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  • Comprehensive Ophthalmology

    This small retrospective study found that IOL scaffold surgery provided an effective, relatively noninvasive means of emulsifying moderate to soft nuclear remnants in eyes with intraoperative posterior capsule rupture (PCR), with good visual outcomes and a favorable complication rate.

    The purpose of the IOL scaffold technique is to prevent extension of the PCR, and also to prevent nuclear fragments from dropping into the vitreous cavity. In this procedure, a three-piece foldable IOL acts as a temporary platform, facilitating nuclear emulsification, followed by placement of the same IOL in the sulcus in eyes with good capsulorhexis support or in the capsular bag, depending on the extent of PCR. The IOL acts as a scaffold or a barrier to compartmentalize the anterior and posterior chambers, thereby preventing vitreous prolapse, vitreous hydration and nucleus drop.

    The study’s authors reviewed the charts of 20 patients (20 eyes) that underwent the IOL scaffold technique after intraoperative PCR left them with soft to moderate nuclear remnants. All surgeries were performed by a single surgeon, Dr. Amar Agarwal, MSOphth, FRCS, FRCOphth. The IOL implanted was a three-piece, acrylic, biconvex 6 mm optic, with modified C-loop haptics, and a 13 mm length.

    At a mean follow-up of 12 months, the corrected visual acuity was 20/20 in 15 eyes and 20/30 in five eyes. The corneas were clear, with a mean endothelial cell loss of 3.65 percent. The mean central macular thickness was 182.5 microns, and clinical macular edema was present in one of the 20 eyes.

    The authors note that the IOL scaffold technique has the advantage of a closed-chamber manipulation that is associated with a relatively low incidence of vitreous loss because the self-sealing, small, clear corneal wound maintains the ocular integrity. This maintains the anterior chamber and IOP and discourages the forward movement of the vitreous, which would otherwise occur in an “open globe” when converted to an extracapsular cataract extraction. T

    They also note that this technique is cost-effective because no specific device is required and inaccessibility or unavailability of the device is not a cause of concern.

    The authors recommend this technique only for soft-to-moderate nuclear remnants. To avoid corneal complications, the technique should be avoided in hard cataracts or shallow anterior chambers.