Is there a role for ACIOLs in developing countries?

The use of anterior chamber intraocular lenses (ACIOLs) in the 1970s produced a flood of late complications mainly from corneal decompensation and uveitis with secondary glaucoma plus hyphaema (UGH syndrome). This led to the development and widespread use of posterior chamber intraocular lenses (PCIOLs) and to ACIOLs receiving a bad reputation. The ACIOLs used were of a non-flexible closed loop design.1 During the 1990s a flexible open loop ACIOL has been increasingly used in the western world for secondary implantation, or if planned extracapsular cataract extraction (ECCE) with PCIOL has not been possible due to capsule rupture. Recent studies in Asia and Africa have evaluated the open loop ACIOL following intracapsular cataract extraction (ICCE) in order to determine whether ICCE + ACIOL is a safe procedure. If so, this could be used as an alternative to ICCE with aphakic spectacles for surgeons who are not able to perform ECCE/PCIOL surgery.