Ortho-Phako-Logy: A Novel System For Classifying Intra-Operative Intra-Ocular Lens Damages, And Its Correlation With Proposed Management Strategies

Background: Intra-operative IOL damages, though uncommon, are indications for near 16% of all-cause IOL explantations. Currently, there is no accepted classification system for intraoperative IOL traumas.

The purpose of this study is to report management strategies of various types of IOL damage based on our novel classification system, termed Ortho-Phakology.

A tertiary eye hospital. Surgical process modeling to propose a novel classification.

Design: Surgical process modeling to propose a novel classification.

Intraoperative damage to IOLs can be due to mechanical trauma from the surgery, improper IOL handling, or injector issues.

Identical to the human skeletal system, IOL has axial (Optic) and appendicular (haptic) systems. A novel classification was derived, which included: Category I (Axial/optic) with subtypes IA (Peripheral), IB (central). Category II (Appendicular / haptic damage) with subtypes IIA is a completely severed optic haptic junction (OHJ), IIB is partial amputation at OHJ, IIC mid third & IID terminal third haptic damage. Category III included polytraumas involving optic and haptic(s). Category IV includes manufacturing IOL defects.

The following are the proposed ways to effectively manage intraoperative IOL damages based on its types: IA – no manipulation required; IB – At the discretion of surgeon to retain/exchange; IIA – IOL explantation warranted; IIB, IIC – alternate fixation like reverse optic capture may be attempted or explantation required; IID- IOL shall be retained (fractured haptic distal to overall diameter of 12mm centers well); III – Explantation of IOL required; IV – At the discretion of surgeon to retain/exchange.

IOLs are identical to the human skeleton. A simple classification of intra-operative IOL damages based on site of damage, extent of damage, may inform the surgeon to make quick decisions on further surgical steps in retaining or explanting and exchanging the damaged IOL.