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ABSTRACT
The IOLAB AZAR 91Z flexible anterior chamber intraocular lens may have the highest complication rate of any contemporary intraocular implant. Over 40,000 of these implants were inserted in human eyes. The complications of this lens includes a much higher than normal rate of chronic inflammation, cystoid macular edema, glaucoma, hyphema, vitreous hemorrhage, and pseudophakic bullous keratopathy. These complications together constitute the multiple manifestations of the UGH Plus syndrome. These complications tend to increase with time. The failure of the 91Z can be ascribed to problems of design and manufacturing causing excess movement, vaulting, and irritation of ocular tissue. Patients with this implant need to be notified of the high complication rate and the need for frequent follow-up. Most 91Z complications are recurrent or persistent and respond best to removal of the implant. Removal of the 91Z requires special technique to avoid traumatizing the eye. The design, materials, testing, manufacture, and recall of the 91Z needs close study to prevent another such problem prone lens from reaching widespread use.
The IOLAB Azar Model 91Z flexible anterior chamber intraocular lens may have the highest postoperative complication rate of any implant of contemporary design and manufacture.1-19 As postoperative follow-up increases so does the complication rate.4,10 This paper will review the problems and complications of the 91Z and propose an approach to symptomatic as well as asymptomatic 91Z patients. It is based on my experience2-4 since 1981 managing 135 9IZ patients plus numerous phone and written consultations from surgeons having problems with their own 91Z patients. These recommendations may prove useful for other complication prone lenses of the flexible, closed-loop anterior chamber design.19
The Model 91Z anterior chamber IOL was manufactured by IOLAB Corporation and designed in cooperation with Robert F. Azar, M. D. The lens (Figure) has a 6mm optic and 4-0 clear polypropylene (Prolene) closed compressible loops. The implant was manufactured in a variety of lengths from 12 mm to 13.5 mm. The 91Z was introduced in 1981 and was heralded in an extensive advertising campaign. Among the claimed advantages of the lens were stable, 3-point fixation, ease of insertion, reduced postoperative tenderness, and increased tolerance to trauma. It received the commercial endorsement of several ophthalmic surgeons.20 The 91 Z became one of the...