Secondary in-the-bag Intraocular Lens Implantation in Aphakic Eyes After Vitrectomy and Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment

Abstract

Purpose: To describe a novel technique for capsular bag reopening and secondary in-the-bag intraocular lens (IOL) implantation in aphakic eyes after vitreoretinal surgery and intraocular tamponade. Methods: We enrolled 14 eyes of 14 patients who underwent primary vitreoretinal surgery with silicone oil tamponade for rhegmatogenous retinal detachment between September 2018 and September 2019. The novel technique was used for capsular bag reopening and foldable single-piece IOL implantation. Patients were followed up at least 24 weeks with routine ophthalmic examinations, corneal endothelial cell density, and IOL tilt and decentration measurement. Results: The procedure was successfully completed in 13 cases; in one case, because of posterior capsular tear, the IOL was implanted with ciliary sulcus fixation. After a mean follow-up of 48.8 ± 14.8 (range, 24.9–65.9) weeks, the best-corrected visual acuity (before 20/76 Snellen, 0.63 ± 0.23 logarithm of the minimum angle of resolution equivalent and after 20/35 Snellen, 0.32 ± 0.32 logarithm of the minimum angle of resolution equivalent; P = 0.001) and spherical equivalent (before +8.22 ± 4.08, after −2.39 ± 1.77 D; P < 0.001) improved, intraocular pressure (before 15.93 ± 4.40, after 16.25 ± 4.25 mmHg; P = 0.743) remained unchanged. The IOL was well centered with a mean horizontal and vertical tilt of 0.5070 ± 0.3319° and 0.4652 ± 0.3465°, respectively, and decentration of 0.1705 ± 0.1334 mm and 0.1712 ± 0.1576 mm, respectively. Conclusion: With this technique, capsular bag reopening and secondary in-the-bag IOL implantation could be achieved in most cases with satisfactory visual outcome and IOL position.

Reopening the capsular bag by removing the capsular proliferative membrane to enable secondary in-the-bag IOL implantation in pediatric aphakic eyes

“…11 Recently, the blunt separation capsulotomy was reported by Wu et al, Li et al, and Liu et al, in which OVDs were injected into the peripheral space of the capsular bag and the adhesions between the anterior and posterior capsules were bluntly separated. [15][16][17] However, this method may not be suitable for pediatric aphakia with a severe proliferative membrane striding over the anterior and posterior capsulorhexis openings.…”

“…14 The second category is the blunt separation capsulotomy, in which ophthalmic viscosurgical devices (OVDs) are used to bluntly separate the adhesion between the anterior and posterior capsules. [15][16][17] Nevertheless, this method may not be suitable for pediatric aphakia with a severe proliferative membrane striding over the anterior and posterior capsulorhexis openings.…”

An improved two-steps method for secondary in-the-bag intraocular lens implantation in aphakia eye

“…In recent research, Wu et al reported on reopening the fibrosed capsular bag via capsular forceps. 8 This method might be suitable for patient in favorable suspensorium statues, however, some cases with high myopia or trauma may suffer suspensorium weakness or dialysis, and their constricted bag cannot be forcibly opened with forceps. Our two-steps in-the-bag secondary IOL implantation involving two critical point: firstly, the "breaching point", we noticed that there is a relatively inattentive adhesion point in the constricted bag ring, with the point of a IOL hook, the anterior capsular could be readily lifted up to create a small gap in this point.…”

“…6 Recently, several capsular bag reopening strategies were reported, 7 In Wu's work, constricted bag was reopened by capsular forceps and proliferation tissue removal. 8 Here，we introduce another novel method for capsular bag reopening ,with IOL hooks and sodium hyaluronate, we successfully detached constricted anteriorposterior capsular bag and the IOLs were implanted into the bag. This is a rather easy and low-risk method even in severe capsular adhesion.…”

Reopening the severely contracted lens capsular bag post-phacovitrectomy by injecting OVD and removing the fibrous membranous material

“…Wu et al removed the fibroproliferative membranous material with capsulorhexis forceps or intraocular forceps. 12 Patients with severe fibrotic capsular bag have firm anterior-posterior capsular adhesions. For these cases, this method can cause zonular rupture and posterior capsule tears.…”