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  • New technique for IOL implantation in eyes with PCR

    Cataract/Anterior Segment

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    Investigators describe a new technique for capsule fixation of 1-piece acrylic IOLs in the presence of a large posterior capsule tear resulting in an open capsule. This technique achieves reverse optic capsulorhexis capture without the challenge of injecting the IOL through the continuous curvilinear capsulorhexis (CCC) with an open posterior capsule. The authors propose the term haptic tuck for reverse optic capture for this technique.

    Study design

    The IOL is placed into the sulcus. If using a toric IOL, the toric marks on the optic should be aligned with the corneal marks. Next, each haptic is separately tucked through the anterior CCC opening, leaving the optic edges above the capsule.

    Watch a demonstration of this technique in this accompanying video on the Journal of Cataract & Refractive Surgery.

    Outcomes

    Surgeons reported using this technique in a 75-year-old patient who had a small tear in the posterior capsule that occurred superiorly during aspiration of cortical material near the equator of the lens. It was not possible to convert the tear into a posterior CCC, and the haptic tuck for reverse optic capture technique was used. At 4 weeks postop, the patient stated that the visual acuity in the left eye was good and clear for distance. The UDVA was 25+1 with a pinhole acuity of 20/20. A slit-lamp examination showed a stable, well-centered IOL with the axis aligned as planned.

    Limitations

    Although this technique keeps the bulky, thick acrylic haptics out of the sulcus, the IOL's optic is in the sulcus. For high hyperopes, the optic may be fairly thick and the anterior segment somewhat crowded, even in a pseudophakic eye. Clinicians must therefore remain vigilant in detecting (and reporting) subsequent iris chafing with resultant pigment dispersion, areas of iris atrophy and hyphema.

    Clinical significance

    This technique is a useful addition to our armamentarium of ways to manage posterior capsule rupture (PCR). It would be especially helpful when a toric IOL is planned.