Sulcus implantation of a 3-piece, 6.0 mm optic, hydrophobic foldable acrylic intraocular lens in phacoemulsification complicated by posterior capsule rupture

Abstract

To evaluate the safety of implanting a 3-piece, 6.0 mm optic, foldable acrylic intraocular lens (IOL) in cases of posterior capsule rupture during phacoemulsification. Department of Ophthalmology, Ahepa Hospital, Aristotle University Medical School, and Interbalkan Medical Center, Thessaloniki, Greece. This prospective noncomparative case series included 28 eyes (28 patients) having phacoemulsification complicated by extensive posterior capsule rupture with or without vitreous loss. In all eyes, a 3-piece, 6.0 mm optic, foldable acrylic IOL (AcrySof MA60BM, Alcon) was implanted in the sulcus. Postoperative examination included best corrected visual acuity (BCVA), anterior segment biomicroscopy, IOL centralization and position, intraocular pressure (IOP), and fundus biomicroscopy. The follow-up was 6 months. The most common postoperative complications were transient corneal edema in 12 eyes and increased IOP in 11 eyes. Slight asymptomatic decentralization from the center of the pupil (1.0 to 2.0 mm) and pseudophacodonesis were observed in 5 eyes each. Friction of the IOL with the iris occurred in 1 eye. Clinically significant cystoid macular edema occurred in 3 eyes. The final BCVA was between 20/15 and 20/25 in 18 patients, 20/30 in 2, between 20/40 and 20/50 in 4, and between 20/60 and 20/200 in 4. AcrySof IOL implantation in the sulcus during phacoemulsification complicated by posterior capsule rupture preserved the advantages of small-incision surgery. The postoperative behavior and centralization of the IOLs resembled those of poly(methyl methacrylate) lenses.

Single-piece foldable acrylic intraocular lens implantation in the sulcus in eyes with posterior capsule tear during phacoemulsification

“…Viscoelastic material remaining in the anterior chamber, the presence of preoperative glaucoma, trabecular blockage by dispersed lens particles and iris pigments, and mechanical damage in the trabecular meshwork can raise postoperative IOP. Yap and Heng 21 reported temporary increased IOP in 6 eyes (13.6%), Brazitikos et al 6 in 39%, and Basti and coauthors 17 in 15%. We observed raised IOP in 17 eyes (19.10%), and this persisted in the later period in 12 eyes (13.48%).…”

“…Brazitikos et al 6 and Amino and Yamakawa 8 reported that postoperative inflammation was more severe in eyes with posterior capsule tear. Amino and Yamakawa 8 reported that anterior chamber reaction was greater in eyes with sulcus-to-sulcus fixation because of contact between the IOL optic and the iris and that this persisted, albeit at a low level, for a long time after surgery; the presence of this contact was revealed by ultrasound biomicroscopy (UBM).…”

“…This is generally temporary. Yap and Heng 21 reported temporary corneal edema in 59% of eyes in which posterior capsule tear developed during phacoemulsification Brazitikos et al 6 reported levels of 43% and Basti and coauthors, 17 11.6%. In our study, a temporary corneal edema rate of 37.07% was observed.…”

“…When posterior capsule tear appears, an anterior vitrectomy must be performed in the event of vitreous prolapse. Brazitikos et al 6 performed anterior vitrectomy in 21 of 28 eyes (75%), Gimbel et al 16 When the posterior capsule tear is small, the IOL can be placed in the bag, but zonular support must be carefully observed. 22 In tears without wide and posterior capsule support, the IOL can be implanted in the sulcus if anterior capsule integrity provides sufficient support.…”

“…26 In our patients, we implanted a single-piece foldable acrylic IOL in the sulcus of 89 eyes of 88 patients. Brazitikos et al 6 implanted 3-piece foldable acrylic IOL into the sulcus in 28 eyes in 28 patients developing posterior capsule tear during phacoemulsification. The most frequent cause of reduced vision in the early postoperative period is corneal edema.…”