vitrectomy cutter at the 7 and 1 oclock positions . the iols were implanted in the ac with the haptics passing through the iridectomies to the pc . the first five patients received polymethylmethacrylate ( pmma ) iols ( aurolab , madurai , tamil nadu , india ) , while single piece foldable iols ( ocuva , vsy , istanbul , turkey ) were implanted in the remaining 28 patients . ( a ) intraoperative posterior capsule rupture and desantralization of the sulcus - fixated iol . ( d - f ) using the same probe at 50 - 100 mmhg vacuum , two iridectomies were created at the 1 and 7 oclock positions . ( g and h ) iol haptics were implanted into the iridectomies using a dialer with the aid of ocular viscoelastic substance . ( i - o ) suturation of the inferior and superior iol haptics to the iris using mccunnel 's technique the mean age of the 16 men and 17 women was 56.3  12.2 years . fourteen eyes had inadequate posterior capsular support due to posterior capsular rupture during phacoemulsification and underwent primary iol implantation . nineteen eyes that had previously been left aphakic for various reasons underwent secondary iol implantations . mild corneal edema , which resorbed in 5 - 7 days , was detected in eight of 14 patients with primary iol implants . pupillary block developed in two of the first five patients who had received a pmma iol , and neodymium - doped yttrium aluminum garnet ( nd : yag ) laser iridotomies were performed to relieve the block in these eyes . one of the patients with a pmma iol presented with dislocation of the haptic into the ac . the haptic was resutured to the iris with a 10/0 nylon suture for this patient . none of the patients had longlasting corneal edema , iris atrophy , uveitis , corneal contact with iol , or retinal detachment during the follow - up period . pigment dispersion was seen in four patients ; however , we did not document any pigmentary glaucoma . while mild guttata was seen in five eyes during the follow - up period , none of the eyes had corneal decompensation . a marked increase in visual acuity was observed in the patients with posterior capsular rupture during surgery compared to the preoperative levels ( 20/50 versus 20/25 ) , while visual acuity increased moderately from 20/40 to 20/30 in those who were previously aphakic and underwent secondary iol insertion . posterior capsular rupture is also a well - known intraoperative complication of cataract surgery . in the presence of a posterior capsular tear , an iol can be placed in the sulcus if the capsular rim is available , or in the bag if the tear is small . if the remaining capsule does not offer sufficient support for the iol implantation , the surgeon may choose one of following options : ac iol , iris - claw iol , iris - sutured iol , pc iris - sutured iol , sutureless iol with iris anchors , or scleral - fixated lol . ac iols and scleral - fixated iols are generally recommended when capsular support is insufficient or absent . complications associated with ac iols , including postoperative inflammation , pupillary transformation , glaucoma , and the loss of corneal endothelial cells have been reported . even though there is no contact between scleral - fixated iols and the fine structures of the ac angle and corneal endothelium , these iols also have some drawbacks , which limit their usage . recently , totan and karadag reported sutureless scleral fixation of a three - piece foldable iol using 25-gauge transconjunctival sutureless vitrectomy trocars in patients with insufficient posterior capsule support . iris - claw iols may be a good alternative , however higher costs limit their extensive usage . by implanting a pc iol in the ac through two iridectomies , the optics and haptics of the iol are placed in positions that are far from the corneal endothelium and the ac angle . we observed that patients had transparent corneas , centralized iols , and iol haptics that fitted into the iridectomies throughout the follow - up period . the number of patients with complications was very small , and the complications were negligible and not vision - threatening . we also found that primary iol implantations gave better postoperative visual results compared to secondary implantations . the main limitation of the study is the lack of availability of data associated with corneal endothelium pre- and postoperatively . we created the iridectomies at one and seven oclock positions 180 apart from the midperipheral iris . , iol dislocation may be due to large iridectomies , loose sutures or suture release , or the inappropriate positions of opposed iridectomies . however , iol dislocation in this technique can easily be overcome by resuturing the haptic into position . the surgical correction of an iol dislocation in our technique is less traumatic and complicated than that for sclera - fixated or posterior iris - fixated iols . this study suggests that this technique is a practical alternative that leads to favorable visual outcomes and minimized risk of complications in eyes without adequate capsular support . however , a long - term study on a large population is required to confirm these findings .
we aimed to evaluate the implantation of a posterior chamber intraocular lens ( iol ) in the anterior chamber ( ac ) with the haptics passing through two iridectomies to the posterior chamber . 
 a total of 33 eyes of 33 patients with inadequate posterior capsular support due to either previous aphakia or posterior capsular rupture during cataract extraction were included in the study . 
 a double iridectomy was performed on all patients using a vitrectomy probe on the midperiphery of the iris . 
 iols were implanted in the ac , and the haptics were passed through the iridectomies to the posterior chamber . 
 the mean follow - up time was 25.3 months . 
 ac hemorrhage occurred in five patients during the iridectomy procedure . 
 corneal edema was detected in eight of 14 patients with primary iol insertions . 
 haptic dislocation was detected in only one patient . 
 this technique may be a good alternative to scleral - fixated iol implantation in eyes with aphakia .