Experience with Extracapsular Extraction and Binkhorst 2-loop Intraocular Lenses: Preliminary Communication

Abstract

Summary: Extracapsular cataract extraction and implantation of a Binkhorst 2-100p intraocular lens were performed on 50 patients. The majority of the patients achieved a corrected postoperative acuity of 6/9. Operative-immediate postoperative and late postoperative complications are discussed. The commonest postoperative complication was the formation of a dense capsular membrane which required capsulotomy in 9 patients. Suggestions are put forward for improving the result of this rewarding operation. IntroductionThere has been, and still is, much controversy about intraocular implants. In 1976, after carefully questioning other surgeons experienced in implant surgery, we embarked on this form of surgery. We chose one of the longer established lenses, the Binkhorst 2·100p (Binkhorst 1973), because it was simple in design, it clipped to the iris immediately around the pupil without impinging on the angle or ciliary body, and had a small area of contact with the tissues. The other major decision was to carry out extracapsular extraction with the implantation. There were four reasons for choosing this. The first was the firmer support offered to the intraocular lens as opposed to after intracapsular extraction, and suturing was unnecessary. Furthermore, there was much less movement of the lens inside the eye, reducing chances of damage to the neighbouring tissues. Secondly, there was minimal risk of vitreous loss. Thirdly, implantation could be more or less guaranteed to the patient. Fourthly, there appeared to be less late macular oedema and retinal detachment than with the intracapsular procedure (Jaffe 1979, Kratz 1979.We realized, however, that there were obvious problems with the extracapsular extraction. It was known to be more time-consuming~nd there was the well known difficulty of removing adequate anterior capsular and cortical lens material giving rise to opaque late membrane formation. About 20% of such extractions are reported to require capsulotomy (Gilson et al. 1979, Jaffe 1979.