2.12\ Surgical Aphakia

Historically, cataract surgery was initially performed without placement of an intraocular lens implant. In the modern era, utilizing small incision cataract surgery, a variety of implantable lenses are in common use. However, in certain situations, the implantation of an intraocular lens after cataract surgery is still not undertaken. For example, the placement of intraocular lenses in very small children has been controversial over the years, and some children are left aphakic after surgery. On imaging, there is no apparent separation between the anterior and posterior chambers of the globe (Fig. 2.46).

Intraocular gas injection is a technique used to tamponade the retina during retinal detachment surgery until chorioretinal adhesions form (pneumatic retinopexy). The procedure is effective for treating retinal detachment in up to 80% of cases. Intraocular gas injection can also be used to restore intraocular volume during scleral buckle surgery. A variety of gases can be used, including air, sulfur hexafluoride, and perfluoropropane. On CT, air lucency is present antidependently in the vitreous body, creating an air-fluid level (Fig. 2.47). Complications of intraocular air injection include secondary glaucoma, subretinal gas or anterior chamber migration, vitreous hemorrhage, new retinal breaks, endophthalmitis, and delayed reabsorption of subretinal fluid.