Hydroview lens implant calcification: 186 exchanges at a district general hospital.

AIM: This paper describes the experience at a district general hospital of coping with an abrupt onset of calcification of Hydroview intraocular lens (IOL) implants requiring exchange surgery mostly for symptoms of glare, even though the visual acuities were relatively good. METHODS: In this retrospective study, the operative details of 174 consecutive lens exchanges by one surgeon were retrieved from the surgeon's notes. Of these, pre and post-operative details of 106 consecutive patients were obtained from the hospital notes. RESULTS: Of the 174 lens exchanges, all were sutureless except one and 31 eyes (18%) had had previous capsulotomies. Of 143 eyes with intact posterior capsules, eight (5.6%) needed anterior vitrectomy. Lens replacements were in the bag in 136 (95%), in the sulcus in five (3.5%), and in the anterior chamber in two (1.5%). Of the 31 eyes with previous capsulotomies, 10 (32%) needed anterior vitrectomy. Lens replacements were in the bag in 22 (71%) and in the sulcus in the remaining nine cases (29%). Postoperatively the best-corrected visual acuity was improved in 53%, remained the same in 35%, and deteriorated in 12%. CONCLUSION: The lens exchange procedure was mostly predictable with satisfactory visual results allowing preoperative counselling of risks to be similar to that for cataract surgery. The onset and resolution of the period of implantation of lenses requiring exchange has not been explained.

The course of surface deposits on a hydrophilic acrylic intraocular lens after implantation through a hexagonal cartridge.

AIM: To evaluate the outcome of surface deposits that occurred during implantation of hydrophylic acrylic intraocular lenses (IOLs) through a hexagonal cartridge. METHODS: Surface deposits were observed on the posterior surface of the ACR6D SE IOLs that were injected through a hexagonal cartridge filled with sodium hyaluronate 1%. All the patients were examined 1 day, 1 week, 1 month, 6 months and 1 year postoperatively. The location of the deposits was recorded and photographed. The patients were questioned about blurred vision, glare or halos. RESULTS: Linear or curly deposits were detected on the posterior surface of the IOL in six patients. In four patients, the deposits were peripheral and were observed 1 week postoperatively. In two patients, the deposits were noticed immediately after implantation. In one eye, they were misinterpreted as a crack in the IOL's optic and were left in the eye. In the second patient the deposits were removed immediately after implantation with forceps. The deposits that were left after implantation (five eyes) did not resolve during 1 year of follow-up. None of the eyes developed abnormal inflammatory reaction. In three eyes the best-corrected visual acuity (BCVA) was 6/6. In the other three eyes the BCVA was 6/12. None of the patients experienced any visual disturbance. CONCLUSIONS: Implantation of the ACR6D SE IOL through a hexagonal cartridge can lead to the formation of deposits on the posterior surface of the lens. The deposits do not resolve and may resemble a crack in the IOL. The deposits left on the IOL had no clinical relevance in our patients.

Suturing a tear of the anterior capsulorhexis.

AIM: To describe a new technique of suturing a tear in the anterior capsulorhexis. METHODS: Continuous curvilinear capsulorhexis (CCC) with lens removal was done in five fresh cadaver eyes. The diameter of the CCC was measured with a calliper. Using the same calliper a tear of the CCC was created while opening the calliper's arms. The distance between the calliper's arms needed to tear the CCC was documented. Using 9-0 Ethilon 9011, CS 160-6 sutures in two eyes, 9-0 Prolene, D-8229, CTC-6L sutures in two eyes, and 10-0 Prolene, 9090, CTC-6 suture in one eye, the tears were sutured. A tear in the CCC was created again in the same way as the first tear. The distance between the calliper's arms needed to tear the CCC was documented again. RESULTS: Suturing of the tear restored some of the strength/elasticity of the CCC. Better results were found while using the 9-0 Prolene, D-8229, CTC-6L sutures than with the two others sutures. CONCLUSIONS: Suturing of a broken CCC can restore at least some of the strength/elasticity of the CCC. This can be important before intraocular lens (IOL) implantation for the safety of the implantation or after the implantation to ensure proper fixation of the IOL.

Linear deposits on the surfaces of intraocular lenses implanted through a hexagonal cartridge which mimic scratches/cracks on the lenses.

AIM: To describe unique linear deposits on the surface of posterior chamber intraocular lenses (IOLs) occurring after implantation through a hexagonal cartridge. METHODS: Five ACR6D SE IOLs (Corneal Laboratories, Pringy, France) were injected/implanted through hexagonal cartridges. Two of these were injected into a petri dish and the remaining three were inserted into the evacuated capsular bag of cadaver eyes. In addition, three other ACR6D SE IOLs were injected into a petri dish through round cartridges. The latter served as controls. RESULTS: All lenses that were injected/implanted through the hexagonal cartridges demonstrated linear deposits on the posterior surface of the IOL optic component. The IOLs that were injected through the round cartridges had no deposits. All the hexagonal cartridges showed signs of internal cracking. None of the round cartridges were cracked. CONCLUSION: Implantation of at least one IOL model, the ACR6D SE IOL, through a hexagonal cartridge can result in linear deposits on the posterior optical surface of the IOL. The shape of the cartridge appears to be a significant factor in causing the depositions.