IOL Placement with Posterior Capsule Rupture
If posterior capsule support for intracapsular placement of the IOL is inadequate, the surgeon should attempt to preserve the anterior capsule and capsulorrhexis to enable placement of the IOL optic in the capsular bag with the haptics placed in the ciliary sulcus (“optic capture”; Fig 10-7A). Generally, a 3-piece IOL with a total diameter greater than 12.5 mm may be inserted into the ciliary sulcus with or without optic capture. In certain situations, a single-piece acrylic IOL may be safely placed in the ciliary sulcus by reverse optic capture (Fig 10-7B). In reverse optic capture, the haptics of the IOL are placed within the capsule, while the optic is captured through the anterior capsule into the sulcus. To avoid possible UGH syndrome, the haptics of the single-piece acrylic IOL must be fully contained within the capsule; otherwise, a 3-piece lens is recommended.
Figure 10-7 Intraocular lens (IOL) capture. A, IOL optic capture. A 3-piece IOL with haptics in the sulcus. The optic is “captured” within the capsule so that the anterior capsule edge is anterior to the optic. B, IOL reverse optic capture. A 1-piece IOL with the optic in the sulcus. The optic is “captured” by capsulorrhexis so that the anterior capsule edge is anterior to the haptics.
(Figure developed by Natalie Afshari, MD, and illustrated by Mark Miller.)
If capsular integrity is insufficient, the surgeon may substitute an anterior chamber lens. A posterior chamber IOL (PCIOL) may also be used in the absence of capsular support by suturing the haptics to the iris or by fixing the haptics to the sclera through the ciliary sulcus. Several techniques for IOL fixation are discussed in detail in Chapter 11. If significant lens material remains in the posterior chamber, it can be approached via a pars plana vitrectomy performed by a vitreoretinal surgeon.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.