Surgeon presents six options for optic capture in absence of capsule bag fixation

April 19 - Washington, DC - If capsule bag fixation is not possible, cataract surgeons may want to consider options for optic capture depending on the particular problems that present, according to Howard V. Gimbel, MD.

Dr. Gimbel, professor and chairman, department of ophthalmology, Loma Linda University, Loma Linda, CA, defined optic capture as "haptics and optics on different sides of a tear-resistant opening in the capsule."

Optic capture provides optic centration, IOL fixation away from the iris, and a barrier to vitreous migration through capsule openings, he emphasized.

He described six options for optic capture, two involving the anterior continuous curvilinear capsulorhexis (CCC), two for the posterior CCC, and two for diffuse capsular membrane in postoperative situations.

Option 1: In the case of large posterior capsular tears before IOL implantation, the rhexis fixation is possible with the haptics and lens in the sulcus and the optic pushing through the anterior CCC.

Option 2: If the lens is already implanted in the capsule and a large tear develops or extends, the surgeon can pull the optic out of the capsule so that it can be captured by the anterior CCC to ensure fixation.

"Another variation of this would be to pull the optic of the piggyback lens out of the capsular bag to allow lens material to spill into the anterior chamber rather than become trapped between the lenses," Dr. Gimbel said.

Option 3: This option of optic capture involving the posterior CCC has been used successfully in pediatric cases for some time, he noted. In a video, an IOL with a very narrow haptic/optic junction is used, The posterior capsule wraps around the haptic/optic junction over the top of the IOL. In this example, it is demonstrated that there is no opacification on the visual axis even though the surgery was performed in 1993.

Option 4: The posterior CCC is employed because of larger anterior capsule tears or multiple tears, which prohibit placement of the IOL in the capsular bag.

"One can do a posterior capsulorhexis, put the lens in the sulcus and push the optic to the posterior capsule to capture and stabilize the IOL without the risk of the lens swimming in the sulcus," Dr. Gimbel said.

Option 5: In the case of diffuse capsular membrane in postoperative cases, the lens is in the sulcus and the optic can be pushed through the opening of the membrane if the opening is slightly smaller than the optic.

"We have used this technique for repositionings, removal and replacement, and unstable sulcus lenses even though they are centered," he said.

Option 6: If the lens is shown to be dangling in the vitreous after vitrectomy, the surgeon can push the lens optic back through the posterior CCC.

"If that membrane opening is of the right size, it will capture the lens and stabilize it without suturing," Dr. Gimbel said.